We’ve made a few trips to the closest city, Mae Sot, and once to a big malaria meeting in Guilin, China. It is a strange feeling to come home to a place that seemed quite foreign only a few months ago, but now feels quite familiar. When I told some people that we’d be moving to Thailand until at least March 2014, several commented on how long that seemed. Now it seems like it is nowhere near long enough. Each passing week I learn something new about the place, a new type of food, the names of mountains, villages and schools hidden down little dirt roads. I have the Thai consonants and most of the vowels memorized and, now that I can read a little Thai, new worlds have opened. Months of field work are certainly better than weeks, but it feels like a lifetime is necessary for me to really understand this place.
I haven’t left but I already miss the Moei River and the Dawna Range. This place has certainly changed me and I think I’m safe in saying it will leave lasting impressions on my family too.
Big changes, little changes…
Things along the Thai-Myanmar border appear to be changing a lot. To be fair, things here have always been in flux and that probably has a lot to do with this region's special place in malaria research. Development has lagged in this region because of a half century worth of fighting between one of the major ethnic groups, the Karen, and the Burmese military. Despite this political and military uncertainty, at least one place has emerged as an economic center in this part of the world: Mae Sot.
Though it is nowhere near being the largest city in Thailand, it is one of the most multicultural. Walking down its streets you see long-bearded Muslim men, Indian men with long, curled mustaches, Burmese and Karen people in beautiful sarongs (longyi) and frequently wearing thanaka on their faces, and a few NGO workers scattered about. Thai street vendors sell noodles and soup in front of beautifully decorated pagodas and small street shops selling roti and samosas flourish across the street from a large mosque.
The city is a center of trade, linking Thailand to not only Myanmar but also India and China. Much of that trade is in illegal goods or through illegal channels, also lending to an interesting city vibe. We are just south of the infamous Golden Triangle. However the opium business here is apparently being exchanged for methamphetamine* and human trafficking thrives. Early in the mornings there are several downtown stores that specialize in precious stones, especially jade, and they are always crowded with an interesting lot. Crowds of the above described people, also including wealthy looking Thai men wearing enough protective amulets to make you wonder why they need so much protection, hover around brightly lit stalls.
Since we’ve arrived here the Myanmar government has opened Karen State for tourism. Previously some people were allowed to visit, but only after flying deeper into the nation, never over the border. On the other side of the Thai-Myanmar Friendship Bridge lies the city of Myawaddy, and until now tourists were allowed to visit there only during daylight hours and were not allowed to travel deeper into the nation from this point. That has now changed. Also, over the last several years, there have been plans in place to connect Mae Sot to Moreh, India. There are systems of roads across Myanmar currently, but they haven’t been kept in good repair in many areas. The new push is an effort to create a new economic zone, with Mae Sot playing a key role.
Where I live (Mae Tan), north of Mae Sot, things are apparently changing too. People and goods have always moved back and forth across the Moei River. The frequency (and legality?) of those movements appear to have changed. Every day people come over from Myanmar and make their way down to the fresh market. Some return on boats with bags of rice, eggs, fruits and vegetables. Some carry toy trucks and bikes back across the border. Sometimes suspicious trucks, full of cargo that I can’t see, make their way down to the river port around midnight. This morning there are several full sized trucks, backed up to the river port, in full daylight, all while the border guards are on duty. This is something new.
But many people who’ve been a part of the conflict in this area or who have kept up with it are suspicious of some of these changes. There is a questionable peace deal that has halted most armed conflicts between the Karen and the Burmese military. However, not everyone has signed on to this deal, and for that matter, there is real question about whether or not it was actually a peace treaty or if it was just an agreement to begin considering a peace process. Regardless, the Burmese military has come in to Karen state with new ease; they have paved roads and have resupplied their military bases. If these changes aren’t well-intentioned, and given what continues to happen up in Kachin State many people are quite unsure, the Burmese military now appears to have a strategic upper hand.
What will these changes mean for the ecology of infectious diseases?
I think it’s much too early to know, but I have some opinions. While most of this region has a malaria problem, Mae Sot does not and has not for several decades. An expert on malaria who has lived in this area for as long, told me in passing that when things like highways, concrete, and air conditioners arrive, the malaria seems to go away. If economic changes are on the horizon, and they appear to be, then perhaps malaria will only continue to be a problem in small isolated pockets in this area. Those trucks that I mention above are full of concrete bags which are being toted across the river. It looks like environmental change is well on its way and I have quite complicated feelings about this.
As someone who comes from a place with lots of luxuries that are either rare or nonexistent in the tropical world (running water, running water that you can drink, few deadly infectious diseases, etc.) I always feel like a hypocrite when I think that others shouldn’t go through some form of industrialization. “Don’t cut all of your trees down. We did that and now I wish we had them back” is an easy thing to say while sitting in front of a fancy computer in a climate controlled room. The U.S. certainly wiped out malaria, but did we do so at a great environmental cost? I don’t really know. I hope that the answer to halting malaria isn’t that we must cut down all of the trees.
Also, I’ve spent the last four years of my life focusing almost entirely on one infectious disease: malaria. There are at least two reasons for this focus. The first is that it is a major threat to global public health. The second, and perhaps more practical, reason is that malaria isn’t something that you can really understand by just dabbling in it. It is such a complicated disease that you really need to jump in and get wet from the literature, the laboratory work, and the field work to really be competent in it. But in the hypothetical future when malaria is no more a problem for this part of the world, there will remain other infectious diseases. Malaria mosquitoes don’t like concrete and streets, but dengue fever mosquitoes do. Tuberculosis and HIV thrive on pioneer highways like the one that is soon to join Mae Sot to India. Even if changing the environment does fix the current malaria problem, it won’t fix the current infectious disease problem: that is a problem of competing risks.