Cambodians Face Threat of Drug-resistant Malaria

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• GWEN IFILL:

  Now, a story about the threat of drug-resistant malaria. Special correspondent Fred de Sam Lazaro reports for our Global Health Unit from the border region of Cambodia and Thailand.

  FRED DE SAM LAZARO, NewsHour correspondent: In the forests along Cambodia's border with Thailand, scientists have spotted early signs of drug-resistant malaria that could threaten millions of lives far beyond these isolated villages. But their first challenge is finding patients.

  It took nearly two hours for a team from the regional center in Thasanh to reach the village of Samlot, which has seen several dozen malaria cases in recent weeks.

  "Is anyone you know ill," they asked? A short walk down the road took them to 22-year-old Pin Sreymom. She was too weak to work the family's small farm field.

• DOCTOR (through translator):

  Have you been vomiting?

• FRED DE SAM LAZARO:

  But inside their tiny home, her 19-year-old brother, Pin Vantim, was in even tougher shape, with a searing temperature that, along with nausea and vomiting, are malaria symptoms. Both siblings agreed to be tested to confirm the diagnosis before they got any treatment. Until now, Pin Vantim had refused all help.

• PIN SREYMOM (through translator):

  Even if you give him pills like paracetamol, if you're not paying attention, he'll throw them out.

• FRED DE SAM LAZARO:

  He even refused to get free treatment available at the health center because he's afraid of both pills and needles. His sister didn't go because it costs too much to get there, and she didn't want to leave the house unguarded. There are lots of reasons people don't take advantage of the offer of free care.

• PIN SREYMOM (through translator):

  I don't want to go. There's no one to take care of the house. I'm afraid to leave it unattended for so long.

• FRED DE SAM LAZARO:

  So like most people who get ill around here, she got some pills from an aunt who bought them from a nearby store. This is a typical example of how drug resistance can begin: A patient doesn't follow the prescription and, in this case, takes only a partial dose.

  DR. DARAPISETH SEA, Cambodia Ministry of Health: This one will have to take four dose, but this one have only two dose.

• FRED DE SAM LAZARO:

  So she's taking the right stuff, but not sufficient amounts of it?

• DR. DARAPISETH SEA:

  Not sufficient, yes.

• FRED DE SAM LAZARO:

  Taking less than a full dose means some parasites remain in the body, where they adapt genetically and become immune to the drug. Dr. Darapiseth Sea of Cambodia's health ministry says many patients are simply too poor to afford the whole dose.

• DR. DARAPISETH SEA:

  They have only enough amount of money to buy only some drug, and then…

• FRED DE SAM LAZARO:

  Not enough for the whole course, in other words?

• DR. DARAPISETH SEA:

  Yes, not enough for the course. And sometimes when they get better, they feel that don't need more medicine, so they throw the rest away.

• FRED DE SAM LAZARO:

  Or they save it for somebody else, possibly.

• DR. DARAPISETH SEA:

  Sure.

• FRED DE SAM LAZARO:

  Another source of partial-dosing comes in counterfeit drugs, mostly from China and Thailand. They contain only a fraction of the active ingredients, so they can be sold cheaply, sold without prescription, and mostly by people with no training.

  There are quality problems even in pharmacies, like this one we stopped by in Battambang, Cambodia's second-largest city. I asked for malaria medications.

  We can see that the expiration date here is May of 2008. So this is an expired drug, but it's on the shelf.

  A customer stopped by complaining of diarrhea. She swallowed one antibiotic pill. There's no guarantee she'll return for the rest of what should be a three-pill regimen.

• YUN SAMEAN, translator:

  She just came and took one pill. Maybe they take one time, and then, when she doesn't feel better, she come back.