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MEDLIB-L  February 2008, Week 2

MEDLIB-L February 2008, Week 2

Subject:

Resource: Malaria: Health Crisis in Burma

From:

Mike Yared <[log in to unmask]>

Reply-To:

Mike Yared <[log in to unmask]>

Date:

Tue, 12 Feb 2008 20:32:12 -0800

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (770 lines)

http://www.menshealth.com/cda/article.do?site=MensHealth&channel=health&category=other.diseases.ailments&conitem=50e09276d3de7110VgnVCM10000013281eac____

Malaria: Health Crisis in Burma
The Doctor, the Dictator, and the Deadly Mosquito 
Saving lives in the jungle of death
By: Adam Skolnick 

It's just after 2 p.m. Filtered sunlight splashes
through the teak forest, illuminating a network of
stilted bamboo huts that stretches into the
surrounding hills. Five neighborhoods are stitched
together with pumpkin patches and banana groves, and
enlivened by scavenging chickens, mud-soaked pigs, and
packs of children dressed in rags. This place is not
joyless, but it is desperate. The sour tang of rotting
trash blows through camp.

Inside the hut that serves as the village health
clinic, it's always dark as night. The air is heavy;
13 patients sprawl on bamboo mats. Adam Richards, 33,
an M.D. from the Bronx who was educated at Harvard and
Johns Hopkins, sits next to 30-year-old He Ni Hta and
her three young children.

Ni Hta's eyes are vacant. She has been complaining of
dizziness and numbness in her legs; her case has
puzzled the young medics who staff the clinic. They've
diagnosed Ni Hta with a thiamine deficiency known as
beriberi, but Dr. Richards isn't so sure. He takes her
pulse, checks her blood pressure, and tests her
reflexes. She appears on edge.

"What do you think caused this?" he asks.

Her eyes stay fixed on the woven bamboo floor. "The
government destroyed our village a little more than a
year ago," she says. "We ran to a hiding place in the
jungle and we stayed there. We couldn't move for many
days. My husband caught malaria. We had no medicine,
and he got very sick. He didn't eat for 2 weeks. Then
he died."

She was 4 months pregnant at the time. Still grieving,
she managed to carry her children and their meager
belongings for 3 weeks over steep jungle peaks to this
camp, all the while dodging government soldiers.

"Four months after I arrived here," she continues,
"when I was 8 months pregnant, I had a stillbirth."
Birth complications, including premature delivery,
have long been associated with malaria. Ni Hta may not
have become ill like her husband -- at least not yet
-- but she may well have been carrying the parasite,
which, according to Dr. Richards, is what may have
killed her unborn child.

Ni Hta's 7-year-old son notices his mother's despair
and leans his head on her knee. She shoos him away
coldly. Her three kids are charming. They smile and
are engaged, but they've already lost a father. And
now they may be losing their mother, too.

This is Ei Htu Hta (ee-TOO-ta), a makeshift village in
eastern Burma's Karen state. The nearly 4,000 people
who live in this camp built for 600 have been run off
their land by the notorious Burmese military
government (calling itself, without irony, the State
Peace and Development Council, or SPDC), which began
its campaign in the spring of 2006 to create a buffer
around its new capital.

Though the reason may be new, the practice is the same
as it ever was. Tensions between ethnic minorities and
the Burman majority date back centuries. Since the
military regime seized power 45 years ago, it has been
targeting opposition groups by clamping down on the
civilians who support them. It is gradually taking
control of Karen state -- home to the second-largest
ethnic minority in Burma -- and selling the state's
natural resources such as timber to multinational
corporations. In the process, the regime's top leaders
have become obscenely rich.

Ei Htu Hta is one of dozens of makeshift camps in
eastern Burma. They house an estimated 500,000
displaced people who are in hiding, with very little
cash to spend and even less freedom to work fields and
move about. (The larger camps are located right on the
Burma-Thailand border because the SPDC is less likely
to attack them there.) Their leaders are exiled and
living as legal or undocumented refugees in Thailand,
and they are fed rations purchased by the Thailand
Burma Border Consortium, a group of 11 international
charities. These are communities in limbo. Danger and
fear linger.

