Miners active in French Guiana cross into Suriname to sell gold and buy equipment Due to a hard-line policy of France towards illegal mining, the miners are not able to do this in French Guiana. The significant malaria problem in French mining areas and continuous cross-border movement of miners result in high importation of malaria into Suriname. The Malaria Program addressed this by establishing border posts for screening at the main garimpeiro crossing points. The Malaria Program has also started executing surveillance by boat along the South-Eastern part of the border, which facilitates provision of services to remote camps, boat landing sites and resting places. The border surveillance along the remainder of the border is supported by the Medical Mission clinics in villages.
Malaria Service Deliverer Network
The issue of prevention and control of malaria in remote areas where illegal mining is done for a large part by Brazilian miners who travel into French territory and return to Suriname with malaria, is a challenging one, in which the MSD strategy provides at least a partial solution. It enables the interception of import cases and the improvement of access to diagnosis and treatment in risk areas. The fact that the MSDs are trained and supervised peers from within the target population who speak the same language further lowers the threshold to these services. The strategy is expected to play a role in the prevention of self-treatment with black market drugs without testing, which is a current source of worry in the light of emerging drug resistance.
The MSDs, many of which are from Brazilian origin, were trained/re-trained with help of Brazilian counterparts. Re-training is a continuous effort due to the high mobility and turn-over of the MSDs. This is the result of changes in profitability of mining areas. The garimpeiros are following the gold. The MSDs and most field personnel of the Malaria Program are Portuguese speaking enabling them to interact with the priority target population.
Active Case Detection (ACD)
The Malaria Program employs ACD in outbreak areas and in the border region, especially at the northeastern village of Albina and in the Southeastern region of Lawatabiki/Benzdorp, where gold-miners active across the border will stay overnight to purchase supplies or sell gold. The threshold number of cases agreed upon for outbreak situations is very low to ensure a quick and effective response.
A new direction of the Malaria Program is the interception of national travelers coming from and going to the main mining areas via the national airport. The Malaria Program provides diagnosis, treatment and is active in awareness building at the airport during selected times of peak traveling. The activity is supported by one of the national carrier companies, which accommodates the activity in its terminal.
Outreach and Awareness building
Active outreach towards the target populations includes activities both in the transmission settings as well as in selected neighborhoods in the capital, where the target population resides. The Program has a trained Outreach Officer for interaction with the populations. The Outreach Officer is also responsible for communication with hospitals and is available for support of hospitals when experiencing difficulties in communicating with patients of the target population (esp. due to language barriers).
Awareness building is done via a variety of means, including provision of presentations to target groups, distribution of folders and posters, broadcasting of audio and video messages, sending of SMSes and the use of banners, stickers and a billboard. The promotion is done in different languages and when possible has a focus on pictoral presentation of the messages.
The clinic of the Malaria Program in Paramaribo is called TropClinic and operates under its own logo.Taking into consideration that malaria is no priority for the population at risk in general and even less as a result of the low transmission rates in Suriname, actions have been taken to integrate other health services, which are a current priority to the population, in order for the malaria program to maintain interaction and be able to continue malaria screening and awareness building. At this moment the Malaria Program is also testing for HIV, blood pressure and blood sugar and is on the verge of incorporating testing for Leishmaniasis in the integrated package.
The Malaria Program and the Institute for Biomedical Sciences in Suriname (MWI) are cooperating on the introduction of molecular screening with Real-Time PET PCR for malaria identification (even with very low parasitaemia). The idea is to set up malaria serology in Suriname and introduce serological testing to allow the country to gradually declare areas of the territory free from malaria. In addition, the emerging of Artemisinin resistance can be assessed through molecular characterizations and drug sensitivity studies.
Annually the Malaria Program organizes a re-training of national malaria microscopists in order for them to maintain capacity for diagnosis in a near elimination setting. The national trainers have been trained and certified abroad. Also the Program is currently in the process of developing and implementing a guideline for all screening posts/personnel (including hospitals, private labs, private clinics, MM clinics etc) on the diagnosis, treatment and data management of malaria cases, again to help maintain capacity in situations where malaria is nowadays seldom encountered.
Personnel of the malaria program have participated in training on recognizing human trafficking and on the prevention of stigma and discrimination (related to illegality/ethnicity of the target population, sex workers in the mining areas, and HIV status (as part of integration of services and testing of HIV by Malaria Program personnel))