Before You Travel – The Great Malaria Debate

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On occasion we post important content from our book, The NuNomad. This post is one such excerpt.

I don’t know about you, but I’m not one to simply follow conventional wisdom. Okay, aside from the obvious choice in my lifestyle design, I’m referring to inoculations and prophylactics that most travelers are recommended to take.

Oh, you’re one of them! you snigger.

Not so.  Am I one to not take aspirin even though I have a major headache? Hell no, I hate pain; and aspirin works for me. But, I am cognizant of the fact that taking any medication when not really necessary is generally considered not a smart thing to do. Aside from the negative side effects the accumulative use of any drug may have on a person’s body, extended use of a drug may make you resistant to the drug’s ability to heal you. That’s why, and my previous article on recommended immunizations notwithstanding, I often accept the risks of not taking certain prophylactic measures. The annual flu shot is one such preventative I shy away from. Another (which is the topic of this current discussion) is anti-Malarials.

Does this make me a risk taker? No, I don’t think so. I do take appropriate steps to avoid infection.

Most medical professionals agree that the best way to avoid getting diseases like Malaria, which are transmitted by mosquitoes, is to avoid being bitten by them. This is done by simply wearing protective clothing (long sleeves, pants and socks as opposed to a beekeeper’s uniform). When you sleep, use a mosquito net and/or burn a mosquito coil or plug in your electric mosquito pad heater. Having a fan blowing directly on you also helps a great deal.

Now, let’s look at a few points.

The pharmaceutical option:

Aside from protecting yourself from mosquito bites, there are the prophylactic options, which I’d alluded to a moment ago, at your disposal: Chloroquine Phosphate or Mefloquine. These medications are widely available, but provide only partial protection and can have significant side effects.

Effectiveness:

In some parts of the world anti-malarials simply don’t work. Moreover, many medical professionals say that if you contact Malaria while taking the pills, it can be more difficult to treat.

If choose to take anti-malarials and you experience severe side-effects from the use of them, then you may need to discontinue their use. Do note that these medicines are not effective if taken intermittently. Also, the exact medicine recommended is different for different places due to resistant strains of the Malaria parasite.

If Malaria is contracted:

Treatment for the disease in areas where it is prevalent is often good because of local doctors’ experience with the disease. Luckily, Malaria tablets are far cheaper in countries where malaria is a problem. (They’re quite expensive in the U.S. and European countries.)

Conclusion:

My opinion (and it’s only an opinion) is that if you plan to be in a high-risk Malaria area for three months or less, then go ahead and take the pills. The short term use of them should be tolerable. If, however, you find yourself in a Malaria-prevalent area for more than three months, then don’t.

Resources:

You may wish to research this subject further, consult your immunologist (who will, no doubt, confuse you even more), the CDC, Internet, and books such as Staying Healthy in Asia, Africa & Latin America.

Special thanks

goes to Dr. Nick Walters, MD tropical and preventive medicine specialist at Mission Hospital, Bangkok, for his help on this article.)

9 responses to “Before You Travel – The Great Malaria Debate”

  1. Rich says:

    Humans love simple answers to complex problems. We yearn for them and search out people willing to provide them. The Great Malaria Debate is a perfect example.

    Having lived in malarial zones in Africa, Asia and Latin America we have experienced first hand the dilemma; take anti-malarial medications for years and risk their horrendous side effects or do not take them and risk malaria. No simple answer.

    When faced with this type of conundrum we are told to ask an expert. Since they are supposedly smarter and more educated than us these experts (Doctor, Travel Medical Nurse…) can weigh the many variables and provide advice based on their expertise. Trouble is, this advice is heavily weighted toward the conventional wisdom by the fear of lawsuits.

    So, rather than making our own decisions and accepting the risk (that word again!) involved with our choices we are tempted to give someone else the responsibility to make the decision in the hope that they will accept the risk. Of course, they give the advice, but out in the real world we are the ones who accept the consequences.

    Malaria is dangerous. So is dengue and other mosquito-transmitted diseases. It is possible that we will contract malaria if we go unmedicated – though we have yet to do so in more than five years of unmedicated life in malarial zones. It is also possible that we will contract dengue, or Japanese encephalitis, or get bitten by a puff adder snake….

    The advice above – to avoid getting bitten if possible – is good advice. The moment you leave the all-enveloping protection of your familiar world you will encounter risks.

    The simple answer; a little bit of risk is a good thing.

