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    Personalities of the Month

    Personalities of the Month

    Personalities of the month:  Lek Sandy, Yeang Chheang and Mey Bouth Denis, Cambodia, 1992

    Good day to you Vector Colleagues! We have received a special request from Dr Michael Macdonald to honour some outstanding malaria personalities in Cambodia. Michael of course himself is a personality of considerable note, having made major contributions to malaria control in SouthEast Asia, but more about him in a future insert. Here are the words straight from Michael:

    For this month’s ORENE ‘Personality of the Month’ I would like to pay tribute to three heroes, Lek Sandy, Yeang Chheang and Mey Bouth Denis at the CNM in Cambodia.  I had the honor to work with them from Jan ’92 to Dec ’95 employed by UNHCR and then WHO. For context, in 1992 we estimated 500,000 cases and 5-10,000 deaths per year due to malaria, from a population of just 9.6 million at the time.  How far Cambodia has come.

    While the CNM had been receiving a minimum level of support from UNICEF before the Paris Peace Accords were signed in November ’91, it was through the heroic efforts of Lek Sandy, the CNM director, Mey Bouth Denis and Yeang Chheang that rebuilt the program through incredible odds.  Before the overthrow of then-Prince Norodom Sihanouk in 1970 and the subsequent take-over by the Khmer Rouge in April ’75 there were about 500 staff in the malaria program, conducting IRS, surveillance and treatment services.  When the Khmer Rouge were pushed back in ’79 only about 35 of the previous 500 staff could be located and from what I was told, the CNM was re-established with only 12 staff.  The 1980’s continued to be a terrible time for malaria, with the isolation, funding and staff shortages exacerbated by the “K5 Plan” from ’84 to ’89 when large numbers of civilians were sent to the highly malarious western provinces to build defenses against the Khmer Rouge.   I was told of trainloads of sick coming into Phnom Penh for malaria treatment.  It was from this very difficult situation that these three heroes (and others!) laid the foundations for today, where malaria in Cambodia is nearly eliminated. 

    Lek Sandy was the consummate hands-on clinician.  I was always struck whenever entering a clinic, Lek Sandy would immediately go to the bedside of a malaria patient, palpate the spleen and talk to the patient, check the records and walk the medic through the newly published national treatment guidelines.  He was always the healer and teacher.   Mey Bouth Denis was trying to establish the Therapeutic Efficacy Sites and switch from seven days quinine tetracycline to mefloquine.  I recall being with Mey Bouth Denis in Kg. Speu doing a TDR-supported compliance study.  Our joke was that when you asked someone if they had completed a full Q7T7 course and they said “yes” they were lying, and if they cupped their ear and said “what?” maybe they were telling the truth.  Yeang Chheang was the most dedicated malariologist I’ve ever met. He was an encyclopedia, both on malaria and on traditional herbal medicines, that he first learned from his grandmother and was the subject of a hand-book he was writing.   When we were able to get the very first funding for a net distribution (to be dipped in buckets of permethrin), I sat down with Yeang Chheang to prioritize the initial villages through a “risk area stratification” of malaria in Cambodia.  Using a list of all the communes, he went through one by one scoring, from his personal knowledge, 0, +, ++, +++.  I would match his accuracy against any RS/GIS technology-assisted stratification that is now possible.  I also credit Yeang Chheang, who along with Om Sophal at the CNHE, Sylvia Meek at WHO and me at UNHCR at the time (before I took over from Sylvia, again, at WHO) initiated the dengue control program, with the assistance of the UN Peace Keeping troops, responding to a dengue outbreak in Battambang in 1992.  The dengue program was then able to get initial funding from USAID and grow to what it is today.   

    I’m eternally grateful for the opportunity to work with Lek Sandy, Mey Bouth Denis, and especially Yeang Chheang and of course Sylvia.  They are my heroes for building, out of the most difficult circumstances imaginable, a program now on the verge of malaria elimination

    Michael Macdonald, Sc.D.

    Catonsville, Maryland. USA