During his 46-year career as a malaria expert, Dr Yeang Chheang has battled more formidable foes than mosquitoes.
More than a quarter-century ago, as the Lon Nol regime tottered toward oblivion, Yeang Chheang was part of a civilian brigade holed up in Siem Reap’s Grand Hotel d’Angkor that repelled a Viet Minh attack. And after 1979, with the country’s malaria program virtually extinguished, he played a key role in rebuilding it.
“Yeang Chheang is not only a veteran malaria fighter, but also serves as a living library of malaria control,” Dr Stefan Hoyer, medical officer for malaria control at the World Health Organization, said Wednesday. “There is no one else who has done more to secure the re-establishment of malaria control following the Pol Pot regime, or put forth such energy and rigor to this day.”
Maintaining this energy has required Yeang Chheang to hold optimism in the face of what has been staggering reversals since the 1960s.
Following a visit to Sihanoukville in late February, the 63-year-old National Malaria Center medical officer noted that last year, the hard-hit area had seen a 60 percent drop in cases following the distribution of impregnated mosquito nets.
Yet, despite signs of progress in the country’s remote and mountainous regions, those most vulnerable to outbreaks of malaria, Yeang Chhang acknowledged that Cambodia has yet to achieve the level of malaria control taken for granted 40 years ago.
“It was better in the 1960s than now,” he said. “Even in the hospitals one rarely saw advanced cases of malaria. Doctors actually had difficulty finding serious malaria patients.”
Beginning his career as an entomologist technician in 1955, Yeang Chhang recalls the heady days when a program supported by the WHO set out to “eradicate” malaria throughout the country.
By 1963, he said, this goal had been modified to malaria control. The country was divided into four sectors in which a total of about 500 personnel carried out bi-annual blood tests and sprayed homes with insecticide at six-month intervals.
But with the overthrow of then-Prince Norodom Sihanouk in 1970, this program was limited to the slices of countryside under the control of the besieged Lon Nol regime.
“Almost all areas of the country were occupied by the Khmer Rouge, and activity in the countryside almost came to a standstill,” he said. “Kompong Som [Sihanoukville] and even Kompong Cham could not be reached except by plane.”
As the program’s northern regional chief, Yeang Chheang was based in Siem Reap in the early 1970s, at the time two luxury hotels in the area were leveled by rebel shelling. By 1972, he was removed to Battambang. Two years later, he was appointed bureau chief in Phnom Penh, which saw severe outbreaks of malaria as refugees streamed in from the war-torn countryside.
By the time the Khmer Rouge claimed total victory on April 17, 1975, the country’s malaria program had spent only $200,000 of the $1.8 million the WHO channeled into the program for that year.
Yeang Chheang, who avoided parts of the countryside where he was likely to be recognized, lived to claim the remainder of that funding a few years later.
When the Pol Pot regime was toppled in 1979, Yeang Chheang was one of about 35 surviving malaria experts in the country. He would serve as provincial health director of Kompong Thom until 1981, when he was appointed by the People’s Republic of Kampuchea to re-establish a malaria control program.
Support for the program was provided through Unicef until 1989, and three years later, WHO re-established an official presence in Cambodia, where it provides technical support and serves as a channel of international funding.
His expertise is still relied upon by the National Malaria Center and WHO, as he makes frequent field trips into remote, malaria-infested parts of rural Cambodia to distribute mosquito nets.
More than most, Yeang Chheang is painfully aware of the toll taken on the country’s health care infrastructure by the Khmer Rouge regime and decades of civil war. But he prefers to focus on the successes of recent years and envisions a brighter future.
“At last, we can see a 50-percent improvement [in malaria control] compared to 1990,” he said.
“This is mainly due to the development of health centers throughout the country and the distribution of bed nets through the Ministry of Health. Our health infrastructure is much better than it was even 10 years ago.”