Forced relocation goes something like this: "They
invaded at night. They came in shooting, and they
killed many people," says 28-year-old Hel Kler, who
was born and raised in the Toungoo district, in
northern Karen. "They set the thatched roofs on fire.
They shot my uncle. They shot two of my friends. Two
other friends stepped on land mines trying to escape.
They blocked the roads to cut off our food supply.
They torched the rice stores and the rice fields, and
they burned the people working in the fields. After
that they burned the village and set more land mines.
And the people who tried to come back for their
belongings stepped on the mines."

The soldiers also typically either seize or slaughter
the livestock. Some of the men are captured and forced
to work as porters for SPDC troops. They march for
weeks at a time carrying military supplies, and always
walk in front so they will be the first to set off
land mines. Young girls are often raped, village
leaders are executed, and troops often demand the
villagers' cash. Other times, entire villages are
emptied and interned at relocation camps. SPDC
officials call them "model villages," except these
villages are overcrowded, fenced in, and watched by
armed guards. If villagers disobey, they can be shot
on sight.

According to the Thailand Burma Border Consortium, the
SPDC has destroyed more than 3,000 villages in the
past 12 years. In addition to the half-million people
who've lost their homes, thousands of others have lost
their lives. (The exact number is hard to pin down.
Some families scatter and others disappear forever.)
"What's happening here is crazy," says Dr. Richards.
"People should be outraged. This is a humanitarian
crisis."

But bullets and land mines aren't the only serious
threats. Malaria is the number one killer in eastern
Burma. "The SPDC has figured out that if people are
cut off from shelter, nutrition, and medicine, nature
will often finish the job," says Dr. Richards.

In other words, malaria has been the SPDC's secret
killer for years.

"No one should die of malaria," Dr. Richards tells me
later that evening as we sit outside our hut in Ei Htu
Hta watching children play in the muddy stream that
snakes through camp. "It's a disease of the poor, and
it's preventable."

Those two statements have become his rallying cry. In
2003, Dr. Richards, then an ambitious med student and
a new member of the Berkeley-based Global Health
Access Program (GHAP), codeveloped a malaria control
program with Eh Kalu Shwe Oo, the exiled chief of the
Karen department of health and welfare. In just 2
years, thanks to simple, low-tech, and incredibly
courageous field medicine, they reduced the number of
malaria cases by 90 percent in the areas their medics
reached. Still, malaria is responsible for 42 percent
of all deaths in the region today.

I met up with Dr. Richards and Eh Kalu at GHAP's
satellite office in Mae Sot, Thailand, last September.
We drove north to Mae Sariang and then entered Burma
by way of longtail boat, traveling 2 hours along the
Salween River to Ei Htu Hta. Mae Sot has become the
base of operations for Karen's exiled government, so
it's the best place from which to launch cross-border
aid. Medics load up on medicine and supplies there,
and then literally carry it into Burma on their backs.

Dr. Richards was making his eighth trip to Burma at an
auspicious time. Buddhist monks hungry for democracy
were assembling in the Burmese city of Rangoon to
protest more than four decades of military rule. I
suspected the protests would fail. This was my fourth
trip into Burma, and I'd seen firsthand the handiwork
of SPDC troops. Beating monks and shooting unarmed
protesters on the street is practically quaint
compared with the brutality that happens every day in
Burma's remote ethnic provinces, especially in Karen,
home to an estimated 1.4 million people.

Dr. Richards and Eh Kalu are in the country to observe
Karen medics such as 24-year-old Thu Ray, whose
village was destroyed by SPDC forces in 2001. He wears
jeans and a faded T-shirt. Drop him into a Starbucks,
and Thu Ray would look like just another java-swilling
hipster. He turns giddy when Dr. Richards enters the
clinic here at Ei Htu Hta, immediately handing over
medical charts and introducing him to patients.

