Antimalarial Drug Resistance

written by: Heather Reese
posted in: 2011, Laos

July 16, 2011

It’s been three days since I’ve been back to the IRD office in Gnommalath town.  I’m sticky with dried sweat and still a little groggy from waking up at 5am after going to sleep after midnight.  But, we needed to have enough time to leave Talong village in Boulapa District and arrive in Hainoua village, Mahaxay District, before everyone went to the fields for the day.

After conducting the assessment of the First Aid Kit in three villages so far, our team now has a pattern.  As the IRD Health Officer begins with the assessment questions, I turn and begin an inventory of the contents of the first aid box.  What medicine and materials have been used the most?  Which medicines are about to expire?  Have any of the medicine or materials been replaced using community funds?  As I look through the box, checking off each roll of gauze or packet of paracetamol before replacing it, I notice a bottle of pink pills.  The pills are in a bottle marked “Berberine” but they are definitely not berberine.  When I ask the community volunteer what they are- chloroquine- I’m surprised.

South East Asia was the epicenter of the emergence of antimalarial drug resistance to chloroquine.  While only one strain of malaria, P. falciparum, is resistant to chloroquine, it is widely believed to be the most dangerous.  And the only ways to differentiate between strains of malaria are too expensive and difficult to perform in rural communities like Hainoua village.  With another wave of antimalarial drug resistance emerging close by on the border between Thailand and Cambodia, this time to artemisinin, it’s more important than ever for communities to be aware of the dangers of drug resistance.

“But why does chloroquine not work now, when it’s worked in the past?”  asks the community volunteer responsible for the first aid kit.  I pause for half a minute, wondering how to explain the development of drug resistance in English words and concepts simple enough that the IRD administrative assistant will be able to effectively translate for the community members.  Eventually I explain “Every time malaria meets a drug and survives, it learns how to survive a little better.  When drugs are not chosen or used correctly, malaria learns more quickly.  Chloroquine has been used for over fifty years- malaria has had a long time to learn how to survive against chloroquine.”

Even though the community had purchased chloroquine to treat malaria in a chloroquine-resistant part of the world, I was very impressed with Hinoua village.  The entire Education Development Committee had come for the assessment meeting, and their dedication to and ownership of the project was evident.  Aside from successfully developing a plan to continue financing the first aid kit, they had decided as a community what medicines were truly needed.

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