Drug Reform in Southeast Asia
The United Nations Office on Drugs and Crime (UNODC) has set forth its own sustainable development goals to reduce global poverty systematically. The third objective of its mission is to “ensure healthy lives and promote well-being for all ages,” and Target 3.5 within that states its intent to “strengthen the prevention and treatment of substance abuse, including narcotic drug use such as opium and heroin.” In suit with this target, the UNODC has recently progressed drug reform in Southeast Asia.

Taking Action

In Bangkok on November 19, 2019, the UNODC concluded a two-day meeting with ministers and other government officials from Mekong countries including Cambodia, China, Laos, Myanmar, Thailand and Vietnam. The collaboration between the six states and UNODC produced the establishment named The Mekong Memorandum of Understanding (MOU) on Drug Control. The sole purpose of the November discussion among these states was to confer over the implementation of necessary legislation that focuses on drug reform in Southeast Asia.

The current illicit substance situation in the Mekong countries is primarily the selling and use of methamphetamine in either pill or crystal form. China and Thailand make up significant shares of the global methamphetamine market (a USD $61.4 billion market) with the largest seizures of the illicit substance reported there. Another concern is the trafficking of precursor chemicals necessary to concoct these synthetic drugs and emerging new psychoactive substances (NPS). On a global level, Mekong countries and China, in particular, have become the largest suppliers of NPS as a result of their advanced chemical and pharmaceutical industries. Illegal horticulture for opium also continues at high levels in this subregion of Asia.

Progress Against New Psychoactive Substances

Previously initiated drug policies have kindled substantial efforts to combat the war on drugs in the Mekong. Record high seizures of substances have occurred in most recent years. In 2018, Thailand law enforcement seized 515 million methamphetamine tablets, which is 17 times greater than the amount for the entire Mekong region 10 years ago. Moreover, Thailand authorities captured more than 18 tons of crystal meth, resulting in a larger number than what authorities found in East and Southeast Asia combined five years ago. The Thai government implemented suppression campaigns along the Golden Triangle (Myanmar, Lao PDR, Thailand) borders, forcing the trafficking routes to its western border, by the Andaman Sea through Laos and Vietnam. These areas have had seizure numbers in the first half of 2019 that already surpass the 2018 totals.

While significant headway has occurred, the UNODC and MOU know continued actions need to happen to increase the suppression of narcotics within the region. UNODC Regional Representative for Southeast Asia and the Pacific, Jeremy Douglas, explains, “the epicenter is North Shan in Myanmar, with active supply routes in and out. And the organized crime syndicates behind the trade have demonstrated they can maintain production even if labs are seized, and that new precursors can be used when others are unavailable.” Consideration of all the relevant circumstances for the illicit substances in Mekong countries is essential when countries and organizations formulate further drug reform in Southeast Asia.

The two-day negotiations in Bangkok are proof that the governments of the six states plan to keep moving in a forward direction. Jeremy Douglas added that the consensus from the meeting is to “emphasize dampening market demand through preventive education and addressing health, harms and social consequences, by increasing cross-border operations, joint training and justice cooperation, and continuing to support impoverished opium farmers in Myanmar and Laos to transition away from the drug economy.”

Eyes on Organized Crime

Thailand’s Deputy Prime Minister Wissanu Krea-ngam made a statement in Bangkok addressing organized crime’s hand in its drug problem, “Organized crime takes advantage of gaps and vulnerabilities that result because of uneven law enforcement capacity and coordination problems. The Mekong MOU helps by providing a framework through which we can deliver a more coherent regional approach.”Organized crime in this subregion of Asia is its government’s new primary focus. It is evident that in future years, there will be a global reduction in illicit drugs, specifically in methamphetamine and NPS, due to the continuing drug reform in Southeast Asia.

Ariana Kiessling
Photo: Flickr

 

10 Facts About Sanitation in Southeast Asia
In many developing Southeast Asian countries, governments seldom prioritize sanitation when there is a limited spending budget. However, over the past decade or so, many countries in the area have experienced steady economic growth which has led to gradual improvements in sanitary conditions for the people. Here are 10 facts about sanitation in Southeast Asia.

