Florence JV Breeveld; Stephen GS Vreden; Martin P Grobusch

“ Creating a map of all the gold mining localities provided an important overview of the malaria problem areas. Because a significant proportion of the people working in the gold mines are illegal foreigners, the strategy of carrying out the programme without law enforcing institutions was essential for successful outreach. The health workers are trusted to only have interest in finding and treating malaria. The population itself is also actively involved in the treatment of malaria among its people. ”

“ The high burden of malaria in this region has been described decades ago. In 1888, Dr. J. Spitzly, chief of the military health service in Suriname, reported a case of fièvre paludienne fulminante, a very dangerous type of malaria, when visiting the hospital of St. Laurent du Maroni, the first settlement to be encountered when crossing the border river to French Guiana. He could not explain the major difference in malaria incidence that seemed to exist between the two border regions, other than that the river had its function in preventing transmission [8] . ”

“ Reports dating back to the early seventies describe difficulties and successes in implementing preventive measures and treatment in Suriname [6] . Knowledge from previous research in the field of social science can prove to be very helpful in the management of programme implementation. Existing social structures must be capitalized on in order to increase the success of any health programme. Costs and rewards for the people participating need to be balanced. Therefore, cooperation with the group itself or native speakers can be essential for the programme to work. ”

“ The rapidly changing and migrating population needs to stay aware of the possible life threatening disease, and pass on their knowledge within the population. Nevertheless, even if the level of knowledge is sufficient, a change in knowledge does not automatically lead to a change in behaviour. To achieve this desired paradigm shift will be a huge challenge for the malaria control programme, MSD's and the target population in the following years. ”

“ Most malaria control programmes in the world are based on the examination and treatment of symptomatic cases, also known as passive case detection. Consequently, only people who suffer from symptoms and can take the time and effort to find health care will be diagnosed. Individuals who are not feeling ill may have persistent gametocytaemia and fuel on-going transmission. ”

“ In Suriname, Plasmodium falciparum has been the most prevalent malaria species for a long time. This can partly be explained by the fact that most Maroon inhabitants of the inland regions, also called Bush Negroes - descendants of runaway slaves - lack the Duffy antigen, an erythrocyte surface receptor that Plasmodium vivax needs to invade red blood cells [17] . This Duffy antigen is also very uncommon in western and central Africa, which is the origin of most slaves that were brought to Suriname. ”

“ Because of this specific target group, the malaria diagnostic and treatment outpatient clinic located in the so-called Brazilian quarter of Suriname's capital city has proved to be very successful. With a native Brazilian working at the clinic, patients are able to communicate their thoughts and concerns with someone they can associate with. As one can imagine, the possibility to speak in one's native tongue is an important factor in any health care situation that must not be underestimated. ”

“ In 1943, J. C. Panhuys put this into words perfectly:
"There seems to be only one solution: nonstop alertness of government and society. Even though, a lot will depend on the knowledge, precaution, insight and sacrifices of medical staff members" [5] . ”

“ All malaria cases in Suriname are currently registered by place of origin and entered in a weekly report that is reviewed by members of the National Malaria Board. The Board initiates prompt active case detection surveys when malaria re-emerges in a village that had been free of malaria or if the number of cases in a specific region increases abruptly. ”

“ In this context, the fact that an important part of malaria infections originate across the border shows that cooperation with French Guyana and Brazil is extremely important - not only for patients but also for the Surinamese healthcare facilities who have to be familiar with working with the specific population of mainly Brazilian gold miners and accompanying professions. ”