2. Cambodia is a Major Threat to World Health

Cambodia: Major Threat to World Health.

Not hyperbole: In Cambodia there is growing resistance to front-line drug treatment for Malaria, due largely to mis-use of anti-malarials and antibiotics. In addition simplest most obvious measures are not taken to prevent mosquitoes from breeding. Strange as it may seem all major health stakeholders - medical professions; administrators, global health bodies, donors and researchers are impervious to my warnings.

You can lead a horse to water but you can't make it drink!

Please go to this Twitter Moment for a quick overview.

Not one major health stake-holder has replied to my messages.

An amazing amount of Foreign Aid goes in to the health sector in Cambodia, probably the largest external intervention is via the Global Fund to Fight AIDS, Tuberculosis and Malaria.

I do seriously question the Global Fund's management especially its unwillingness or inability to hold the government to account to take elementary measures across public services to prevent hazards such as mosquitoes and improper sales of antibiotics and anti-malarials.

Frantic mothers carry their babies from faraway for reliable free diagnosis and treatment.
There are reputable medical facilities, none up to Kantha Bopha standards.

Background: In 2010 I took overall responsibility for the Malaria Health Education project in Mondulkiri. This was a highly successful project. It used creative learning methodology for modern scientific approaches to malaria to be conveyed in villages through theatre performances in indigenous languages while respecting local contexts and belief systems . We were the first NGO to adopt this methodology that is now replicated by others. We reached saturation point in target areas, after several years and wanted to focus on (a) particularly vulnerable groups in need of special attention such as mothers and babies, and [b) refresher + reinforcement activities. Oddly the Global Fund, its senior co-ordinating partner, refused indicating that we should simply keep replicating the same training. We decided to withdraw despite the loss of funding. (Not long after other NGOs took over the task including one USAID-funded with no experience in the province with indigenous people.)

My first doubts about the Global Fund's management in Cambodia were confirmed when major corruption was discovered within its governmental partner, the National Malaria Centre. Those responsible have never been held fully to account. The official Anti-Corruption Unit decided to take no further action even though it has powers to prosecute. The Global Fund and its donors did not press them to do so. Soon after they resumed normal business.

Two Big Health Hazards

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Cambodia's Health Hazards - Drug Resistance:
Numerous unlicensed pharmacies

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Small cocktails are sold no prescription with one or two antibiotic or anti-malarial tablets.

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Some untrained people practise as doctors. Most drugs are bought from "pharmacies" and shops, rarely with examnation of patients, blood-tests, etc.

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Mosquitoes proliferate because of construction in Cambodia. Bull-dozers dig holes - not for foundations - but to extract earth. The holes are left to fill with water and mosquitoes to breed in the wet season.

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Earth is taken by trucks for "landfill" i.e. to build up construction sites by 1-2 metres above the natural flood-plain levels of the Mekong, all around Phnom Penh and other riverside urban cities.

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Uncontrolled development not only creates trapped stagnant water by extracting earth for land fill but also by blocking natural drainage channels.

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Cambodia's wet season starts in May. Areas like this - if not drained artificially or naturally - will breed mosquitoes until November.

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The school here is surrounded by stagnant water. Such deep ponds are a serious danger to children from mosquito bites and by drowning when playing in them. It's easy to see how water contaminated leads to diarrohea and other water-borne illnesses.

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1. Drug resistance and professional negligence.

The Cambodia Government, especially the Ministry of Health does not face up to tackling issues. One is proliferation of untrained and unlicensed medical and pharmacy businesses in every settlement, urban and rural, throughout the country. The most extreme case is of a bogus doctor who contaminated patients with tainted blood. As well drugs - many donated to Cambodia - being sold without proper prescriptions by qualified doctors, patients do not take them properly, and they are given to children and at-risk groups despite warnings not do so. Many are potentially lethal fake drugs.

Little wonder that first-line and in some cases the only drug remedies are failing in Cambodia posing a grave risk to the outside world.

2. Creation of serious health hazards - breeding ponds for water-borne diseases and traps to drown children.

Phnom Penh and other urban areas have experienced vast construction developments over the last 10 years. The city is built on the low-lying flood plain of the River Mekong at the confluence of the Tonle Sap and Tonle Bassac tributaries. Almost everywhere new roads and building sites are land-filled to raise them above flood-levels. To do this considerable sand-pumping and extraction of earth - digging deep holes - takes place, creating literally tens of thousands of ponds where Malaria and Dengue mosquitoes breed. Contamination is made worse by wanton dumping of waste and sewage-seepage. Numerous cases of children drowning are also reported. It is hard to believe that not one major health stake-holder takes action even though these negligent actions counteract and undermine their work.

Not only are these hazards enormous risks in their own right, but of course they mean that elimination of diseases like Malaria and Dengue Fever in Cambodia and around the world is farther away, not nearer contrary to aspirations and even claims otherwise. I must add that official figures in Cambodia should not be believed. Most illnesses and causes of death are not reported officially. Sad but true: far more money and effort is expended on funerals than keeping people alive.

Malaria, Dengue, Diarrhoea, Drownings

Representations from 2015

All major health stakeholders have been sent this message in all forms including social media.
Malaria Dengue Tweets
How Malaria and Dengue proliferates

This elementary message about the formation and spread of mosquito-borne disseas has been widely viewed, yet no stakehholder has replied.
Care-free Mosquitoes
Ponds of Danger

This stagnant water pond existed in a residential area with old and new housing. Note that it is unfenced, strewn with dunmped waste. In addition sewage from the factory - allowed to be constrcted with no local consultation - drained in to it.
Ponds of Danger
Trapped Water

The entire area around this house in the same residential area is under water from May to November during the rain season. It's trapped due to landfill and a new road blocking previous natural drainage channels.
No hydrology in Cambodia