Rags, riches and resistance – the story of mining and malaria

- 0 Comments

Gold and gem mining is a lucrative business which attracts people from far and wide hoping to make their fortunes (or just enough money to feed their families). Mining gold and gems is a dangerous but people are willing to put themselves, and often their families too, at risk to make money.

Whilst the damage to the environment is a well documented consequence of mining, gold and gem mining has also created another surprising and just as unwelcome problem – the spread of resistance to antimalarials such as chloroquine ad mefloquine. This issue was discussed at a special session at the American Society of Tropical Medicine and Hygiene’s annual meeting on 11th November.

In South East Asia, gem mining rushes brought hopeful immigrants to Cambodia and Thailand in search of rubies and other gems. The Ruby Rush of 1988 -1992 brought an influx of as many as 100,000 people from as far afield as India, Bangladesh and Sri Lanka to exploit the deposits in the Borai region of Cambodia – assisted by the Khmer Rouge who wanted to finance their wars with money from the mines. Intent on making as much money as possible, miners worked day and night and, more often than not, did not have bednets, which made them vulnerable to diseases such as malaria. Once infected they often self medicated using antimalarials that were either too low dosage, expired or illicit, so that they could continue working in the mines. This created the right conditions for resistance to evolve, said Chansuda Wongsrichanalai of USAID in Thailand during the session. To make matters worse, the workers would then carry resistant parasites back to their homes or to new mines, thus spreading antimalarial resistance to a wider geographic region. Chansuda went on to describe the potential artesunate-mefloquine seen in a recent study.

In the Guiana Shield, which includes French Guiana, Guyana, Suriname, parts of Venezuela, Colombia and the northern fringes of Brazil, most of the cases of malaria occur in gold mining areas. The governments of these countries have been working to reduce malarial occurrence. In French Guiana, despite multi-pronged measures to reduce malaria, there has been no real difference to the incidence of malaria in the last ten years, mainly because illegal gold mining has countered the beneficial effects of the government programmes. Similar to the gem miners of South East Asia, the gold miners behaviour is a major factor in the evolution and spread of antimalarial resistance.

The Guiana Shield

In Suriname, 81% of malaria cases are amongst miners, reports Stephen Vreden of the Suriname Ministry of Health. The government has recruited and trained local volunteers who live and work in the mining community to diagnose and treat malaria properly. The results have been encouraging, but there is still much progress needed.

Unfortunately, as the financial incentives will always outweigh the risks, gold and gem mines will continue to be hotbeds of anti-malarial resistance. However, the introduction of tighter regulations on these mines could help to reduce the evolution and spread of anti-malarial parasites.