10 Facts About Sanitation in Southeast Asia

  1. Increased Coverage for Improved Sanitation: As of 2018, 95.5 percent of Southeast Asia’s urban population and 85.6 percent of its rural population had access to improved drinking water. This marked a 2.4 percent increase in access for urban locations and an 8.9 percent increase for rural areas since 2005. Approximately 80.8 percent of people living in urban areas and 64.3 percent living in rural areas had access to improved sanitation such as flush toilets and piped sewer systems in 2018. Access to improved sanitation is also increasing at greater rates than improved water in most countries.
  2. Improved Health Due to Better Conditions: Around 0.71 percent of all deaths in Southeast Asia in 2017 was the result of unsafe sanitation conditions. This percentage has dropped 2.3 percent since 1990 and is lower than the world average of 1.38 percent. Cases of infectious diseases, diarrhea, malnutrition and other negative health effects that open defecation caused have also gone down as the share of the population practicing such actions decreased. As for countries where substantial toilet infrastructure is still lacking, such as Cambodia, Timor, Laos and Indonesia, scientists are working to design and install new flush toilets. One team at the Asian Institute of Technology in Bangkok has received a $5 million grant from the Bill & Melinda Gates Foundation to fund such a project.
  3. Creating Comprehensive National Policies: Certain developing Southeast Asian countries lack comprehensive regulations regarding the design and construction of sewers and other sanitation systems. Existing regulations often fail to take variations in local conditions into consideration and people do not always strictly enforce these regulations. Some also neglect to assign the responsibility of management to an institution.
  4. Establishing Institutional Management: Limited ability to implement sanitary systems and unclear institutional division of responsibility has caused gaps in service provision, resulting in low-quality infrastructure, delayed constructions and miscommunications. Multiple international committees have called for government officials to receive training in all essential aspects of sanitation management.
  5. Raising Awareness Among Policymakers: Internationally, the U.S. Agency for International Development recommended that local policymakers become aware of the benefits improved sanitation systems have regarding health, environment and economy through regional research collaborations and water operator partnerships. The intergovernmental Association of Southeast Asian Nations has also come together to discuss Indonesia’s progress in delivering improved water and sanitation to its people. Locally, increasing media coverage and discussions about sanitation are also helping the subject gain focus.
  6. Raising Awareness Among Local Community: Many locals are unaware of the dangers that lie in unsanitary defecation and do not understand the purposes of an improved sewer system. In Indonesia, Water.org has held media sessions to encourage dialogue and awareness regarding sanitation. Similarly, many community health centers and international organizations are working to educate locals on the benefits of improved sanitation, as well as to inform them of the services and financial support available.
  7. Community-led Sanitation Installations: Community-led total sanitation efforts have drastically improved conditions in many Southeast Asian countries as self-respect became the driving force behind the movement. With help and guidance from local authorities, community households can get the financial and institutional support necessary to connect to the more improved sanitation systems.
  8. Financing On-Site Sanitation Installations: Government sanitation funding often focuses on the large-scale municipal infrastructure like waste treatment plants, tending to overlook the construction of supporting connection infrastructure necessary for on-site household sanitation systems. As a result, people have turned to local banks and other financial institutions for loans that would enable them to build the necessary infrastructure necessary to access improved water on a daily basis.
  9. Local Programs Improve Water Sanitation: There are several local efforts that are working to preserve Southeast Asia’s largest freshwater lake, Tonle Sap, so as to improve the lives of approximately 100,000 locals living in the surrounding area. The Cambodian enterprise Wetlands Work is selling innovative technologies, such as water purifying system HandyPod that uses bacteria to turn raw sewage into grey water. Meanwhile, the NGO Live & Learn Cambodia is in the process of testing new toilet innovations.
  10. Water Privatization Limits Accessibility: The privatization of water is a common phenomenon in Southeast Asia. In Indonesia, for example, European companies Thames Water and Suez have 25-year contracts with the local government in 1997 to provide water for the country’s capital, Jakarta. With the goal of ensuring piped water coverage for 97 percent of the popular by 2017, the actual number came up to only 59.4 percent. However, in Surabaya, another Indonesian city, the government provided water publicly through the government and coverage reached 95.5 percent in 2016. Calculations determine that average water prices in the city are one-third of that in Jakarta.

