CAMBODIA: Rural poor most at risk from rabies

Hundreds of people die of rabies in rural Cambodia (Photo: Contributor/IRIN)

KAMPOT, 1 April 2011 (IRIN) - Yinn Siet, 65, recalls in horror when a snarling dog bit her husband four years ago. Before he died, the farmer hallucinated and convulsed. “He barked like a dog,” she said. “We put a chain on him and locked him up.”

He had contracted rabies, a virus that kills nearly all victims who develop symptoms.

Yinn could not afford to bring her husband to the capital Phnom Penh, the only city in Cambodia that has a centre offering free treatment.

Even if she had, it would have been too late.

CAMBODIA: Winning the battle against schistosomiasis

Freshwater snails act as hosts for the parasitic disease (Photo: Lynn Maung/IRIN)

KRATIE, 6 January 2011 (IRIN) - Health officials in Cambodia are making inroads in their battle against schistosomiasis, a chronic and debilitating disease commonly known as snail fever.

In northeastern Cambodia, more than 80,000 people living along the 5,000km-long Mekong River are at risk of schistosomiasis, according to the National Center for Parasitology, Entomology and Malaria Control (CNM).

"We've seen a very [big] drop from the last decade," Muth Sinuon, a parasitic worms specialist at the government body, said. She places current prevalence rates at less than 5 percent - a steep fall from the mid-1990s.

Nurse: Disease will claim lives if Cambodia-Thai temple talks fail

Aug 17, 2008
DPA

Preah Vihear, Cambodia - Personnel near an ancient temple on the Thai-Cambodia border warned Sunday that if talks over disputed borders fail, lives will be lost - but to disease, not war.

Nurse Keo Neang from the Preah Vihear district health department said malaria, scurvy and also diseases spread by poor sanitation had all begun taking a toll on locals and troops alike.

Troops on both sides were moved back from the border Saturday ahead of Monday's talks scheduled for the Thai seaside resort of Hua Hin, but could be redeployed at any time if the talks fail.

'We have received drugs from the government and the royal palace, but we will need more if troops move back in: basics like (paracetamol-based) Mixagrip for fevers and vitamin C,' Neang said.

'If Thailand does not permanently withdraw its troops after these meetings, we are looking at some serious potential epidemics on the border as well as some very big sanitation issues.'

Sergeant Nguon Samnang, on the frontline of Cambodia's defence, agreed that fighting was far less of a peril than disease for troops.

'We have plenty of food, but it is all dried or tinned and there are no fresh vegetables,' he said.

'If the talks fail and we have to dig in again, there are going to be casualties on both sides from poor nutrition and of course malaria; some have fallen ill already.'

Malaria is endemic to areas around both Preah Vihear temple, an 11th century temple around 300 kilometres from the capital, and the Ta Moan group of temples, 150 kilometres to its west.

Thai troops occupied areas around both sites after UNESECO granted Cambodia World Heritage status for Preah Vihear over Thai objections early last month. Cambodia matched the troop movements.

Cambodia says the land is sovereign but Thailand disagrees, causing major strains on the formerly friendly bilateral relations between the neighbours and even fears that fighting may break out.

A rich nation crippled by poverty [-A view into Cambodia's future?]

Economic misrule by Myanmar's military government has made the resource-rich country one of the poorest in the world

TUESDAY, NOVEMBER 06, 2007
By Dinah Gardner in Yangon
Al Jazeera

Min Lwin U was 5-years-old when he found out he was HIV positive. That was three years ago. His doctors now say he has three months to live unless he gets anti-retro viral therapy (ART) soon.

Every day Lwin U is at a Medicins Sans Frontieres-run clinic in one of the poorest suburbs of Yangon. He comes to eat the three free meals of rice and curry the humanitarian organisation dishes out a day to malnourished and HIV positive children.

Even so his tiny arms are like sticks. His growth has been so stunted by the virus that he looks no more than four.

His dirty T-shirt and shorts hang loosely on his tiny, bony body. He scoops up the rice with his fingers and stares listlessly at some infants sprawled on bamboo mats being fed their meals.

Mismanagement

According to the World Health Organisation, 32 per cent of all children under five in Myanmar are seriously malnourished.

Your Views
"Until the generals' military hardware is crumbled, they won't listen to anyone" -
Oomlwin, Yangon, Myanmar

Decades of economic misrule by Myanmar's military government have made this resource-rich country one of the poorest in the world.

The ruling generals earned more than $2bn from natural gas exports last year, but the country's impoverished millions do not have free access to even basic healthcare.

And with the average daily income around $1 a day, many families cannot afford to pay doctor's fees – around $1-2 – when they get sick, much less the $35 price tag on a month's worth of ART.

The poverty here is crippling. In many ways it was the trigger that ignited September's protests.

Ten of thousands of people followed marching monks in the country's main cities and towns until the army moved in to crush the rallies on September 27.

While Western media stressed a public desire for democracy, for most in Myanmar, the demonstrations were about having enough food to eat and the right to basic healthcare.

"Most people here don't care about politics," says Su Hlaing Htwe, a doctor at the MSF clinic in Yangon's slum suburb of Hlang Thayar.

She waves her hand at the wooden and corrugated iron homes clustered behind the centre; an emaciated dog leaps over a ditch - a swill of filthy water cluttered with rotting debris.

Survival

The average daily income in Myanmar is around $1 a day [GALLO/GETTY]

"The people just want a chance to earn enough money to survive. Many of them can barely write. Mostly their education is very basic – just primary level."

Myanmar does not publish its budget but most experts agree that it probably spends less than a paltry dollar a person on health each year.

