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Nov 18 2013

Those darn anti-malarials

It is such a tough decision: First, whether to take anti-malarials while travelling, or not.  Second, which ones to take.  For a short trip to Africa – or any malaria area – the answer is straight forward: definitely take them.  For a longer trip, especially for a year or more, the answer is less straight forward.  Is taking strong medication for such an extended period more harmful to the body than dealing with malaria itself?

In the end, we decided that it was worth taking anti-malarials.  While there is no one medication which is 100% guaranteed to prevent malaria (it is important to realise this), we felt that only relying on covering up and insect repellent was taking a bit of a risk.

Lariam / Mefloquine
First, we started with Lariam / mefloquine.  Mefloquine is the ingredient, Lariam the brand name drug.  To my mind, these are one and the same, but some people we met were reacting to one and not the other – which confuses me no end.

Unfortunately, I reacted to the Lariam – but not in the way I expected.  If I had had hallucinations, I would have known immediately what the problem was.  Instead, I was anxious.  And I realised much much later that the “anxious” side-effect is different for each person, which is why it is difficult as a sufferer to know when you are reacting to Lariam.

It seems that the Lariam takes whatever your natural, every day anxiety is, and grows it into a super-sized monster that controls you.  For me, my natural anxiety is about personal safety, and a fear of being physically attacked.  The Lariam did a stupendous job on this – I got to the point in Senegal where I was physically unable to get out of the car at markets to browse and buy groceries – I was petrified that I would be attacked.  I had to sit and compose myself for 5 minutes in the car before I could contemplate opening the door and stepping out.  I would behave like a frightened rabbit the whole time I was in the market – ready to bolt at the slightest nudge or bump from a person – and would rush back to the vehicle as soon as I could.  Horrible for me.  Horrible for Viking Explorer.

Even after I worked out the issue and stopped taking the drug, it took many weeks to come out of the system.  While we were camping south of Dakar (for 2 weeks), and I was cleaning out the system, I was physically afraid to walk 300m out of the campsite to the bakery to buy bread.  I was terrified.

We met cyclists when we were in Namibia, and the lady had also reacted to Lariam earlier in the trip.  In her case, her natural anxiety was her nut allergy, and making sure that she didn’t eat any foods containing nuts.  The Lariam made her similarly neurotic: she tells how she would be halfway through eating a meal containing no nuts, when she would be convinced that there were indeed nuts in the food, and so stop eating.  It got to the point where she wasn’t eating very much at all – all because of the drug.  She too came off it.

Doxycycline

Then, while we were in South Africa waiting for the vehicle to arrive, we visited Kruger National Park for 10 days – a known malaria area.  This time, we opted for Doxycycline – mainly as it was about 2% of the price Malarone / Malanil.  There was some concern about sun sensitivity, a known side-effect of Doxycycline, as we were going on a walking trail.  Fortunately, we were unaffected.

However, our nut-allergy friend told us that when she switched from Lariam to Doxycycline, she had extreme sun sensitivity, and as they were cycling, this was a real issue.  Despite layering the Factor 50 sunscreen, and covering up with bandages and clothing, she was being severely burnt, with oozing welts.  She stopped taking this too.

Artemisia Annua

When we were preparing to depart from South Africa on stage 2, we again needed to make the decision about anti-malarial medication.  We were reluctant to take Doxycycline for an extended period as it is an antibiotic.  This time, 2 different friends in South Africa recommended going down the natural route, and so we decided to give Artemisia Annua a try.

Artemisia Annua has been used by the Chinese for over two thousand years in the treatment of many illnesses, including skin diseases and malaria.  More recently, in the 1960s and 1970s a Chinese research project was set up under the Chinese Army to find adequate treatment for malaria.  Artemisia annua was one of 5,000 traditional Chinese medicines tested, and was found to be the most effective, and cleared malaria parasites from patients’ bodies faster than any other drug.

There is some scepticism from WHO about using Artemisia for prevention, and there also seems to be confusion caused as the name Artemisia is used to indicate both the natural compound (grown from the plant) and the most active ingredient of the plant which is synthesized chemically in a laboratory.

In spite of WHO scepticism, we decided that taking a natural remedy was likely to be less damaging to the body than antibiotics, and was certainly better than taking nothing.  We took the natural, whole plant version, manufactured by Nordman.

We had no side-effects, and were fortunate not to contract malaria while taking this.  We may just have been extremely lucky, but we felt that the natural remedy was instrumental.

Update July 2014: It was brought to our attention by a kind reader that this product has since been declared “undesirable” by the South African Medicines Control Council as it only contains Artemisia afra (which has no anti malarial properties) and not Artemesia Annua (which has proven anti-malarial benefits although resistance is beginning to develop if not used in combination). I guess we may just have been rather fortunate that we didn’t contract malaria.

Treatment of malaria

We were extremely fortunate not to contract malaria while travelling – as many people still do even while taking anti-malarials.  That said, it seem to us that treatment for malaria in Africa is probably some of the best, since these countries deal with it day in and day out.  Testing for it is almost routine, and treatment starts immediately.  Many aid organisations and charities have poured a lot of money into malaria treatment in Africa, and the treatment seems readily available.  Our dear friends Tom and Jemina (cyclists from opdentandem.net) contracted malaria in Tanzania, and said that they received excellent treatment.  Malawi had many clinics and health centres, also appearing to provide easy access treatment.

Summary

This article by no means constitutes medical advice, but we want to share with you our first hand experience of trying to prevent malaria while on the road.


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