Malaria, drug-resistant TB flourish in Myanmar

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.


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."


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."


Reuters - Thomson Reuters Foundation
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