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29 May 2007 23:04:05 GMT
Source: Reuters By Ed Cropley MAE SOT, Thailand, May 30 (Reuters) - Simmering civil war, fake drugs
and a non-existent health service in Myanmar are creating the perfect
breeding ground for new, drug-resistant strains of killer diseases such
as malaria and tuberculosis.
While the most immediate threat beyond Myanmar's borders is to Thailand,
home to a large migrant and refugee population from the military-ruled
former Burma, the long-term implications of neglect could be felt right
across the globe, experts say. At stake is a Chinese drug called artemisinin, the world's most powerful
weapon against malaria, a disease that kills more than a million people
a year, most of them children in sub-Saharan Africa. The drug is most
effective when used with other treatments in what are called
artemisinin-based combination therapies (ACTs). But doctors say taking ACTs incorrectly or in doses that include fake
pills is one of the easiest ways of allowing the mosquito-borne parasite
which causes malaria to build up immunity. Such behaviour appears to be commonplace, Thai health officials say, in
Myanmar, where health spending is only a few dollars a year for each of
the country's 53 million people. Decades of civil war against ethnic militias in eastern Myanmar have
worsened the situation; A study by the Thailand-based Backpack Health
Worker Team showed the region's 500,000 internal refugees have malaria
infection rates as high as 12 percent. "So far, the malaria parasite has started to develop resistance to all
drugs apart from those in the artemisinin family," said Francois Nosten,
a French malaria expert in the northwestern Thai border town of Mae Sot. "If this starts to happen, there is cause for real concern." One drug-resistant strain born in southeast Asia has already made it to
Africa, Nosten said. If an artemisinin-resistant variety reached the
continent, the effects would be devastating. "If we find evidence that it has changed to become resistant to
artemisinin, we would have to contain it here -- but how you would do
that, I just don't know," said Nosten, director of the Shoklo Malaria
Research Unit, a field station attached to Bangkok's Mahidol University. TB MAKES COMEBACK While Nosten said there were no signs yet of malaria becoming immune to
ACTs in the jungle-clad border region, the same cannot be said of
tuberculosis, a disease that -- as with malaria -- had been on the
retreat in Thailand. Mae Sot general hospital, a sprawling complex overflowing with Burmese
and Thai patients, has admitted 105 Thai and 38 Myanmar TB patients so
far this year compared to 102 and 79 in the whole of 2006. More worrying still, five cases were "multi-drug resistant", meaning
patients have to undergo an expensive and arduous two-year course of
pills and injections. Even then, there is only a 50 percent chance of
survival. Aid agency Medecins Sans Frontieres (MSF) (Doctors Without Borders),
which is treating 15 "multi-drug resistant" Myanmar patients in a
refugee camp in Thailand, is acutely aware of the problems of treating
TB patients in fluid populations. Treatment normally lasts six months, but many patients feel better after
half way through and so stop taking the pills. "There needs to be a huge push in TB education, in telling people the
extreme importance of taking the treatment properly and not stopping as
soon as you start to feel better," MSF Mae Sot's field coordinator
Andres Romero said. "But with migrants, how do you follow up to ensure
they have not become a defaulter? They've no mobile, no landline, no
address." STRUGGLING Although wealthy and advanced by regional standards, Thailand's public
health system in Mae Sot is struggling under the weight of dealing with
an estimated 150,000 migrants from Myanmar -- and the diseases they
bring with them. Apart from a one-off payment from the Global Fund to treat TB in
migrants, Mae Sot hospital gets no extra government cash for the
thousands of Burmese flooding across the highly porous border, drawn by
the prospect of free health care. All the signs are of a hospital struggling to cope. Its open-air corridors are choked with beds and patients hooked up to
drips beneath whirring ceiling fans. Relatives of the sick, who range
from landmine amputees to TB patients on respirators, lie curled up on
reed mats beneath many of the beds. "We treat every patient who comes here, Burmese or Thai, exactly the
same. Not to do so would be completely unethical," director Kanoknart
Pisultakoon said. "Often the Burmese have tried to treat themselves and it hasn't worked
so when they come to hospital they are very sick. Then, when they get
better, they go back to Myanmar and tell their friends. "The word spreads and every year, there are more migrants, more patients
and more serious diseases," Kanoknart said. "It makes me worry for the
future -- how we can control the migrants."
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