SAI YOKE, Thailand (AlertNet) - Meow, a six-year-old ethnic Karen girl, does not even flinch as the needle pricks her little finger. She smiles shyly as a small drop of blood forms on her fingertip, and is transferred to a thin plastic testing strip.
Now the wait begins.
In 15 minutes, Meow, whose parents left Myanmar and are now living in Thailand, will know whether the malaria parasite that attacked her last month is still in her body.
A malaria strain that’s increasingly resistant to treatment is spreading through the border region where Meow’s family lives. It’s a strain of the deadliest form of malaria, called Plasmodium falciparum.
The malaria centre Meow’s attending is one of hundreds trying to stop its spread by testing anyone with a fever and offering proper treatment to those with malaria, all free of charge.
The strain is resistant to the most effective malaria drug available to doctors – artemisinin. Experts say it has spread because of the incorrect use of artemisinin and fake and substandard versions of the drug.
Doctors have little alternative to artemisinin and it would take years to develop a new malaria drug. They’re worried that if the drug-resistant strain goes unchecked it will spread to Africa where the majority of malaria cases and deaths occur.
Malaria killed 655,000 people in 2010, 90 percent of them in Africa, the majority children.
ON THE FRONTLINE
Hospital is often not an option in the remote Thai-Myanmar border area. For many it’s a long trip, and Burmese living in the area are reluctant to travel because they have no identity cards and fear getting arrested.
So Thailand’s malaria centres are on the frontline of treatment. They are manned by villagers who receive three days’ training and are paid by the Global Fund to Fight AIDS, Tuberculosis and Malaria.
Laksanara Kaewlere, a 32-year-old rice farmer-turned-community health worker who works in Meow’s village, sees three or four patients a day, both Thai and Burmese.
Sitting in an airy, half-finished wooden structure amongst lush foliage, Laksanara keeps a neat record of test results and patient details. The records go up the chain of command all the way to the health ministry’s department of disease control in Bangkok.
Malaria is endemic in the village, 10 kilometres from the border with Myanmar, in Sai Yoke district in western Thailand. Almost everyone’s had it, including Laksanara and Meow’s sister.
Chong, who lives a couple of doors down from Laksanara, gets malaria every year. The 57-year-old from Myanmar lost his young son to malaria some 30 years ago. Both his wife and daughter have had it too.
His latest bout came last month after he spent a month in a jungle in Myanmar, cutting bamboo shoots and sleeping in the open. He gets malaria every time he goes there but he doesn’t have a choice.
“There’s no work here,” he says.
After he was ravaged by days of fever and “pain in his bones”, the parasite left his body following three days of treatment from Laksanara.
Many others aren’t as lucky and, despite receiving treatment, still have malaria weeks later.
In the 1970s and 1980s, strains of malaria that were resistant to previous generations of medicines, such as chloroquine, originated in Cambodia and spread to Africa via Myanmar and India.
The first cases of confirmed artemisinin resistance were found in the late 2000s in western Cambodia along the Cambodia-Thailand border. They have since been reported in Thailand, Myanmar and Vietnam.
“If we don’t care about (this resistance), what will happen is what happened with the chloroquine resistance – more cases, more deaths … We don’t have any products to replace artemisinin,” Fatoumata Nafo-Traore, executive director of Roll Back Malaria, a partnership of U.N. agencies, the World Bank, leading drugmakers and aid experts, said.
“What needs to be done is to say, ‘Now we have a small window of opportunity to contain it and let’s contain it’,” said Nafo-Traore, who was in Thailand prior to the Malaria 2012 summit in Sydney which began on Oct. 31.
One of the main challenges is funding.
Frank Smithuis, a doctor who’s worked in Myanmar since 1994, criticised donors in an earlier interview with AlertNet, saying Cambodia, Thailand and Vietnam were included in malaria containment programmes but not Myanmar, despite it having the highest malaria burden in the Greater Mekong region.
Donors have traditionally been reluctant to fund programmes in Myanmar for fear of propping up the previous military regime, which ruled for five decades. But a military-backed reformist government which took over last year is generating more goodwill.
On Oct. 27, authorities from Thailand and Myanmar met in Thailand’s Kanchanaburi province to discuss the issue and experts hope Bangkok will provide much-needed support to its impoverished neighbour.
The Global Fund, which accounts for almost two-thirds of malaria control efforts worldwide, announced a funding freeze last year. It later said it had an additional $1.6 billion for the next three years, but it is unclear how this will be allocated and how much will be available for longer-term projects.
Roll Back Malaria’s Nafo-Traore said current funding for malaria is globally about $2 billion, when the needs are $6.7 billion a year until 2015.
“How do you secure that in a situation of financial crisis?
“The window of opportunity to deal with the resistance is a very short one. It is critical that we mobilise the required level of resources for this fight. It has to come from the governments, the Global Fund and other donors,” she warned.
There’s good news at least for Meow. The parasite is gone from her young body.
(Editing by Alex Whiting)