These 10 facts about sanitation in Southeast Asia show how these countries are making consistent progress in procuring improved sanitation for their population. With the assistance of intergovernmental organizations and nonprofits, more people are now living under safe and sanitary conditions.

– Kiera Yu
Photo: Flickr

Antibiotic Resistance in Southeast Asia
In September 2016, the United Nations General Assembly (UNGA) declared antimicrobial resistance (AMR) a major health threat for nations in every part of the world. AMR comes about when bacteria evolve to resist antibiotics used for the treatment of many infectious diseases such as pneumonia, tuberculosis and salmonellosis. According to the Center for Disease Control and Prevention (CDC), AMR can bring harm to people of all types and agriculture, health care and veterinary industries. Antibiotic resistance in Southeast Asia is of particular concern. 

Antibiotics have been essential to curing infections ever since Alexander Fleming discovered the first form of antibiotics, penicillin, in 1928. In the developing countries of Southeast Asia, antibiotics often do not have regulation and are available for purchase without a prescription from a physician, which exacerbates the phenomenon of AMR and causes major concern. This is an example of how poverty in Southeast Asia contributes to the antibiotic resistance crisis.

Contributions to Antimicrobial Resistance

AMR is a natural process. With or without the use of antibiotics, bacteria will always evolve to fight for survival by strengthening their resistance or by multiplying. Despite this, humans make AMR worse. A plethora of unnatural issues exaggerates AMR, but there are two that are cause for the greatest concern: unregulated sale of antibiotics and the use of antibiotics not as medicine for humans but as growth promoters and disease treatments in livestock. 

Unregulated Antibiotics and Self Medication in Southeast Asia

The World Health Organization Southeast Asia Region (WHO SEAR) includes the countries of Bangladesh, Bhutan, Democratic People’s Republic of Korea, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand and Timor-Leste. These countries are notorious for selling antibiotics as an unregulated product to the public, a reality of many developing countries around the world. In developing countries, the prevalence of infectious deadly diseases is higher than in more developed nations, making the likelihood of death from these issues higher.

Many consider the countries in Southeast Asia listed above to be hotspots for the spread of AMR. Here, the cost of antibiotics bought over the counter is lower than the cost to visit a physician or health professional. As a result, many self-medicate, making it the leading cause of AMR. Self-medication refers to the use of medication to treat ailments, diseases or infections without the guidance of a medical professional. Without curbing this habit practiced in WHO SEAR, bacteria quickly mutate to resist treatment, leading to more intense illnesses, increased medication prices and death. 

The Use of Antibiotics for Livestock in Southeast Asia

In this region, the use of antibiotics in livestock outweighs the use of antibiotics in humans. To keep livestock in countries around the world healthy, farmers commonly use antimicrobials to treat and prevent diseases and decrease mortality in livestock. Though people widely practice this, the countries of WHO SEAR use this technique excessively due to poverty. With weak regulatory laws to govern or survey the effects this has on the AMR crisis, AMR is aggressively growing. 

Where previously people ignored it when considering the causes of AMR, livestock antibiotic use has recently become a growing concern across the globe. With recognition came complication: in developing countries, farmers rely on the use of antibiotics to prevent illness or death of their animals so they can continue to make a profit. In Southeast Asia especially, the hard reality is that these issues layer and mix with other issues, such as poverty and food security. Policies regarding antimicrobial consumption in livestock that work for developed nations often do not work in underdeveloped nations, due to the complex differences of cultural differences and locations. It is for these reasons that poverty contributes to antibiotic resistance in Southeast Asia.

