Development: Malaria

My experience with malaria goes back a long way. In 1966 when I first arrived in Tanzania to work there I used to take quinine-based malaria medicine once a week, on Sundays. On Mondays as I headed off to work I typically had a headache. I reasoned to myself that it seemed like I really did not like my work very much, since going to work on Mondays gave me a headache. I have since learned quite a bit about quinine based anti-malarial medicine. More of that later. First let me share a few words about the nature of malaria itself.

Malaria is caused by a parasite that when introduced into the blood stream reproduces and if not treated can cause a debilitating fever and even death. It is transmitted by the female anopheles mosquito. The mosquito is only the vector. It must first bite an infected person and then bite you in order to give the disease to you. There are four different kinds of malaria – Plasmodium vivax, P. malariae, P. falciparum and P. ovale. Of these, P. falciparum is the most dangerous. After the symptoms occur, one has only 3-4 days to treat this type of malaria before the situation gets very serious. The incubation period, i.e. the time between the mosquito’s bite to the appearance of symptoms (headache, fever, nausea) is about 12 days for P. falciparum. The incubation period can be up to several months with the other types of malaria. An understanding of these facts is extremely important if one is to practice the type of self medication that I have now followed for years in dealing with malaria.

Because of the rather long incubation period it is important to connect the dots from the time of the mosquito’s biting to the appearance of the first symptoms. During my tenure at the University of Ottawa, a professor visited Africa for the first time. A few weeks later he developed a strange fever while he was in the north-eastern United States. No one there, including the doctors he visited connected the dots back to his time in Africa. He was eventually rushed back to the military hospital here in Ottawa. By the time he was correctly diagnosed the parasite load was too great and he died.

Let us now come back to the medications used to treat malaria. For a long time various combinations of quinine-based medications were the medicine of choice. Quinine is a very toxic substance. It has to be to kill all of those malaria parasites. Quinine also tastes horribly bitter. In the 1960s when we were first in Tanzania, quinine pills were sugar coated to make them more palatable. I will never forget visiting a doctor who was working in the Lake Victoria region. He had come there with his wife and two little girls. While he and his wife were busy working in the hospital the little girls discovered the bottle of anti-malarial pills. They thought they were candy and together they ate the pills. They both died.

Quinine is also very harmful to the retina of the eyes. An optometrist in Dar es Salaam showed me the warning on quinine medicine about the danger to the eyes after prolonged usage. He testified that long term European residents in Tanzania had significantly poorer vision than the average European.

In 1985 when we were on our way to spend a year’s sabbatical in Senegal, we stopped at a small hotel in southern France. The owner had very thick glasses. When he learned that we were going to Africa he told us his story. He had spent two years in Zaire. His doctor said that because much of Zaire was a tropical jungle with many mosquitoes, he should double the quinine dose while he was there. While he was talking, his wife appeared. She also had very thick glasses. They had to put their heads a few inches from a paper sheet just to read the print.

If all of this is not enough of an indictment against long-term use of quinine, another serious problem has developed because of its overuse. If large numbers of people use any medication long enough, they will increase the probability that that the pathogen will eventually mutate and find a way around the medicine. This is in fact is what has happened. Quinine is now almost useless because quinine –resistant malaria is now so widespread. As a result, new medications have been developed to combat malaria. Overuse of these medicines will result in resistance of the disease to these new medicines. And so the biological warfare of mankind vs. the microbes goes on!

In this context what do I do to protect myself from malaria? Because to the negative side effects of most medicines, and because of the danger of disease mutations to counter the medicines, I no longer take any malarial medicine in a prophylactic (preventative) way. Instead I carry with me a “knockout” dose of the medicine. If I get a strange headache, fever or nausea and I think that I may have malaria, I then immediately take the knockout dose. For some time my knockout dose was three pills of Camoquin (a quinine derivative). Later I switched to Fansadar as quinine became ineffective. Now Fansadar is losing its effectiveness and what I carry is Malarone (Atovaquone/Proguanil HC).I got this in 2005 when I went to work on the tsunami in Sri lanka. Fortunately I have never had to use this medicine. The side effects of some of these new anti-malarial medicines can sometimes be worse than the malaria itself.

This idea of taking a knockout dose when needed as opposed to taking regular prophylactic doses has an interesting history. The Europeans (English, French) in Africa tend not to take malarial medicine prophylacticly. This probably is a result of their long term colonial experience. On the other hand, Americans tend to prefer prophylactic applications. This may reflect the strength of the pharmaceutical industry in the US. Also, taking medicine prophylaticly makes more sense for short term visits.

So how does all of this work out for me? Once in 1988, while travelling across Africa from west to east, I spent a few days in a small local low cost hotel in Nairobi. It was at my request. I tend to like these little hotels. In this case the window screens were broken. In the morning I awakened to see many mosquitoes on the walls filled with my blood. About two weeks later in Khartoum, Sudan I was giving a workshop. During that time a strange headache and fever descended upon me. I immediately gulped down three Fansadar tablets and went to bed. The next morning, I was not in great shape but I knew I had turned the corner. That is how my system works.

Finally, you might ask, how the local population survives - since often they cannot get the required medicines. Malaria does tend to kill babies in Africa. We had only been in Tanzania a few months when a baby nearby died of malaria. After a day of mourning, the parents were back at work. It was “shauri ya Mungu” – (the working of God) and had to be accepted. However, people who survive early malarial attacks seem to develop a natural resistance. I have been in rural areas that were heavily infested by mosquitoes – and there were Africans who never got malaria. However, when quinine –resistant malaria appeared, some of these people to their amazement were getting malaria for the first time!

Ottawa

January, 2010