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Thursday, August 07, 2008

CAMBODIA: Tuberculosis rates steady but challenges remain

PHNOM PENH, - Tuberculosis, which has been on the rise globally, has generally remained steady in Cambodia since 2003, even declining slightly, but detection rates are low.

According to the Cambodia Ministry of Health's 2007 Tuberculosis Report, the number of patients who die after treatment is extremely low, at 3 percent, while the number cured remains high, at 90 percent.

The target cure rate for the World Health Organization (WHO) is 85 percent.

In 2007, the total number of reported TB cases in 2007 was 36,495, up by about 1,000 reported cases from the year before. Cambodia had an incidence rate of 500 per 100,000 people in 2007, unchanged from 2006.

"The situation is definitely getting better," Jamhoih Tansing, a WHO tuberculosis physician, told IRIN. "But case detection rates remain low and Cambodia's TB burden is quite high."

According to a report by Family Health International (FHI), 13,000 Cambodians die annually of tuberculosis out of a population of about 14 million.

Drug-resistant tuberculosis, or MDR-TB, a deadlier strain of the bacterium, has been on the rise slightly in Cambodia, but is not the pressing issue as in Africa and South America, said Song Ngak, deputy country director for FHI.

The main challenge now, she said, was accurate data as current TB numbers rely heavily on estimates.

"I would venture to question the validity of the estimates," she said. "We still need to conduct door-to-door surveys and pin down a closer number to the actual case detection rate."

In addition to the challenges in detecting the disease, Tansing cited poor prison conditions, poverty, and lack of a regular system of TB screening for HIV patients as all contributing to TB.

Over half of HIV-positive patients in Cambodia will become infected with TB in their lives. However, HIV is becoming less prevalent, down to 0.8 percent of the population in 2008 from 3.1 percent in 2003, according to the Joint United Nations Programme on HIV/AIDS (UNAIDS).
"The HIV component of TB is definitely declining," Ngak said. "But there's still not much decline in the TB incidence rate."

In 2007, the number of TB patients who were HIV-positive in Cambodia declined to 7.8 percent, a sharp fall from a 2003 high of 11.8 percent. But the number of TB cases without HIV has remained steady.

Detecting TB through community action

To more efficiently treat and control the spread of TB, the WHO has implemented a treatment strategy called DOTS (directly observed treatment, short-course), emphasising community-based disease detection over reporting by individuals, as well as directly observing a patient's medication intake for six to eight months.

"The problem was that patients were not taking their TB treatment, so they would get sicker," said Ngak. "Now, we can ensure patients are taking their treatment through the local community, with local doctors watching them."

The strategy also emphasises providing better quality treatment centres, enhancing healthcare legislation to fight TB, and creating better systems of supplying drugs to patients.

"Some groups, like in prisons, are not even receiving correct treatment for TB," Ngak said. "DOTS will better procure the correct drugs to them."

But despite these efforts, challenges remain.

According to specialists, community-based TB detection still does not catch carriers of the disease who show no symptoms. Nearly 60 percent of Cambodians carry the bacterium in their lungs, but have not actually succumbed to TB.

In many cases, carriers could take 10 years or more to show noticeable symptoms, such as excessive coughing, weakness and chills. In the meantime, they can easily spread the disease.

Yet for Chun Ratana, 53, who has TB symptoms from living in cramped conditions in a Phnom Penh slum, community-based detection and treatment still have not arrived.

"I don't know where to get free treatment, because I can't afford drugs," she said. "No NGO has ever spoken to me about being sick, and when I ask them, they say they can't help."

A free tuberculosis treatment centre is situated near her house, but she fears being hospitalised because she could lose too many months of work.
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Hari Krishna leader to appeal Cambodia child sex conviction

Phnom Penh - The leader of a Hari Krishna-affiliated aid organization in Cambodia was to appeal a conviction for molesting a 12-year-old girl, a Phnom Penh court said Thursday.

Police said US national Thomas Rapanos Wayne, head of a Hare Krishna aid group, was found naked in the company of two girls, aged 12 and 16, when he was arrested in a guest house in the capital in March. The age of consent in Cambodia is 15.

Wayne, alias Tattva Darshan Das, 55, was sentenced Wednesday to two and a half years in prison for committing indecent acts against minors.

'He was convicted but he said he was innocent and he will appeal,' court clerk Keing Bokhea said by telephone.

Wayne was formerly president of the relatively obscure Bhaktivedanta Eco Village (BEV) Cambodia, an educational aid organization.

He held a copy of the religious text Bhagavad Gita and a portrait of the Hindu god Krishna during his sentencing, the English-language Cambodia Daily said.
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Man avoids prison for scheme preying on Cambodia immigrants

By Jonathan Saltzman, Globe Staff

A Rhode Island man who pleaded guilty to participating in a pyramid scheme that bilked $27 million from some 500 victims was sentenced today to probation by a federal judge who cited the defendant's ill health and testimony against two others convicted in the scam as mitigating circumstances.

Federal prosecutors had recommended that Christian Rochon, 57, of Warwick, R.I., serve a decade in prison for his role in the scheme that preyed predominantly on Cambodian immigrants.

But US District Court Judge Richard G. Stearns said he had wrestled with the matter and concluded that Rochon deserved a sentence of five years on probation, the first spent in home confinement.

The judge said Rochon had nothing to do with hatching the scheme and was largely "a prop'' who did not even realize he was participating in a massive fraud until the scam began to unravel.

Stearns also credited Rochon for testifying against James Bunchan and Seng Tan, the couple who led the scheme. And the judge said he was convinced that Rochon, who has struggled with a heart condition, cancer, and other illnesses, would not survive prison.

"I'm persuaded ... that any period of incarceration would likely result in a death sentence,'' Stearns said.

Michael K. Loucks, first assistant US attorney in Massachusetts, who attended the sentencing, declined to comment afterward.

Rochon, who stood with apparent difficulty as he faced Stearns before he was sentenced, apologized to the victims, some of whom lost their houses because of the fraud.

"I’m very sorry for what happened to all of these people," he said.

Bunchan and Tan told investors from Long Beach, Calif., to Lowell between October 2000 and November 2005 that their money was put into World Marketing Direct Selling Inc. and an affiliated company, One Universe Online Inc., with several offices in Massachusetts, prosecutors said.

Investors who contributed a minimum of $26,000 were promised monthly payments of $300 for life and a one-time sum of $2,600. But prosecutors presented evidence that the payouts, which were made for a limited time, came from investors’ own principal or from money put up by other investors.

Bunchan and Tan spent more than $3 million of investors’ money on Mississippi riverboat gambling trips and Las Vegas casinos, millions more on a Florida home and fancy cars, $23,000 on hairpieces, and $5,000 for tennis lessons, prosecutors said.

Bunchan and Tan were convicted last year of numerous fraud and conspiracy charges and received long prison sentences from Stearns –- 35 years for Bunchan and 20 years for Tan.

Rochon’s lawyer, James B. Krasnoo, of Andover, said Bunchan originally hired Rochon to repair his computers and then duped him into believing he would be a legitimate president of the enterprise. Only toward the end did he realize it was involved in a monumental fraud, Krasnoo said.

Rochon received a company car and got a free trip to Las Vegas while working for the couple but did not lead a lavish lifestyle, Krasnoo said.

"If my guy were healthy, he would be doing time," Krasnoo said. "But his health is so bad that if he were sentenced to even a short period of time, it is likely he would die."

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