Efforts to Slow Antibiotic Resistance in Southeast Asia

Given that this crisis is on a global scale and affecting every nation, some are making efforts to control AMR. Unfortunately, there is no way to stop it completely. There are, however, the WHO’s action plans that can bring light to this topic. WHO has laid out five strategic goals: to increase recognition and understanding of AMR, to increase global monitoring and research, to decrease the prevalence of infectious diseases requiring antibiotic treatment, to improve the use of antibiotic treatment and to create a case for sustainable investment that includes all nations, no matter location or level of development

An example of raising awareness is World Antibiotic Awareness Week. Every year brings the annual World Antibiotic Awareness Week, created by the WHO in 2015. This week in November sets goals to increase awareness and encourage health care providers, policymakers and the public to practice healthy and sustainable techniques to slow the spread of antibiotic resistance in Southeast Asia.

– Anna Giffels
Photo: Flickr

Drug Resistant Malaria
A new variation of the parasite causing malaria has captured the attention of medical professionals in South East Asia. They first noticed a strain of drug-resistant malaria in 2013 and it has spread aggressively throughout the region. Medical researchers from the Wellcome Sanger Institute, University of Oxford and Mahidol University noticed that the new strain has replaced local malaria strains in Vietnam, Laos and northeastern Thailand. They have also seen the strain developing new mutations from when they initially identified it in 2013 and this may be enhancing resistance even further.

Resistance Through Time

In 2018, studies showed that the usual first-line drug used for malaria failed to cure the disease at an overall rate of 50 percent, 13 percent in northeastern Thailand, 38 percent in western Cambodia, 73 percent in northeast Cambodia and 47 percent in southwestern Vietnam.

The advancement of the new drug-resistant malaria might stem from the heavy usage of anti-malaria drugs in the region. Medical professionals commonly distribute the drug throughout the area, forcing the parasite to evolve or die out. Patient usage is also giving the parasite a leg up, as often people are taking a weaker dosage or do not finish the treatment but terminate usage when they begin feeling better.

Cause of Malaria

Malaria is the result of the Plasmodium parasite that transmits through a mosquito bite. The drug-resistant malaria strain is called KEL1/PLA1 because of its combination of genetic mutations. A recent study has noted that KEL1/PLA1 has diversified into a subgroup of strains that contain the genetical modifications causing resistance. These parasites are also showing resistance to several classes of anti-malarial drugs. The new adaptations are limiting treatment options and making them increasingly expensive. Currently, clinical trials have begun to test the effectiveness of a triple combination treatment for the new drug-resistant malaria.

The current front-line defense is a two-drug combination of dihydroartemisinin and piperaquine or DHA-PPQ. But a 2018 study showed the resistance to dihydroartemisinin-piperaquine spread undetected for five years in Cambodia, giving the drug time to mutate further and wipe out existing non-resistant strains. One solution is to change the partner drug, piperaquine, to a drug that is currently effective such as mefloquine or pyronaridine. Cambodia and Thailand have implemented this solution but it could be logistically challenging on a large scale.

Consequences of Infection

For now, health officials believe they will be able to manage the situation as malaria rates are lower in Southeast Asia. Officials, however, believe if the drug-resistant malaria parasite spreads to Africa, the consequence could be dire. Sub-Saharan Africa sees the most substantial numbers of malaria and faces the most significant logistical problems when attempting to treat it. In the 1960s, a similar situation occurred where a strain developed in Asia and spread to sub-Saharan Africa, where due to a lack of alternative medications, malaria-related deaths double.

People are currently using rapid test kits to help prevent and treat drug-restraint malaria. The kits can identify which parasite strain is causing malaria, allowing medical professionals to treat malaria accordingly. This tool will be increasingly important if the drug restraint parasite spreads to Africa. Sub-Saharan Africa alone accounted for 66 percent of the 276 million rapid diagnostic test sales worldwide in 2017. The test allows for professionals to best allocate supplies that are scarce in sub-Saharan Africa. As the fight against drug-resistant malaria continues, the rapid test kits are a cost-efficient way to increase their odds of eradicating the parasite.

