Cambodia drug-resistant malaria stirs health fears

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PAILIN, Cambodia (Reuters) - In a dusty village near the Thai-Cambodia border, 24-year-old Oeur Samoeun sits on a dark green hammock recovering from a strain of malaria that has resisted the most powerful drugs available.

Ravaged by days of fever and chills, he is considered lucky: the parasite has left his body. But for many others, the potentially deadly disease never quite disappears.

His province of Pailin is the epicentre of strains of malaria that have baffled healthcare experts worldwide, raising fears a dangerous new form of malaria could already be spreading across the globe.

"The fear is what we're observing right now could be the starting point for something worse regionally and globally," said Dr. Charles Delacollette, Mekong Malaria Programme Coordinator at the World Health Organisation.

A new England Journal of Medicine study last year showed that conventional malaria-fighting treatments derived from artemisinin took almost twice as long to clear the parasites that cause the disease in patients in Pailin and others in northwestern Thailand, suggesting the drugs were losing potency in the area.

That is echoed by U.S. development agency USAID, which says artemisinin-based combination therapy is "now taking two to three times longer to kill malaria parasites along the Thai-Cambodian border than elsewhere." The agency has helped to monitor the situation in the area for years.

The disease transmitted via mosquito bites kills more than 1 million people worldwide each year and children account for about 90 percent of the deaths in the worst affected areas of sub-Saharan Africa and parts of Asia.

The studies shine a spotlight on the remote province of Pailin, a former stronghold of ultra-communist Khmer Rogue rebels and once reknown for blood-red rubies and lush forests.

MULTIPLIED AND DISPERSED

Pailin is the origin of three drug-resistant malaria parasites over the past five decades. Thanks to prolonged civil conflict, dense jungles and movement of mass migrants in the gem mines in the 1980s and 90s, the strains multiplied and dispersed through Myanmar, India and two eventually reached Africa.

Few can say why it is a hotbed for drug-resistant malaria but experts point to a combination of sociological factors and a complicated history spanning the Khmer Rouge era when 1.7 million people, nearly a quarter of Cambodia's population, perished from execution, overwork or torture during their 1975-79 rule.

Driven from the capital, the rebels waged an insurgency from western Cambodia with Pailin one of their last holdouts until their defeat in the late 1990s.

"During the Khmer Rouge era, people came here illegally and when they get malaria, they go to the market, buy pills and self-medicate," Sophal Uth, a Pailin-based field officer for non-profit Malaria Consortium said. "It was difficult for the government to control."

With weak public health infrastructure and rising malaria cases, Cambodia made malaria drugs available over the counter more than a decade ago. Most Cambodians don't have access to public health services and rely on private medical centres.

The strategy carried risks. Easy access reduced the number of cases but also led to incorrect dosages and substandard or counterfeit medicine, which instead of killing the parasites only make them stronger.

For some like Oeur, a migrant worker who likely caught malaria on a logging trip or while sleeping in his rickety shed without a mosquito net, artemisinin-based medicine still works.

Artemisinin, derived from the sweet wormwood, or Artemisia annua plant, is the best drug available against malaria, especially when used in artemisinin combination therapy (ACT) medicines made by firms such as Swiss drugmaker Novartis AG and France's Sanofi-Aventis.

MOST HAVE HAD MALARIA

After three days of ACT, Oeur is weak but parasite-free.

The Mekong River region of Thailand, Cambodia, Vietnam and Laos use ACTs against the "falciparum" parasite, the most severe form of malaria, as suggested by the World Health Organisation.

"Artemisinin is the most effective antimalarial we have left," Dr. Chansuda Wongsrichanalai of USAID's office of public health in Bangkok said. "We don't have any ideal alternatives available and ready to for use in a control programme right now."

Pailin's gem mines are gone and so are most foreign migrants and the troops. Severe deforestation has left most hill tops barren. Yet the parasites are as virulent as ever. Most of its inhabitants have had malaria at least once in their lives.