In one corner, a 28-year-old man, teeth stained red
from chewing too much betel, rocks his month-old baby
girl in a hammock. His wife is out getting some air.
The young couple has barely slept all week. When they
arrived, the baby was near death. She had chronic
diarrhea, and blood in her stool. Dr. Richards grabs a
stethoscope and moves toward the hammock.

"She arrived with very bad dysentery and pneumonia,"
says Thu Ray. "She coughed and cried so much."

"You treated her with ampicillin?" asks Dr. Richards,
as he listens to the child's lungs.

"Yes. Injections for 3 days."

"Good," Dr. Richards replies. He checks her chart and
turns to me. "The ampicillin is obviously important,
but so are oral rehydration salts when breast milk
isn't enough. These men administered both and saved
this baby's life."

He swings to the father and smiles. "Her lungs are
clear. She's doing well." Thu Ray translates as the
man nuzzles his child, relieved.

Next, Dr. Richards examines two 13-year-olds with
malaria, a boy and a girl. Both are out of danger, but
they will remain at the clinic with their families
until their medication cycles are complete.

"Some patients come here from more than 100 miles
inside Karen, so they must stay until they have
completed their medicine and it's safe to return,"
says the soft-spoken Eh Kalu, 52, as a bright-eyed
10-month-old girl pops out from behind his leg to
catch our attention. Her grandmother laughs and Eh
Kalu chuckles as the toddler hams it up.

"She had a very high fever for several days," says Thu
Ray.

Dr. Richards glances at her chart. "Yes, malaria, but
her fever has really come down. She's doing great," he
says.

As we walk away, Dr. Richards puts Burma's malaria
problem into perspective for me: "If it weren't for
our program, those kids may not have survived, and the
village of Ei Htu Hta would likely be in the midst of
an epidemic."

In Burma, malaria peaks during the rainy season, June
through October. More people die of the disease in
Africa, but here it's more deadly because residents
aren't exposed to the parasite year-round and don't
build natural immunity.

When Dr. Richards first arrived, malaria was the
region's biggest health threat, in part because it was
becoming resistant to chloroquine and
sulfadoxine-pyrimethamine, the anti-malarial drugs of
choice, and had become resistant to quinine. There was
little hope for change. "Nobody had ever tried to
implement a malaria-control program in eastern Burma,
at least not in a drug-resistant area of active
conflict and where the people frequently migrate,"
says Dr. Richards. "A lot of people were skeptical.

"Early diagnosis and treatment are key," he continues.
"In remote villages, the ability of our health workers
to reach patients often means the difference between
life and death."

To bring health care to the displaced, the 500-plus
medics -- many of them Karen refugees -- trek through
dense jungle, dodge land mines, and evade hostile
military units. Their salaries: $780 a year. Some work
out of clinics like the one in Ei Htu Hta. Others work
out of backpacks as they go from village to village,
often sleeping in the jungle, for up to 6 months at a
time. In addition to treating malaria, they're trained
to deal with pneumonia, dysentery, and malnutrition,
perform amputations with camp saws on land-mine
victims, and deliver babies. They're general
practitioners for families on the run. The SPDC does
not want them here. In fact, the SPDC has torched half
a dozen clinics and killed seven backpack medics since
1998.

At first, diagnosis was a significant challenge. "A
number of illnesses, including dysentery and
meningitis, have similar symptoms," says Dr. Richards.
It's even more difficult when your only medical tool
is a solar microscope. The solution: a 15-minute
diagnostic test known as Paracheck, developed by a
company in India. It's like a pregnancy test, except
you spread blood instead of urine on the stick. It's
95 percent accurate.

As for treatment, Dr. Richards ditched the existing
options in favor of a drug combination known as ACT.
The malaria parasite can quickly mutate and become
resistant to single drugs, often within a year or two.
Using a combination improves the efficacy of the
therapy. "We're not seeing any resistance yet," he
says.