That's among the lowest level in the world.

It's left to a few UN agencies, MSF and a handful of other NGOs to do what they can, but their efforts are just a drop in the ocean.

Myanmar's poor suffer not just because their military government ignores them but also because the international community – citing discomfort over working with the generals – has been giving the country the cold shoulder for years.

And even among the few agencies that entered the country, some have pulled out.

Global Fund and MSF-France quit in the past two years citing excessive government interference in their humanitarian programmes.

According to 2005 World Bank figures, overseas development aid (ODA) per capita in Myanmar was about $2.90.

In nearby Cambodia, ODA per person in 2005 was about $38.50.

Double blow

"Now you have a people with a government that doesn't do anything for them, and an international community that also doesn't do anything for them" - NGO worker

"So now you have a people with a government that doesn't do anything for them, and an international community that also doesn't do anything for them," one long-term expatriate NGO worker in Yangon says.

"What little ODA you do have goes mostly on UN salaries anyway. So the people get nothing."

The four doctors at MSF-Holland's Hlang Thayar clinic see around 200 patients a day – mainly malnourished children and sufferers of HIV and TB.

Despite the surrounding slums and the plainness of the centre – basically a large wooden shed on stilts – the staff have made the place a comfortable escape from despair.

Doctors joke with their patients, local pop songs are piped over the speakers and there is a television in the waiting room.

But there is real suffering beneath the smiles.

Many of the women are widows – husbands already dead from Aids, their only legacy the virus in their wives' bodies.

Too sick to work, many of the women with HIV sport cropped hair, transforming them into teenage boys, because they can earn about $1.50 from selling their locks.

But their shaven heads act as a badge, alerting their neighbours to their likely HIV status.

Many are wholly reliant on the MSF's daily handout of rice and beans to its patients on ART.

Aids challenge

The WHO says 32 per cent of all children under five in Myanmar are malnourished

Min Min comes into the consulting room with a brilliant smile but within minutes her eyes begin to mist up and she crumples into her chair.

The 24-year-old mother is recovering from stage 4 HIV – the point at which a patient's immune system is so battered she is on the brink of being diagnosed with full-blown Aids.

Her soldier husband – dead now for four months – gave her the disease.

She is pleading with her doctor to let her have a month's worth of ART so she can leave Yangon for the southern city of Mawlamyine where her parents-in-law live with her five-year-old son.

But her doctor wants her to stay in Yangon. She is too sick and needs to stay close to the MSF clinic.

UNAIDS estimates there are around 360,000 people living with HIV/Aids in Myanmar and only a fraction of those can ever hope to get treated.

The bulk of the care is carried out by MSF. The group has committed to treating 16,000 sufferers but has reached the limit of its resources and announced a cap on new patients in July.

But that still means "tens of thousands of people die from Aids every year and nobody does anything about it", says Frank Smithuis, MSF-Holland's country director.

In some ways Lwin U is one of the lucky ones. He is already on MSF's list.

The organisation put him on ART when he was first diagnosed with HIV. But two years later, his mother, who is also HIV positive, took him out of the city, cutting him off from the drug that was keeping him alive.

Now he's back and very sick. But the clinic cannot restart his treatment until it is sure his family will stay put in Yangon and properly administer the therapy to him.

Stopping and starting ART can render it ineffective as the virus may become resistant to the cocktail of drugs.

"This situation is very common," says Hlaing Htwe. "Many patients here are poorly educated; they don't understand how important the drug is, and how important it is to take it properly."

The international community may be focusing on UN envoy Ibrahim Gambari's visit and meeting with the generals to persuade them to start a dialogue with the opposition, but Hlaing Htwe is concentrating on getting Lwin U's family to oversee his treatment.

"We are trying to persuade Lwin U's parents to commit to giving him the drug. But it is very difficult."

She smiles as she watches him take his bowl into the kitchen to be washed.

"But we are trying our best."

Nhiek Bun Chhay inflicted with diabetes and high blood pressure

Nhiek Bun Chhay prosterning in front of Prince Ranariddh whom he later engineered the removal from Funcinpec's presidency

Friday, August 10, 2007
Rasmei Kampuchea
Translated from Khmer by Socheata

Nhiek Bun Chhay, Funcinpec party secretary-general, is facing health problems due to diabetes and high blood pressure.

A source from the Funcinpec party said that, in the afternoon of 09 August, Nhiek Bun Chhay’s health is weakening. He is inflicted with diabetes and high blood pressure. The same source indicated that, on 09 August, during a visit to Thbong Khmum district, Kompong Cham province, Nhiek Bun Chhay’s high blood pressure caused him to become dizzy, and he was forced to take a blood pressure measurement. Nevertheless, later on, he was able to get back up. On 08 August, Nhiek Bun Chhay almost fell down during a visit to Kroch Chhmar district in Kompong Cham province, because of too low level of blood sugar. The Funcinpec official source added that the condition inflicting Nhiek Bun Chhay in the past two days is due to his diabetes and high blood pressure.

Nouv Sovathero, secretary of state of the Ministry of Information and Funcinpec spokesman, denied the weakening of Nhiek Bun Chhay’s health. He said that Nhiek Bun Chhay is still strong. Regarding the two recent incidents inflicting Nhiek Bun Chhay, Nouv Sovathero said that, at the time, Nhiek Bun Chhay was weak because he took medicine to lower his blood sugar level, and the medicine lowered his blood sugar level too much.

Nhiek Bun Chhay is known to be a powerful secretary-general of the Funcinpec party. He is known to be the organizer of the Funcinpec extraordinary congress to remove Prince Ranariddh from his position as Funcinpec party president.