– Carly Campbell
Photo: Flickr

Top 10 Facts About Living Conditions in Cambodia
Cambodia is a small South-East Asian nation bordered by Thailand, Laos and Vietnam. The nation is still recovering from the damages wrought by the Khmer Rouge regime that ruled from 1951 – 1999. The unfortunate legacies are numerous. Despite this, Cambodia is making strides to face the many challenges that being a rising developing nation entails. Overall, living conditions in Cambodia are steadily improving.

Top 10 Facts About Living Conditions in Cambodia

  1. Cambodia has a population of 15.9 million people. Ninety percent of them are of Khmer origin while the remaining 10 percent are Vietnamese, Chinese or a member of another minority. The country is made up of predominantly rural dwellers, who have settled in villages in areas near rivers. Only 12 percent of the population lives in the capital, Phnom Penh.
  2.  The average life expectancy is 67 years old for males and 71 years for females. The median age of the population is 24. There is a high prevalence of HIV and AIDS in Cambodia, among the highest in Asia. In 2016, 71,000 people were living with HIV. The government is making concerted efforts to combat this illness and increase awareness of how to keep it from spreading.
  3. Health care is an issue that the government is overlooking as it makes strides in its policies to benefit its people. Health care only comprises 1 percent of the overall GDP. There is a massive disparity between the quality and availability of medical resources in rural and urban areas. In rural areas, many people are forced to travel long distances to get the care that they need. The Social Security System currently in place only covers employment injuries for formal workers, making it hard to get coverage.
  4. The education system in Cambodia was largely destroyed by the Khmer Rouge Revolution when education was banned. Schools were destroyed and teachers were executed. The government is making great efforts to build this system back up, dedicating 18.31 percent of the national budget to education. They have almost achieved universal access to primary education at 97.7 percent. Cambodia has strengthened gender parity with girls making up 48.2 percent of students. The country has built 1,000 new schools in the last 10 years.
  5. The Cambodian government is dedicated to child protection. It is improving child development and strengthening child protection services by addressing violence against children and the use of residential care institutions. The government has a goal to reduce the use of these institutions by 30 percent and to prevent family and child separation.
  6. While poverty has decreased significantly in Cambodia, many families survive while hovering just above the poverty line of $1.25 per day. Three of four people live on less than $3 a day. Most of these people are rural, but urban poverty is also on the rise.
  7. Urban slums account for 25 percent of the population of Phnom Penh. These areas face many challenges, including poor sanitation and hygiene, high rates of diarrhea and malnutrition. They lack toilets, decent drainage and garbage disposal systems. These slums are overcrowded and ridden with poverty and domestic violence.
  8. One in four women are survivors of physical, emotional or sexual violence. One in five women between the ages of 15 and 49 have experienced physical violence by the age of 15. In Cambodian society, violence against women is frowned upon, but domestic violence is acceptable. This creates a culture where women have the pretense of protection but are not safe in their own homes.
  9. Cambodia’s elderly population is growing as they become more prosperous. People above 60 years of age makeup 6.34 percent of the population, at 849,911 people. The country expects this population to triple in the coming decades. They are a largely forgotten group of people in development and democracy debates. Most presume that they are taken care of by their families. These people contribute to society by taking care of children and those afflicted with HIV and AIDS.
  10. There is a general disregard in Cambodia for those with disabilities. They are generally denied normal opportunities to live comfortably and improve their lives. Because of this injustice, they often end up begging on the street to feed themselves and their families. Rehabilitation centers are limited in cities and rural areas, particularly for children and women with disabilities.

While the national government is putting intense focus on improving living conditions in Cambodia, there are still aspects that need work. The country needs to focus on poverty, domestic violence and those with disabilities to try to protect their citizens from the pain they receive at home and then increase the health care accessibility so that these victims can receive the care that they need.

– Michela Rahaim
Photo: Flickr