Thursday, January 22, 2009

Meeting Malaria

And that's the last thing I want to while I'm here in Africa.

Well there's no one to blame but me. Knowing that Malaria is endemic here, I should have taken prophylactic measure before going. I had my first blood test taken last month and it turned out to be negative. It was a relief. I even attempted to laminate the test result. Then I started to think that I am just being paranoid; maybe fatigue is due to overwork and chills is due to aircon running overnight. Plus the fact that I learned later that one Pinay died after going home. If I were in the Philippines, flu-like symptoms might just be a flu. But being in Sub-Saharan Africa one can not just dismiss the fact that this might be something else. It was since last weekend that I again feel exhausted and dizzy. Even sleeping a significant amount of hours on a Sunday didn't take away the discomfort. Though I will always think of Malaria, the lab test seems to be a psychological treatment; looking on a "No malaria parasites seen" statement alleviates worries. So I said to myself that I will just observe. Lab test doesn't come cheap. Then last Tuesday early morning I was waken and found myself shivering with some abdominal pain. I could feel twitches on some parts of my body. It was like some kind of Gremlin trying to get out of my muscles (if you watched the movie, you get the point). And I was palpitating (no Starbucks planner in Africa, take note). Not to mention my head in twice the gravity pull and my urge to throw up. You might want to laugh at me but at that point I unlocked the door of my room in case I might not wake up later that day; we have a household help that regularly cleans the room by the way. There were no life moments flashing before my eyes so it was no "time's up" for me then. But it was an hour or so of pangs, delusional or not. I managed to go back to sleep though; waken later by the alarm on my mobile. No more pain. The hot shower seemed to washed away a bad dream. But then I decided to have myself checked again. If before I went to a clinic in a mall, this time I went to a hospital just to make sure I am getting the right diagnosis.

The result? No parasites found. Ok, it was a relief again. But there was a catch. My white blood this is what has been prescribed to me as antimalarial treatmentcells (WBC) count is nearing the higher mark for normal. Learning from my high school Biology, WBC is like my inner army against invaders; in this case, the Plasmodium parasite. Yes, malaria is not caused by a virus or strain of bacteria; it is caused by a parasite (I guess Malacanang can be diagnosed with malaria on its highest stage). The doctor said that this is an indication that something's going on inside me since the immune system is preparing for a battle. To be honest, I was a little skeptical on that diagnosis. But the symptoms are just hard to ignore. Maybe the parasites haven't been released to the blood to infect the red blood cells. You see, malaria in humans develops via two phases: it infects the liver first where they multiply for up to 15 days then they all go swimming in the blood stream. If left untreated, it will result to severe complications. And we have the ever-charming female mosquitos to thank for. So the doctor prescribed me a "treatment" drug. As per its leaflet, the drug is "a treatment for adults, children and infants with acute, uncomplicated infections due to P. falciparum." WTF! P. falciparum is said to be the most fatal and I am having a drug for that??! But then, this specie of Plasmodium parasite is still curable and I thanked God that I am having it (maybe) on its earliest stage. Of all the prescriptions I got so far in my life, this has been the one I really strictly followed: 4 tablets on the first take then 4 tablets 8 hours later (I have to wake up early for this; the thing I failed on other prescriptions). Then 4 tablets twice a day for the succeeding days (it means every 12 hours). The key for effective treatment is proper absorption of the dose so I need food intake first and it is recommended to intake food or drink rich in fat such as milk. If I really do have those bastard parasites I need to eradicate them once and for all. But it comes with side-effects like anorexia (me and less appetite?), sleep disorders, dizziness and cough. Just today I had a half-day work and making myself concentrate on those figures and numbers on my computer screen was great effort. Well, rather than go home in a wooden box.

So, for my fellow travelers heed my advice: have the necessary precautions when going to places where malaria is endemic. There is no vaccine developed so far but as per medical advice, take antimalarial drugs 1 week before the travel, continue the regimen while in a risk area and end the treatment one or more weeks after leaving the area. Malaria is present in Asia, Sub-Saharan Africa, Central and South America, the Caribbean, the Middle East and parts of Eastern Europe. Note, however, that these drugs will not prevent the parasites from entering the body but do prevent or supress the symptoms caused by the parasites. Afterall, they are parasites. That is the main reason why prevention by controlling, if not eliminating, is a major concern for those countries that are endemic. It means a war on mosquitos. I bet these pesky insects are contemplating in a Purpose Driven Life sort of way.

Distribution of Malaria: dark coloured means high risk

Note also that not all drugs are effective on a certain endemic area so one should consult with a physician on what drug is best suited for the travel plan. These parasites are part of the animal kingdom and they evolve; later being resistant to most of antimalarials in the market. In the Sub-Saharan Africa P. falciparum is the most common. The physician prescribed me Coartem (by Novartis; generic name: artemether-lumefantrin) for the treatment then Daraprim (by GlaxoSmithKline; generic name: pyrimethamine) for prophylaxis. So I guess these are the antimalarial drugs suited for this area. Moreso, one can use repellants when going out. Mosquitos always have feeding frenzy during dusk and dawn. So watch out!

Meeting malaria is serious but is not a reason for panic. Hey, even HIV can be treated on its early stage (though in our society, accepting that one has HIV is a different story). Malaria is both preventable and curable. Sad to say but there are still millions of people, mostly children, die because of this. My consultation, lab test and medications cost me about USD65. Lucky for me I have this to spare (there's a probability that I can even reimburse this thru my medical insurance). How about those who have none; barely making USD2 per day? In the news, the conflict-stricken Zimbabwe is nearing a Malaria outbreak on top of the worsening cholera and HIV. Prevention fails when tools for it are out of reach. We can help:

After this treatment, I should start prophylaxis so as to prevent future infections. It means that when I come home the month after next I should continue taking antimalarial agent for 4 weeks just to be sure. That was the unfortunate lapse of that Pinay who died because of malaria – shrugging off the eventuality.

It will always hold true that prevention is better than cure, and that was my own lapse.

GMT 0 Accra, Ghana

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