The program is now operating in 53 villages that are
home to more than 40,000 people. Karen medics visit
other villages, too, when possible. In total, they
treat more than 270,000 patients each year.

How successful is the program? Malaria deaths are
extremely rare in areas where the program is active.
In fact, death occurs only if the medics can't reach
the patients because of SPDC patrols, or when Thai
officials tighten the border a few times a year,
typically after the SPDC makes a stink about illegals
(i.e., the medics) entering Burma. "We started with
just 10 medics," says Dr. Richards. "It's amazing to
see what they've accomplished. This is their program
now."

Eh Kalu Shwe Oo is dignity personified.   His isn't a
stuffy or haughty dignity. It's in his quiet openness,
warmth, incisive intellect, and tireless ability to
listen. Just after sundown on our first day in Ei Htu
Hta, Eh Kalu leads a succession of meetings.

First he sits down with the camp's elected leaders.
Mudslides have swallowed several classrooms, and the
kids need a new school. Latrines dug too close to the
creek are overflowing with untreated sewage after
heavy rains. And there's a water shortage--a major
concern, considering that more displaced villagers are
on the way.

"There are fresh springs in the mountains behind
camp," says Eh Kalu. "Let's pipe water over to the new
huts."

Wang Htoo, the camp leader, looks downcast. "We have
no pipe left," he says.

Eh Kalu nods. "Don't worry. I will make calls, find
the money. We must have water. It's good for health,
right?" He chuckles, and the group laughs together in
relief.

Next Eh Kalu meets with a handful of medics. They
discuss challenging cases and go over the medicine and
supplies. The medics look up to him, not simply
because he's the boss -- he oversees the 200 field
medics and advises the 76 five-person backpack teams
-- but because he's one of them. Eh Kalu spent 18
years as a medic with the Karen National Liberation
Army, where he too dodged SPDC bullets to treat both
soldiers and villagers. He's now based in Mae Sot, and
his main duties are raising funds and coordinating
with Karen leaders to maintain open supply lines and
ensure the safety of his personnel. He's always armed
with two cellphones, so he can make calls and fire off
text messages simultaneously. In short, he's the
linchpin that holds together the entire health-care
system of a forgotten state.

The next morning, Eh Kalu and I take a walk through
camp. We pass groups of uniformed children heading to
school and timeworn men smoking their morning pipes.
The wind carries sounds of crowing roosters, barking
dogs, a rushing stream, and women smacking wet laundry
on creekside boulders. Barefoot troubadours strum
guitars and sing to giggling teenage girls whose
cheeks are painted with thanaka swirls.

I spot an intensely beautiful woman dressed
traditionally in a crisp, bright-pink sarong and
carrying a baby strapped to her back. She is unusually
tall for a Karen woman, and her long, lean legs and
ample hips carve an idyllic profile as she strides
along the muddy trail between bamboo huts. She turns
and offers a smile, her dark eyes sparkling, before
disappearing into a papaya grove.

"How does it make you feel," I ask Eh Kalu, "that the
SPDC wants that woman, that baby, and all of these
people dead?"

He stops and offers a half smile. "I used to get very
angry," he says. "But that's a young person's
reaction. I have to keep that anger inside and
concentrate on how to improve the situation. Not think
about revenge."

He tells me that the Toungoo district in northern
Karen is under attack, in "the worst offensive since
1997." Battalions of soldiers are flooding the region,
and thousands of newly displaced people are running
for their lives toward Ei Htu Hta. To make room, Karen
leaders have started a new section of camp, but unlike
the current five, which are all on the same plot of
land, Section 6 is hidden in the teak forest an hour
north, up the Salween River.