Malaria experts, weary of being called alarmists, are quick to point out ACTs still work -- they are just taking longer. The WHO isn't even calling it drug-resistance, they preferred to use the term "altered response" or "tolerance to artemisinin."

"From a public health perspective, I don't think it really matters much if it's resistance or something else given that at the end of the month, patients are returning to the health facility with the same malaria," Dr. John MacArthur, chief of the President's Malaria Initiative at the U.S. Centres for Disease Control and Prevention said.

Potential fallout from ACT resistance led the Bill & Melinda Gates Foundation to fund a $22.5 million (15 million pound) containment programme. Cambodia will also receive $102 million from The Global Fund to fight malaria in the next five years.

The Gates Foundation programme aims to use screening, bed nets and grass-roots muscle to contain the parasites along the border area and eliminate them before they can spread further.

Last November, Malaria Consortium said studies show artemisinin resistance already may be present in Myanmar, China and Vietnam, where between 12-31 percent of patients still had the parasite in the system after three days of treatment.

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CAMBODIA: War crimes court juggles public demands

PHNOM PENH, 10 March 2010 (IRIN) - Competing pressures in Cambodia's Khmer Rouge war crimes tribunal could work against the victims it is supposed to represent, human rights groups warn.

Since its establishment in 2006, the UN-backed tribunal has sought to provide a greater voice to victims of the regime, while at the same time expediting a legal process bogged down by delays. As a result, the court decided last month to filter the representation of all victims through two lawyers because of the high number of applicants seeking to participate in the second case.

Known as the Extraordinary Chambers in the Courts of Cambodia (ECCC) [http://www.eccc.gov.kh/], the tribunal includes a "civil party" system designed to give lay people an official role to provide testimony, question suspects and request reparations.

More than 4,000 people applied and about 250 had been accepted by the end of last year. By contrast, just 90 civil parties participated in the tribunal's first case.

Court delays

In the tribunal's first case last year against the regime's most notorious prison chief, Kaing Guek Eav, civil parties were represented by four legal teams, giving victims a strong presence in the courtroom.

But participation was often muddled by repetitive and irrelevant questions from some lawyers that steered testimony away from the core issues of the trial and slowed proceedings.

This, coupled with the ballooning number of civil parties, prompted the tribunal to seek victim participation reforms for its remaining case.

Still awaiting trial in the second case are four ageing leaders, widely considered the architects of the Khmer Rouge's vision to transform the country into an agrarian utopia. Some 1.7 million Cambodians died in the process, according to estimates.

In a 9 February ruling, the court said victims would be represented in the second case by two lead lawyers, one Cambodian and one international, whose strategy and views are supposed to reflect a consensus among the individual civil party lawyers.

"The number of Civil Party applicants, combined with the complexity, size and other unique features of the ECCC proceedings, make it necessary to adopt a new system of victim representation during the trial and appeal stage," the court said in a statement. [http://www.eccc.gov.kh/english/news.view.aspx?doc_id=336]

But while most observers recognize that the original system of individual legal representation would be impractical in the much larger second case, they warn that their diminished role could make victims feel disenfranchised.

"A lot of people's stories will be lost," says Thun Saray, president of the local rights group Adhoc. "The victims have an important role to play and this gives them a smaller role."

Applications limited

The charges against the suspects in detention are restricted to particular crime sites, which means prospective cases pertaining to other sites will not be able to participate in the trial.

"It's common in all courts dealing with crimes of this magnitude to limit the investigation to a representative sample of all the crimes committed because of time and resource constraints," court spokesman Lars Olsen told IRIN.

While the court's investigation into the second case began in 2007, the public was not told which sites were involved until last November – leaving them little time before the deadline in January.

"I think it will be a very big problem when many of the victims who want to be civil parties are told the crimes against them don't apply [to the trial]," said Sok Sam Oeun, director of the Cambodian Defender's Project [see: http://www.cdpcambodia.org/] , a legal aid group. "Many didn't know about the guidelines until very late."

