Malaria Expert Leaves Cambodia for Africa

When Stefan Hoyer arrived in 1996, Cambodia was a “very different country.”

Some areas of the country were still controlled by the Khmer Rouge. And those areas happened to be high-risk malaria zones, said Hoyer, who came here with the World Health Organization as communicable-disease control coordinator.

Anlong Veng district, which was part of Siem Reap province at the time, was the last stronghold of hard-line Khmer Rouge, he said. Between 1997 and 1999, 400,000 people in that region fled in all directions to escape the fighting, he said. Since danger prevented them from farming, famine set in, plus malaria and the dengue epidemic in 1998.

This led health and relief agencies to combine food and malaria-control programs, and it met with such success that WHO is transferring Hoyer to Zimbabwe this month, where he will try to adapt malaria-control strategies pioneered in Cambodia.

Hoyer, who is from Germany, will be assigned to the office of the International Federation of Red Cross and Red Crescent Societies. He leaves Cambodia after seven years of working with the National Malaria Center and the Ministry of Health. During that time, Cambodia has seen the number of malaria cases drop from 3,749 cases in 1997 to 2,673 in 2002.

Southern Africa is facing famine threatening about 13 million people. In addition, months of drought soon to be followed by the rainy season make health authorities fear a malaria epidemic. Relief agencies plan to distribute food and bed nets at the same time, just as was done in Cambo­dia in the 1990s.

At the time, the situation called for innovative approaches.

“The most difficult problem initially was security,” in malaria-prone areas under Khmer Rouge threat, Hoyer said. Displaced people had neither access nor money for treatment, he said.

In 2000, Cambodian health authorities and agencies decided to combine measles vaccination and malaria-control programs for efficiency and better use of available resources. This also will be incorporated into Africa’s vaccination program of 40 million children per year, Hoyer said.

Finally, the concept of pre-packaged combination drugs, which Cambodia was the first country  to implement nationwide, will be developed for Africa, he said.

Why have so many new strategies been pioneered in Cambo­dia? Unlike the Laotian government, which moves at a very slow pace, and the Vietnamese who, al­though highly organized, are not that receptive to ideas from outsiders, Hoyer said, “Cambodia seems to be very open, and is very progressive, at least in my area of work.”

The level of cooperation bet­ween the government and NGOs and UN agencies is “quite extraordinary,” Hoyer said.

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