Yes, the badly overmatched Karen National Liberation
Army has been thoroughly defeated, but it does manage
to warn villagers when SPDC troops are on the way. The
alert system is so sophisticated that villagers can
escape to designated hiding places in the jungle. That
doesn't mean the villagers are safe once they escape,
however. "It's very difficult and dangerous for our
medics to reach people hiding in the jungle," says Eh
Kalu. "They could be killed or accidentally give away
the location of the hiding place. We want to give
health care to everyone in Karen. But it's
impossible."

Two hours later, Dr. Richards, Eh Kalu, and I climb
back into our boat and head toward Section 6 to meet
the new arrivals. The mocha-colored Salween is about
650 feet wide, draped on both sides by impenetrable
jungle that's home to SPDC military positions. When
SPDC scouts come into view, we veer hard to the far
bank to avoid detection.

The camp is a quarter-mile walk from the river's edge.
We pass three young boys dragging bamboo to the site
of what will be their new home. They are all from
Toungoo. They tell me they spent 2 weeks hiding in the
jungle, then trekked 15 days to reach this place.

There are seven medics in the village already. Not
only are they testing for malaria and treating the
sick, but they're also collecting stories --
human-rights data. "This information is important,"
says Dr. Richards. "We've found that food insecurity,
forced relocation, and forced labor are all associated
with an increased risk of malaria." And the risk is
twice as high in households reporting more than one
human-rights abuse.

"The fact that most medics are indigenous," he
continues, "helps villagers feel like they can speak
freely." Many also believe that by sharing their
tragedy with the world, help will arrive one day.

As we stroll through Section 6, children follow us,
women size us up, and men ignore us as they quickly
dig latrines and build huts. About 300 displaced
people are here, and 1,000 more are reportedly en
route. Eh Kalu has already arranged for an additional
team of medics to motor upriver, but there aren't
enough huts for 1,300 people yet.

Eh Kalu notices a woman standing in her doorway and
stops. He's still a medic, after all, and she doesn't
look right. "Are you okay?" he asks.

"I have malaria, but I'm feeling better," says Blu Tu,
22, as her 3-month-old baby yawns in her arms and her
15-month-old son hides behind his dad.

Blu Tu's case shows how displacement leads to disease.
After her village was torched, she lived in the jungle
for weeks. She was healthy at first and delivered her
baby without complications. But at some point a
tainted mosquito bit her. The symptoms began the day
after she arrived at Section 6.

"It was raining and I was very tired. I went to take a
bath, and afterward I felt a chill."

"Did you go to the clinic?" Eh Kalu asks.

She laughs, embarrassed. "No. I waited 2 days. By then
the fever was worse, so I went."

The medics put her on ACT meds immediately. Her fever
broke, and gradually she regained her energy. Luckily,
she's the only one in her family who became infected.

She leads us into her small hut, which is roughly 10
feet by 10 feet. We take off our shoes at the door and
sit cross-legged in a circle on the woven bamboo
floor.

"How many people live here?" Dr. Richards asks.

"Five."

"But you have only two nets. Do you sleep under a
net?"

She nods. Dr. Richards turns to Eh Kalu. "That's
probably why the malaria stopped with her."

Distribution of insecticide-treated nets is also
important for malaria control. Humans can infect
mosquitoes as easily as mosquitoes infect humans. If
someone in a household is infected and a clean
mosquito bites him or her, the mosquito becomes a
carrier. But if infected mosquitoes come in contact
with the nets, they won't live long enough to spread
the disease.

If there aren't enough nets for everyone, the next
best option is to put the malaria patient beneath the
mesh. "If the mosquito dies after biting an infected
person, the cycle is broken," Dr. Richards explains.
"That's how we gain the advantage."

Before leaving Section 6 later that afternoon, we stop
by the village church. Four weeks ago, this building
didn't even exist. Now it's packed with people hoping
for some kind of salvation. After the service, Shut A
Paw, a young mother, notices us and smiles. But the
little girl in her arms, her 6-year-old niece, becomes
terrified and hysterical.

"The SPDC killed her father, my older brother," says
Paw as I follow her outside. "They came and took him
and two other men and killed them in front of the
whole village. My niece saw everything.

