On the road to Pailin, Cambodia, the signs reflect the perils of life here. On the left, it was announced that the field has been cleared, a serious danger in one of the most heavily mined countries in the world. On the right, a sign warns parents to keep their children away from stoves. Other stationed along the road to promote rapid diagnostic tests for malaria and quality-assured artemisinin combination therapies (ACTs), part of a huge push to stop the use of counterfeit antimalarial medicines or inferior quality.
We head to the remote village of calf Roulem, meaning "wet field" in Khmer, one of many sites where a team of the Research Unit Mahidol Oxford Tropical Medicine in Bangkok winding down a radical approach pilot study of malaria elimination. Known as mass drug administration (MDA), it is essentially to give a village a set of so-called hot-spot malaria drugs people healthy powerful malaria in hopes of eliminating the malaria parasite Plasmodium falciparum.
There is a strategy "quite unpopular, somewhat controversial," said Tom Peto, a co-leader with Rupam Tripura the study, which is done in collaboration with the National malaria control Programme in Cambodia. And it is the work of Chhoeun Heng, who is widely known as Mr. Heng, sell it to a naturally suspicious community.
Educate participants on malaria transmission.
Tom Peto
When we pull up to a house that did double duty as a field office and sometimes dormitory Mahidol team, a little girl short on and jumps in Mr Heng arms. He laughed and door to the outdoor kitchen where his adoptive parents, farmers in their 50s, are sitting in the shade. Like almost every one in the village, they were conscripted into the Khmer Rouge, and the mother lost a leg when she stepped on a landmine bringing food to the battlefield in 1983. After two decades in the province Mr Heng still amazed at the lack of bitter people. Laughter comes easily that the three make up a breakfast of omelettes and rice.
This is far from the way the team was received about a year ago, when they arrived to start their study. "Some thought we were here to test drugs on them, and they were going to die in a year or two," says Heng, Cambodian nurse who worked in a refugee camp before signing with the group at Mahidol . recruitment community heads HIV / AIDS was a fear: About 100 people in the province had been recently infected when a doctor without a license, since convicted reused dirty needles, according to press reports villagers also worried that. they were weakened by frequent blood draws.
participants registering for the elimination of malaria study targeted.
Tom Peto
team had already set up shop in another town. But they decided to move here when rumors have threatened to derail the entire project. "We came here to build trust," says Heng. During the study, the team would stay in the village for 15 to 20 consecutive days. Other times, they would be stranded here when swollen rivers have risen too high to ford and washed away bridges.
The study is similar to a clinical trial, the Mahidol group recently completed along the border between Thailand / Myanmar. Volunteers are given the standard 3-day course of ACT 1 month intervals for 3 months, whether or not they have malaria. At baseline and every 3 months after one year, researchers take blood from a vein in the arm, and then send the samples to Bangkok for analysis. The assumption is that if, after treatment, the parasites have disappeared from almost all of the population of the village, the transmission cycle will be broken.
To get people on board, the team visited the village chiefs, accompanied by officials of the local health department and the governor's office. Then came a series of community meetings to explain the study; Informed consent was obtained from house to house. Several evenings Heng and the crew brought in bands and dancers or embarrassed singing karaoke.
The inscription in the first round was an impressive 0%. But proved the confidence fragile, said Mr Heng. Many villagers caught colds. Others complained of weakness and nausea, and, too, blamed the drug. Registration for the second round dropped to 72%.
The team has redoubled its efforts, focus groups with women, who make decisions about health in a family. At meetings of the community, they refined their message. And they brought the police-well-respected authorities, army and border guards to vouch for them. Buddhist monks blessed the project. In round three, enrollment reached 85%
The final results are not yet, but one thing is already clear, Peto said :. . "MDA is not impossible, but it is not a trivial thing"
Read our article on how drug resistance triggers the war to eliminate malaria in the Mekong region.
statement was supported by a grant from the Pulitzer Center on Crisis Reporting.
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