    • Thanks for your feedback on that, Rich. When I originally posed the subject of not taking anti-malerials to Dr. Nick Walters (tropical diseases expert at Mission Hospital, Bangkok) I was expecting him to lean toward the recommendation of taking pills. He totally agreed with my findings and recommendation–which is to avoid taking the medicine and be careful instead. But as you say, taking risks is a good thing. In fact, great living demands it.

      • Rich says:

        That is one of the reasons I absolutely love Bangkok! Straight answers in a crooked world. Or crooked answers in a straight world. Whichever.

  2. You are right Ricardo and Carmen, this one resonates with me and I think it's another important post, glad to see it is from your book.

    I also loved what Rich had to say and wish I could express it as well.

    My kid tends to attract mosquitoes abundantly ( even when her parents do not & she has the very bad habit of picking them for ages so they scab and rescab) so Malaria and Dengue are fears, but I think we will skip the drugs and go for prevention plus consciously keeping our immune systems strong and hope for the best.

  3. Destabee says:

    Thank you for this post. I am leaving soon for three years in Afghanistan and have been sifting through my options as they relate to Malaria.

  4. Theodora says:

    Just to add a little more confusion. There are other treatments than those you mention. Doxycyline, used by a lot of armies, because it’s cheap and relatively effective, is a low dose antibiotic. Malarone, a relatively new combination treatment, is highly effective in high-risk areas.

    Travelling with a nine year old — same as SoulTravelers3 — I err on the side of caution. Meaning, avoiding a potentially fatal disease rather than some minor side-effects. We take them when in high-risk areas (and for the duration before and afterwards as recommended on the packet), stay off them when not.

    I take doxycyline, because it’s cheap. He’s on Malarone, a combination treatment, which works much better where mosqitoes are resistant to Lariam (he takes this where they aren’t).

    So Chiang Mai, Bangkok, Koh Tao, Penang, KL: almost zero risk, no tablets. (No point being on pharmaceuticals for longer than necessary.)

    Up-river Borneo or rural Laos? We take them, because they’re high-risk areas.

    As a general rule, in high-risk areas (which tend to be rural and poor), the medical care is of a shockingly low standard: and if you get seriously sick, you’ll often need a medical evac to places like Bangkok or KL for treatment.

    In terms of side-effects? He’s had none from the Malarone. If I take Doxycycline on an empty stomach (you are supposed to take it with food), I might feel sick. So, I take it with food as instructed, and I’m fine.

    I find the NHS malaria map really helpful in making decisions:

    http://www.fitfortravel.nhs.uk/destinations/asia-(east)/malaysia/malaysia-malaria-map.aspx

    And, yes, of course we use repellents and cover up too in high-risk areas. But that can’t protect one entirely…

    So… Thanks for posting. But I think it’s not quite as black and white as “Take tablets, or don’t take tablets”. You can do both…

  5. Theodora says:

    Just to add a little more confusion. There are other treatments than those you mention. Doxycyline, used by a lot of armies, because it's cheap and relatively effective, is a low dose antibiotic. Malarone, a relatively new combination treatment, is highly effective in high-risk areas.

    Travelling with a nine year old — same as SoulTravelers3 — I err on the side of caution. Meaning, avoiding a potentially fatal disease rather than some minor side-effects. We take them when in high-risk areas (and for the duration before and afterwards as recommended on the packet), stay off them when not.

    I take doxycyline, because it's cheap. He's on Malarone, a combination treatment, which works much better where mosqitoes are resistant to Lariam (he takes this where they aren't).

    So Chiang Mai, Bangkok, Koh Tao, Penang, KL: almost zero risk, no tablets. (No point being on pharmaceuticals for longer than necessary.)

    Up-river Borneo or rural Laos? We take them, because they're high-risk areas.

    As a general rule, in high-risk areas (which tend to be rural and poor), the medical care is of a shockingly low standard: and if you get seriously sick, you'll often need a medical evac to places like Bangkok or KL for treatment.

    In terms of side-effects? He's had none from the Malarone. If I take Doxycycline on an empty stomach (you are supposed to take it with food), I might feel sick. So, I take it with food as instructed, and I'm fine.

    I find the NHS malaria map really helpful in making decisions:

    http://www.fitfortravel.nhs.uk/destinations/asi

    And, yes, of course we use repellents and cover up too in high-risk areas. But that can't protect one entirely…

    So… Thanks for posting. But I think it's not quite as black and white as “Take tablets, or don't take tablets”. You can do both…

  6. Jhanella says:

    Malaria is so alarming and as much as possible we don’t want to be infected by this horrible decease. I am so glad I have come across this blog spot… you have shared a very useful and informative materials for travelers. This article serves as a warning to us and as a guide to all travelers. Keep up the good work.

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