"I come to church to pray for peace," she continues.
"So one day we can go back home and be free." She
smiles and waves goodbye. Dr. Richards, Eh Kalu, and I
hike back down to the river in silence.

Mae Sot, Thailand. This isn't a pretty town. The
outskirts are rimmed with large camps built for the
120,000 Karen who were granted refugee status by Thai
authorities over the past 10 years. Our driver veers
down a rutted alley to the dilapidated compound, a
huddle of two-story wooden buildings with concrete
floors and cobwebs in the rafters, where Eh Kalu lives
and works. Similar compounds are scattered throughout
Mae Sot, filled with members of Karen state's
government-in-exile and pro-democracy Burmese
activists.

"You know," says Dr. Richards, after we drop off Eh
Kalu, "it's very dangerous for Eh Kalu and his staff
here. Border groups have been infiltrated by SPDC
spies, and Thai immigration officials can arrest and
deport them at any time. But he'll never quit, no
matter the danger. He's in a unique position, in which
he can help people and promote democracy and political
change at the same time."

Of course, political change is often influenced
through evidence and policy. That's why Dr. Richards
is a self-avowed public-health geek. And why the next
day, he's preaching the importance of inputs,
outcomes, and needs assessments to a classroom of
Karen medics.

"You need to count how many nets you see," Dr.
Richards tells them, "and ask how they're being used.
Then you have to write the answers down in your
house-visit book," he says, cradling an example. "This
is our source of data. This is precious information."

There are rumblings in the back of the room. A few
medics are concerned that they won't have time to
collect all the data -- they have too many patients to
see.

"Of course your patients come first," Dr. Richards
responds. "But can you train a villager to do this? A
volunteer?" Heads nod in agreement; a rumble of
affirmation fills the room.

And because of this discussion, somewhere inside Burma
a villager will soon go door-to-door in the malaria
zone. What he or she learns will be translated by Dr.
Richards and his team into food, medicine, and
mosquito nets. Lives will be saved. Children will grow
to adulthood. Karen communities will become stronger.
And maybe, someday, a nation will find peace.


Burma's Hidden Health Tragedy 
While the world watches the crackdown on urban
protesters, the country's minority groups are being
wiped out on the eastern border. The secret weapon:
malaria
By: Adam Skolnick 
On assignment for Men's Health, 
Adam Skolnick spent 2 months on both sides of the
Thai-Burma border interviewing doctors, medics, and
survivors of military attacks on ethnic minorities. He
found that the government's most insidious weapon is
malaria. And it will not do anything to stop it.

EI HTU HTA CAMP, Karen State, Burma -- This beautiful
land hides a hideous reality.

Filtered sunlight splashes through the teak forest,
illuminating a network of stilted bamboo-hut
subdivisions scattered with thin, scavenging chickens
and packs of children dressed in rags.

It is a desperate place. The sour tinge of rotting
rubbish and raw sewage blows downwind through the
jungle village.

Welcome to Ei Htu Hta (ee-tu-ta), a camp for displaced
people in Karen State in eastern Burma, or Myanmar, as
military rulers renamed the country 19 years ago.
These "Internally Displaced People" camps are
administered by the local people known as the Karen.

The nearly 4,000 people who live here were run off
their land by the notorious government, a.k.a. the
State Peace and Development Council (SPDC), beginning
in spring 2006.

The world's attention is understandably on cities
where thousands of protesters were beaten, arrested,
or killed. But in remote eastern Burma, along the Thai
border, a virtually unseen genocide is taking place.

Human Rights Watch and the Karen Human Rights Group
have documented the genocide for a decade. I have read
numerous first-hand accounts of the atrocities and, in
four illegal trips across the border, interviewed
dozens of survivors.

Typically, government troops invade villages, seize
and slaughter livestock, destroy rice stores, poison
wells, plant landmines in the rice fields, torch
homes, and send villagers scattering into the night.

