Recent decades have seen tremendous progress in the fight against malaria in Cambodia. But even with the greatest successes, malaria is never a fully solved problem, and it lingers in pockets, hard-to-reach or overlooked. In the absence of easy access to care, education, and treatment, mobile malaria workers are a significant asset in the fight against the disease. They work in the most challenging situations in remote, hard-to-reach, and underserved areas, bringing services, information, and medicines to people who need them the most. Personal accounts from some of these mobile malaria workers in Cambodia provide a glimpse into what their work means to them and to the communities they serve, and the critical role they play in malaria control.
The Context of Malaria in Cambodia
With concerted efforts on the part of the Cambodian government, non-governmental and international organizations, and local health workers, malaria incidence dropped from 1.6 million cases in 1998 to around 350,000 cases in 2014, and malaria deaths fell as well. Despite these gains, Cambodia still faces foci of endemicity in remote, forested regions, especially places that are hard to access by traditional roads or air travel. Drug resistance is a persistent issue, and logistical challenges obstruct the eradication of malaria in these regions.
Personal Stories from Mobile Malaria Workers
1. Sokha Chann: Navigating Remote Forests for Malaria Control
He spends most of his working hours tramping through the thick forests of northeastern Cambodia, going from remote village to remote village to diagnose and treat malaria, distribute mosquito nets, and give health classes. Sokha Chann is a 32-year-old mobile malaria worker.
Victory: Sokha’s work has changed lives for the better, at least in the communities he serves. ‘Once I went to a village that had high malaria,’ he says. ‘After we worked there, after a few months, the number of cases dropped. The villagers explained that malaria was gone. And what; and what; our environment becomes cleaned, so; like, so suddenly, they so happy by, by, see; see by themselves, the number of cases dropping; it means, ahh, to me no more, from zero, then suddenly the number of malaria is down to zero. So it gave me a great feeling that our work was helpful.’
Toiling in the fields of Cambodia is a far cry from his UN days when, as an interpreter, he traveled the globe. Sokha faces all manner of challenges, from tough terrain and the prospect of meeting wildlife to the challenge of reaching isolated looms. ‘These villages can be quite far away,’ he says. ‘The roads can be quite muddy, some areas are steep. Plus, sometimes we have difficulties getting enough goods in or out.’ But thanks to their determination and the importance of the work, he accepts the challenge.
2. Sreymom Phan: A Beacon of Hope in Remote Villages
Sreymom Phan, a Cambodian health worker and 27-year-old who travels into isolated villages in the west of the country where malaria is endemic gives medications, antimalarial drugs, and techniques for prevention.
Victory: For Sreymom, one of her greatest accomplishments is in support of malaria awareness. ‘One time, a village chief came to me and told me to pass on his gratitude to our whole MLP team,’ Sreymom says. ‘He told us he is aware of the home practices against malaria and will inform his village about the importance of following them.’ Thank God for more women like Sreymom.
Barriers: Sreymom confronts community resistance and misconceptions about malaria. ‘Sometimes people don’t believe they can get malaria,’ she says, ‘Or they think that bed nets or medicines aren’t safe. It takes patience and perseverance to overcome resistance. We need to build trust and give people clear, accurate information about changing their attitudes and changing their behaviors.
3. Rithy Tan: Combating Drug Resistance and Ensuring Effective Treatment
Rithy Tan, a 34-year-old mobile malaria worker, is part of the team focusing on improved treatment and diagnosis of the disease, especially in areas where the disease is highly prevalent, and where strains of the parasite are resistant to the four most commonly used drugs. His responsibilities involve diagnosis and treatments (giving tablets), as well as monitoring the impact of intervention.
Victory: Rithy’s work has been a great help in preventing drug resistance. ‘One of our greatest achievements was the identification of an outbreak due to HIV drug resistance,’ he relates. ‘We were able to implement targeted treatment protocols to halt the outbreak from spreading and to make sure that the treatment remains effective.
Drug resistance and the constant vigilance required to stay abreast of proper treatment and protocols remain significant challenges for Rithy. As he puts it, “The biggest issue we have is drug resistance. We need to ensure that we know what is new, what we are doing, what we should be doing, and the changes as they arise. Furthermore, we must identify the protocols we need to adapt effectively.” This ongoing need for education and adaptability underscores the importance of staying informed in the fight against malaria and ensuring that treatment remains effective. Transporting the medication we require to remote sites is also challenging. We must work hard to see that we have the medication we need when we need it. We get too few resources and a lot of activities happen in the cities rather than in the rural areas where people need it most.
4. Chantha Leng: Building Trust and Community Relationships
Chantha Leng, a 29-year-old mobile malaria worker, establishes relationships with the communities she serves in the central part of Cambodia. She not only administers care but also builds trust and collaboration with local leaders and residents.
Victory: Chantha says ‘The most incredible thing I experienced was the fact that a local village chief who didn’t believe we were there at first to help, became our spokesman for the intervention and led the village to take prevention very seriously’.
Despite Chantha’s challenges (navigating local politics, dealing with local social dynamics, and earning respect from community leaders), she said that the positive results outweighed the difficulties. ‘It takes time to build relationships and overcome initial antagonism. But to achieve consistent results, we need to be respectful of local mores and work closely with local community leaders who can advocate for us and make sure that we’re being effective.’
The Impact of Mobile Malaria Workers
In rural Cambodia, mobile malaria workers such as Sokha, Sreymom, Rithy, and Chantha are a vital element of the country’s public health resources – significantly contributing to its effort to eliminate this deadly disease.
- Increasing Access to Care: Mobile malaria workers bring medical care and prevention to difficult-to-reach and underserved populations.
- Enhance Prevention and Education: By educating communities on how to prevent pediatric injury, OCWs improve health and reduce the number of victims.
- Overcoming Drug Resistance: Mobile workers such as Rithy can increase our effectiveness in fighting drug resistance by keeping an eye on the success of treatment and taking tailored action when new challenges emerge.
- Community Friendship: The hard work and commitment of workers like Chantha – building friendships with communities – is important in ensuring the success of malaria control programs. Their work is based on trust and collaboration that ensures that interventions are welcomed and efficient.
Future Directions and Recommendations
These stories coming from mobile malaria workers in Cambodia reflect on the gains but also the challenges in malaria control to be addressed next. To make further inroads in the fight against malaria, key areas in focus will be:
- Tightening Up Support Systems: Ensuring greater support and resources for mobile malaria workers would help fortify their effectiveness and address logistical and operational challenges.
- Enhance Training and Education: Keep mobile workers up-to-date on the latest treatment protocols and prevention strategies through sustained training and education.
If you work in a challenging setting, your score is probably quite low. Community engagement strategies are designed to increase the level of support for your malaria intervention (your community ratings) and to increase the amount of trust placed in your health program (your trust scores) by developing new strategies to interact with local communities.
Invest in Infrastructure. Enhancing infrastructure is necessary to improve the efficiency of transportation and communication networks that deliver services to the needy and hard-to-reach areas.
The voices of the front line in Cambodia offer a poignant sample of the dedication, resilience, and impact of mobile malaria workers, along with touching glimpses into their lives and human experiences as they confront the challenges and enjoy the triumphant rewards of their role in the malaria control effort. Malaria elimination beckons to Cambodia; the legacy of the workers is a potent and timely example of the human face of that ever-elusive health endeavor.