The court, in turn, says victims should not regard their status in the court as an official judgment of their suffering.

"It's a technical decision as to how they relate to the particular cases," Helen Jarvis, head of the court's Victims' Support Section, told IRIN.

"Even if they're not designated a civil party, their information is valuable to the court's investigation of the systematic nature of the crimes. There is bound to be some disappointment but they should not feel there are first-class victims and second-class victims." Read more!

JETRO opens office in Cambodia to promote trade, business ties+

PHNOM PENH, March 10 (AP) - (Kyodo)—The Japan External Trade Organization officially opened its office in the Cambodian capital Wednesday to promote trade and business ties between Japan and Cambodia.

Cambodian Commerce Minister Cham Prasidh said at the opening ceremony in Phnom Penh that JETRO will play an important role in "bridging business ties" between Cambodian and Japanese businesspeople, and expressed his strong hope that two-way trade as well as and Japanese investment in Cambodia will rise in the near future.

JETRO Chairman Yasuo Hayashi said at the ceremony that the new office in Cambodia will focus not only on promoting Japanese investment in Cambodia and bilateral trade, but also on developing Cambodia's export industries.

The Japanese government-backed organization, which was set up in 1958 to promote Japanese exports, changed its charter after Japan became a major exporting country and now helps Japan's trading partners to tackle the Japanese market.

Hayashi said two-way trade between Japan and Cambodia has more than doubled over the past decade, from $104 million in 2000 to $255 million in 2009.

Japanese exports to Cambodia declined by 39.4 percent in 2009 year on year to $112 million, mainly because of the financial crisis, but imports from Cambodia grew by 18.3 percent to $143 million, he said.

Japan's main exports to Cambodia are vessels, machines and transportation equipment, and its main imports are footwear and sewn products.

Hayashi said the number of Japanese companies investing in Cambodia has increased from 36 in 2008 to 57 as of the end of January this year, a growth of over 20 in less than two years.

Cham Prasidh noted that Japan ranks 14th among foreign countries investing in the country, far behind China and South Korea which rank first and second respectively in terms of size of capital investment.

He said Cambodia can offer Japanese investors a central location in Southeast Asia, a good seaport and cheap labor.

Including the newly launched office in Phnom Penh, JETRO now has offices in eight of the 10 ASEAN countries -- all except for Brunei and Laos.

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Cambodia to preserve for tourism sites at Khmer Rouge stronghold, including Pol Pot grave

By Associated Press


Phnom Penh, Cambodia (AP) — Cambodia will preserve 14 sites at the last bastion of the murderous Khmer Rouge, including the home of their leader Pol Pot, as tourist attractions, an official said Wednesday.

Following Cabinet approval last week, the sites at Anlong Veng will be protected from destruction by local people and illegal encroachment, the area's district chief Yim Phana said.

Anlong Veng, about 185 miles (300 kilometers) north of Phnom Penh, fell to government forces in 1998 after nearly 20 years of fighting.

The Khmer Rouge regime, under which an estimated 1.7 million people died from execution, disease and malnutrition, was toppled in 1979 but its guerrillas fought on in the jungles, with Anlong Veng becoming their last stronghold.

Yim Phana said the 14 sites include homes belonging to Khmer Rouge leaders, an ammunition warehouse and the grave of Pol Pot, who died in 1998.

Once a remote town, Anlong Veng is now connected by good roads to nearby Thailand and Cambodia's greatest tourist attractions, the temples of Angkor.
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Cambodian rubber exports rose 36pc last year, government says

CAMBODIA’S rubber exports to international markets increased by an annualised 36 percent in 2009, according to official figures obtained from the Department of CamControl Tuesday.

Data show that the Kingdom exported 32,871 tonnes of rubber worth about US$61 million to Vietnam through the Trapaing Thlong border in Kampong Cham province and O’Yadav crossing in Ratanakiri province last year.

Around 24,199 tonnes of rubber, worth about $45 million, were exported in 2008.