Young girls are often raped, village leaders are
summarily executed, and others are interned in
relocation camps. According to the Thai Burma Border
Consortium (TBBC), at least 3,077 villages have been
destroyed in eastern Burma over the last 10 years,
displacing at least half a million people.

If you are shocked by the willingness of SPDC troops
to beat monks to death in Rangoon's streets and fire
upon peaceful protestors, then imagine eastern Burma,
where the SPDC are far more than brutal thugs. In
Burma's remote ethnic provinces, they are genocidal.

The most recent atrocities have taken place in the
Taungoo District in northeast Karen State. Saw Peter,
the chief administrator of Ei Htu Hta, calls it "the
worst offensive since 1997." It started in 2006 and
intensified last spring.

On my second trip inside the country I met a 48-year
old man whose village was torched four times. When he
returned after hiding in the jungle for days, he found
a note. "It said, 'If we see you Karen, we will kill
you all,'" he told me through a translator.

"They don't want another generation," he said.

On another visit to a displacement camp, a hysterical
6-year-old girl jumped into her aunt's arms,
hyperventilating. "Her father was murdered by the
SPDC," said her aunt. "They took him and two others
and killed them in front of our whole village."

Bullets, landmines and fire do the most visible
damage. But that's not what has been killing the Karen
people in large numbers.

In the unforgiving jungles of eastern Burma, malaria
is the most serious threat. Four years ago, 46 percent
of all deaths in Karen state were malaria related.

Surveys by the medics show a link between uncertain
food supplies, forced relocation, and malaria. "We
found that displaced people are at least three times
more likely to die of it," says Eh Kalu, a former
Karen rebel army medic and now the exiled chief of the
Karen Department of Health and Welfare.

Malaria is the SPDC's silent killer. That's what
brought an American doctor, Adam Richards, M.D., to
the jungle.

In the displacement camp, Richards makes his rounds
inside the camp's mobile health clinic. He crossed the
Thai-Burma border illegally and ducked SPDC positions
on the Salween River to get here. Most of his patients
are suffering from malaria.

"No one should die of malaria," says Richards. "Those
that do die have no access to proper care."

Richards, 33, is Bronx-based, educated at Harvard and
Johns Hopkins, and holds a masters degree in
epidemiology. He is a member of a U.S. physician-run
non-governmental organization called the Global Health
Access Program (GHAP). Although GHAP physicians have
been active in Eastern Burma since 1998, they had not
yet contained malaria.

Richards had his share of skeptics, including some
fairly large players on the global malarial front,
namely the Shoklo Malaria Research Unit. "But nobody
had really even tried to implement a malaria program
by and for displaced people in a drug-resistant area
with frequent migration," he says.

"People weren't exactly knocking on our door telling
us it wouldn't work," he recalls, "but NGO leaders
around here certainly thought cross-border delivery of
health services could not significantly decrease
malaria transmission across the board. We proved them
wrong."

In 2002 he co-developed a malaria control program with
Kalu. Merging courageous field medicine with high-tech
diagnostics, they have reduced both malaria incidence
and mortality in the areas they work by 90 percent.

Kalu's intrepid medics, all of them Karen refugees,
create access. They trek through dense jungle, dodging
landmines and hostile military units to bring health
care to their people. Some work out of mobile health
clinics -- large bamboo huts that can be rebuilt in a
manner of days. Others work out of backpacks.

The SPDC does not want them here. They have burned
down a half dozen clinics and killed seven medics in
the last 5 years.

GHAP physicians and public health professionals help
procure medicine and supplies, and travel to the
Thai-Burma border twice a year where they train the
medics to treat malaria, pneumonia, dysentery, and
malnutrition, perform amputations on landmine victims
with camp saws, and deliver babies.

"Clinical diagnosis for malaria is notoriously poor,"
says Richards. "It's even more difficult to make a
correct diagnosis when you're in the jungle during the
rainy season with a solar microscope as your only
diagnostic tool."

