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Hong Da recovered from malaria two months ago, but now the dizziness and headaches are back. He's been sickened by the disease six or seven times in his short life -- too many to remember. He knows that if he doesn't get to a hospital soon, he could die.
With no new treatments in the pipeline, normally reserved scientists are quick to use words like "disaster" or "catastrophe" when asked what might happen if they don't contain the disease that's ravaging young Hong Da before it spreads to Africa. There, malaria already kills an estimated 2,000 kids daily.
For the past 50,000 years the malaria parasite has been evolving, and migrating, alongside humans. It moves within the huts of O'treng, and into neighboring towns when men like Hong Da's father and older siblings float from job to job.
Some work is close enough for them to return home at night, but other jobs keep them away for stretches of time. They sleep in tight rows, sweating and weary, in disintegrating bamboo huts with workers who are also traveling, and possibly infected with malaria.
The concept of containing drug resistance has never been tried before. Scientists wonder: How do you control the spread of a resistant parasite transmitted by mosquitoes that bite people who live and work in infested jungle areas, then scatter in all directions, all the time?
This area, the former stronghold of the murderous Khmer Rouge, has a notorious history. Burmese migrant workers who once mined rubies and sapphires in these now deforested hills are believed to have helped transport strains resistant to the drug chloroquine back to Myanmar a half century ago. From there it spread to India and later over to Africa until the drug was useless worldwide.
A decade later, history repeated itself when resistance to the drug sulfadoxine-pyrimethamine followed the same path.
Now, in western Cambodia, scientists are concerned because the artemisinin-based drugs are taking longer than usual to kill the parasites. Earlier this year, an army of aid agencies and experts from the WHO began racing to this impoverished corner on the Thai-Cambodian border to divvy up a $22.5 million grant from the Bill & Melinda Gates Foundation, aimed at stopping this virulent new strain.
But grants haven't stopped lines of Cambodians, sick or not, from queuing up every morning at Thailand's border, charging past the checkpoints in search of work or goods. Some may carry resistant strains in, others may bring them home.
And grants haven't stopped the parasite from spreading in the O'treng area, despite widespread bednet distribution, awareness campaigns and enhanced surveillance systems. Some scientists say the only sure way to fix the problem is to eradicate malaria entirely from western Cambodia.
"It's really dangerous," says Dr. Rupam Tripura, who's conducting a study in Pailin for the Wellcome Trust-Mahidol University-Oxford Tropical Medicine Research Program. "What will happen to the mosquitoes? Can you kill those living in the jungle? No, so you cannot kill the strain."
If O'treng is the epicenter of this emerging disease, Phoun Sokha is the point man aimed at controlling it.
At 47, Phoun Sokha is the village malaria worker who lives at the mouth of the hamlet and proudly displays an orange plastic kit that resembles a tackle box.
Phoun Sokha is serious about his packets of medicine and his rapid tests to prick blood from sick villagers' fingers to determine if they have malaria and if so, what type. He makes sure patients are taking their free medicines and checks to see if they're improving. If not, Phoun Sokha can even arrange transportation to the hospital.
But treating O'treng's malaria patients can be frustrating.
"Some of the patients, when they went to the hospital, after one month, maybe they get malaria again," he says.
Today Hong Da, the village boy who has fought malaria so many times before, heads home from the hospital after a few days of treatment. He clutches a new mosquito net he hopes will prevent yet another infection. Together, the recovering boy and his weathered mom shuffle past sick neighbor Chhien Rern's shack before disappearing among the tassels of the cornfield toward their home.
But all is not well.
Under a tattered quilt, Hong Da's 9-year-old sister Hoeun Chhay Meth is curled on a thin mattress atop the wooden floor inside the family's open-air home.
She had malaria alongside her brother two months ago. They share a mosquito net that she burned a hole in when she stayed up one night reading by the light of a makeshift candle. Her brother thinks that's how the mosquitoes infected them.
"Very afraid of dying," says Chhay Meth, who has started taking medicine provided by the village malaria worker. "I feel worse than before. I cannot walk myself or stand up by myself and cannot eat well."
Hong Da understands. He gently lifts his little sister's limp body, scooping her up, his strength returning. Chhay Meth reaches weakly for her mother.
Like her big brother, this child doesn't know about counterfeit drugs or antimalarials.
She only knows she's sick. And the medicines don't seem to work as well any more in this little village she calls home.
Copyright 2009 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
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