Village Volunteers Treat and Prevent Malaria in Western Cambodia

DECEMBER 2008 – Phnom Dambang is a village in the forests of western Cambodia near the Thai border. Thirteen-year-old Chroeun Nith lives there with his mother; his father was killed in the country's civil war. The nearest town, Pailin, is 30 kilometers away, and the road becomes too muddy to navigate during the frequent heavy rains. No bridge crosses the nearby river, which often swells with rainwater until it, too, is impassable.
 
It was under such conditions that Chroeun got a high fever. His mother suspected it was malaria, a disease familiar to inhabitants of Cambodia's forests. With no means to transport Chroeun to the hospital in Pailin, she gave him what someone had told her was an antimalarial drug. But his fever continued to rise until he nearly lost consciousness. Fortunately, a neighbor suggested that she contact the local village malaria worker.

FHI/Cambodia began managing the Village Malaria Worker program in Cambodia in 2006. Although the Cambodian government has reported an overall drop in the number of malaria cases treated in public health facilities over the past 10 years, the disease continues to be a leading cause of death, accounting for 10 percent or more of hospital mortalities. Especially vulnerable are the nation's poor, including those living in or near the forests that cover 62 percent of the country: plantation workers, miners, migrant laborers, internally displaced persons, and the "mountain people," or Hmong.

In Pailin Municipality, FHI ensured that village malaria workers were trained and sent to 23 high-risk villages to provide malaria education, diagnosis, and treatment. Three mobile supervisors visit the workers regularly, distributing testing kits and antimalarial drugs, monitoring test and treatment results, and supporting them in the many challenges inherent to their work. To date, village malaria workers have visited more than 8,000 clients in these remote areas, and treated over 1,500 for malaria.

The village malaria workers are also helping address another problem that has arisen in western Cambodia. Over the past few decades, a number of counterfeit antimalarial drugs have been produced and distributed in the Pailin area. This contributes to the evolution of resistant strains of the parasite that causes malaria, and contributes to compounds such as quinine and Fansidar losing their effectiveness. The reliable artemisinin compound appears to be the next potential casualty.

However, now that appropriate malaria treatments are available locally and free of charge through projects like the Village Malaria Worker Program, the flow of counterfeit medications has lessened. Clients are also more likely to follow proper medication protocols with assistance from the village malaria workers. These changes provide some hope that the dangerous trend toward drug resistance can be slowed.

Chroeun's mother contacted Long Vuthy, the VMW in Phnom Dambang. He soon arrived at their home, pricked Chroeun's finger for a blood sample to test, and gave him a sponge bath while waiting for the result, which turned out to be positive. Vuthy then administered the antimalarial drugs Athekin and Paracetamol to Chroeun. Twelve hours later the fever had subsided, and, according to his mother, "Chroeun's life was saved." Vuthy, after providing malaria support and saving the lives of many villagers, was later appointed chief of Phnom Dambang.

– Ngak Song

PHOTOS: (Top) A village malaria worker's home in Andoung Thmor. The sign says "Free of charge, three-day malaria treatment program in the community." (Bottom) In Pich Kiry, mobile malaria team members Hak Map and Chhreung Veasna supply Paracheck (rapid blood test system) and antimalarial drugs to village malaria worker Chea Lim. (FHI/Cambodia)