Richards' solution was to employ an innovative rapid
diagnostic test known as Paracheck. This simple
blood-based test made malaria diagnosis easy for
medics on the move. "In remote villages early
diagnosis and treatment makes a huge difference
between life and death," says Richards.

Distribution of nets treated with insecticide was
crucial. When it came to treatment, Richards ditched
quinine, which was contributing to drug resistance in
malarial parasites, and implemented a more effective
combination of the drugs mefloquine and artesenate.

While large organizations are compelled to adhere to
international law and often seek the Burmese
government's approval of their cross-border aid, KDHW
medics make illegal border crossings and GHAP doctors
procure non-FDA approved meds as a matter of course.

"There's a humanitarian crisis in Eastern Burma," says
Richards. They don't have time for formalities. They
are too busy saving lives.

Mike Yared
[log in to unmask]


      ____________________________________________________________________________________
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April 2001, Week 1
March 2001, Week 5
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March 2001, Week 3
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March 2001, Week 1
February 2001, Week 4
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February 2001, Week 1
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January 2001, Week 3
January 2001, Week 2
January 2001, Week 1
December 2000, Week 5
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December 2000, Week 3
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December 2000, Week 1
November 2000, Week 5
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November 2000, Week 1
October 2000, Week 5
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October 2000, Week 3
October 2000, Week 2
October 2000, Week 1
September 2000, Week 5
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January 2000, Week 1
December 1999, Week 5
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December 1999, Week 1
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December 1998, Week 5
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December 1998, Week 3
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December 1998, Week 1
November 1998, Week 5
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October 1998, Week 5
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October 1998, Week 1
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June 1998, Week 5
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May 1998, Week 5
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May 1998, Week 1
April 1998, Week 5
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April 1998, Week 3
April 1998, Week 2
April 1998, Week 1
March 1998, Week 5
March 1998, Week 4
March 1998, Week 3
March 1998, Week 2
March 1998, Week 1
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February 1998, Week 3
February 1998, Week 2
February 1998, Week 1
January 1998, Week 5
January 1998, Week 4
January 1998, Week 3
January 1998, Week 2
January 1998, Week 1
December 1997, Week 5
December 1997, Week 4
December 1997, Week 3
December 1997, Week 2
December 1997, Week 1
November 1997, Week 5
November 1997, Week 4
November 1997, Week 3
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November 1997, Week 1
October 1997, Week 5
October 1997, Week 4
October 1997, Week 3
October 1997, Week 2
October 1997, Week 1
September 1997, Week 5
September 1997, Week 4
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September 1997, Week 1
August 1997, Week 5
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August 1997, Week 3
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August 1997, Week 1
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July 1997, Week 1
June 1997, Week 5
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April 1997, Week 5
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April 1997, Week 1
March 1997, Week 5
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March 1997, Week 3
March 1997, Week 2
March 1997, Week 1
February 1997, Week 4
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February 1997, Week 1
January 1997, Week 5
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January 1997, Week 3
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January 1997, Week 1
December 1996, Week 5
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December 1996, Week 3
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December 1996, Week 1
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October 1996, Week 5
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October 1996, Week 3
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October 1996, Week 1
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April 1996, Week 1
March 1996, Week 5
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February 1996, Week 5
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February 1996, Week 1
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January 1996, Week 1
December 1995, Week 5
December 1995, Week 4
December 1995, Week 3
December 1995, Week 2
December 1995, Week 1
November 1995, Week 5
November 1995, Week 4
November 1995, Week 3
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October 1995, Week 4
October 1995, Week 3
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September 1995, Week 1
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July 1995, Week 1
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April 1995, Week 5
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April 1995, Week 1
March 1995, Week 5
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March 1995, Week 3
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March 1995, Week 1
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February 1995, Week 2
February 1995, Week 1
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January 1995, Week 3
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December 1994, Week 5
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December 1994, Week 3
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December 1994, Week 1
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June 1994, Week 5
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