Commentators believe the real amount of rubber leaving the country may have been even higher than CamControl’s statistics, due to still-prevalent illegal smuggling.

Ly Phalla, director general of the Cambodian Rubber Plantation Department (CRP), told the Post Tuesday: “We believe that the real quantity of rubber which Cambodia exported last year would be more than what was shown in the official statistics, considering the amount of rubber plantations in the country in 2009.”

The real quantity of rubber which Cambodia exported last year would be more.

According to statistics from the CRP, Cambodia had 34,000 hectares of yielding rubber plantations in 2009.

Ly Phalla added that Cambodia may be able to harvest at least 60,000 tonnes of rubber in 2010, as 50,000 hectares of trees would reach yielding maturity this year.

However, Mork Kim Hong, president of the Cambodian Rubber Association, said he believes that although the country has produced newly yielding trees, others have been cut down and replaced with other crops.

“We agree that there are newly yielding trees, but we do not think that rubber output will be very high,” he said, adding that at present, average output at big plantations is 1.4 tonne per hectare. At smaller plantations it can be up to 2 tonnes per hectare, he said.

Nevertheless, Cambodia’s rubber exports have increased each year since crop prices on international markets increased in 2008.

In 2009, Cambodia’s rubber price was between $1,000 and $3,100 per tonne. This high price has been echoed in recent months on international markets.

According to Bloomberg, rubber futures traded in Japan have advanced 7 percent so far this year, after doubling in 2009.

Production has fallen, while global economic recovery and government stimulus measures in China and the United States have boosted demand for tyres.

Regional rise in output
Rubber output in Malaysia, the world’s third-largest grower, is set to rise by 17 percent this year as farmers boost yields to benefit from high prices, a Bloomberg report said Tuesday.

Malaysia’s Minister for Plantation Industries Bernard Dompok said that production may reach 1 million tonnes in 2010 from 856,189 tonnes last year.

India, the world’s fourth-biggest producer, increased production by 6.7 percent last month after record prices prompted farmers to boost yields in the main growing region, the state-operated rubber board said.

Predictions that rubber production will continue to be on the rise worldwide during this year have also been echoed by the Association of Natural Rubber Producing Countries, an organisation of which Cambodia is the newest member following admission last year.

On March 1, the association said that output was set to surge in Vietnam, Malaysia and India between February and April this year, typically a period of low production. Read more!

Man to be deported after 27 years in Oz

KARLIS SALNA

Authorities are seeking to deport a Cambodian-born man, raised and educated in Australia since arriving as a nine-year-old some 27 years ago.

The unidentified man does not want to return to Cambodia where six of his eight siblings are reported to have been killed.

He says he no longer has any family or other contacts in Cambodia.

A report by the Commonwealth and Immigration Ombudsman, tabled in the federal parliament on Wednesday, reveals his tragic past.

It includes time spent in jail, where he had a history of self-harm that continued after being placed in immigration detention.

In May 2009, a noose was discovered in his room at the Villawood Detention Centre where he has been for almost three years.

"He is recorded as having attempted self-harm a number of times when previously in gaol, including at least one attempt at hanging," according to the Ombudsman's assessment.

While the report concedes the man has not responded well to attempts at rehabilitation, it points out that having been in Australia for the majority of his life, he is basically a member of the community.

"It nevertheless remains relevant that Mr X came to Australia as a child of nine, was raised and educated here, and, despite his poor record as a member of the community, has been part of the Australian community for almost 27 years."

But despite having been here for much of his life, he is considered a non-citizen, and the Department of Immigration and Citizenship wants to "remove Mr X to Cambodia".

The ombudsman has recommended the man be considered for a suitable visa until a decision is made about his long-term immigration status.

He is one of seven individuals the Ombudsman has reported on.

Five of those included in the document have been in detention for more than three years, including one for almost seven years and another for five years and nine months.

Four of the detainees are being held at Villawood while the other three are in community detention.

Read more!