I’ve been hesitant to take mefloquine from the beginning because of the potential side effects (see previous post), which—according to the prescription—include but are not limited to “a sudden onset of unexplained anxiety, depression, restlessness or irritability, or confusion (probably signs of more serious mental problems).” Like most people, I’ve never been treated for depression, but I have felt ‘depressed’ before, lacking in confidence and motivation. A concern of mine is, would a drug like Larium (the brand name for m) instigate the “more serious mental problems” that the manufacturer delegates as the responsibility of the consumer? Besides, I don’t want to feel more anxious or depressed than what naturally occurs during episodes of cultural shock and adaptation, particularly not in situations that may already have their own normal levels of stress and misunderstanding that comes when being in unfamiliar cultural surroundings.

The warnings continue on the box with, “you may develop other serious side effects, including persistently abnormal heartbeat or palpitations,” but this time without the disclaimer blaming the person taking the medication. I’m not sure if I’ve had palpitations before but I may have. Are they warning that a heart attack may follow while taking these pills? Not something I want to contemplate from Southern Sudan or anywhere else for that matter!

Last night while chatting with Carla (the guesthouse owner) and another guest at Miti Mingi , we decided to make some tea. The only choice in the house was a herbal tea made of crushed leaves from the neem tree (Azadirachta indica). On the back of the box is written, “… Neem has remarkable healing properties…” Then it continues by listing them: boosts body’s immune system, stimulates the production of T-cells, purifies the blood, and prevents or cures during treatment of sore throats, colds, fevers, food poisoning, lowering blood pressure and cholesterol, irregular heartbeat… and the list finally mentioned malaria. Finally, an alternative and natural treatment against malaria. This tea was produced from trees in Kenya, and in the Kaswahili language the tree is called Muarubaini, which can be translated as the tree with forty cures.

According to Vandana Shiva, physicist, environmental activist, intellectual, author and future Nobel Prize winner(!?), the medicinal and chemical uses of the neem tree’s bark, leaves fruit and seed oil have been known and used in India for more than 4000 years.

I noticed the mention of neem on a back page of a pamphlet given to me at the Santé Voyage clinic where I received my vaccinations and consulted about malaria prevention. None of the medical staff mentioned any natural products as a possible alternative for the common prophylactics like mefloquine, aralen, chloroquine, etc.

In Senegal, there is a movement to bring neem to the masses to decrease the numbers of unnecessary deaths from malaria. Below is a video from the Al Jazeera show ‘People & Power’, dating from December 8, 2008:

The Forestry Department at the Food and Agricultural Organization (FAO) of the United Nations have coordinated since 1994 the International Neem Network whose activities are documented in their recent, The Activities of the International Neem Network. Other online documentation can be read from the website.

So, I’ve decided to forgo the mefloquine prescription by leaving it in my bag. I will now drink neem herbal tea and will look for neem soap to wash with as an added repellent. Or course this will be done in tandem with my other preventative measures, like sleeping under a Permethrin-impregnated mosquito net, and using mosquito repellent on uncovered skin areas between dusk and dawn when mosquitoes are most active.

I’ve always been reluctent to take Malaria pills for periods longer than a 4-6 weeks. According to the Center for Disease Control and Prevention (CDC), the following are the anti-malarial pill options: atovaquone/proguanil, chloroquine, doxycycline, mefloquine or primaquine. Some of the prescriptions require to take a pill once a day during travel in areas where malaria is prevalent, and up to one week before and after being in the area. For me that would mean taking anti-malarial medication for more than three months! Side effects vary depending on which of the pill options are prescribed but common ones include: stomach pain, nausea, vomiting, headache, dizziness, blurred vision, and itching.

These general side effects are listed in various combinations for most of the prescriptions listed above. Some have specific side effects. Doxycycline increases sun sensitivity (sunburning faster than normal) and women may develop a vaginal yeast infection. More disturbing are the side effects associated with mefloquine. After reading through the CDC’s side effects and warnings for mefloquine (which is more elaborate than the others) I remembered a friend of mine who travelled extensively through eastern Asia for longer than six months, taking anti-malarial pills the entire time. When he returned to Canada he was not well at all. He has symptoms of psychosis, schizophrenia that lasted weeks if not months! He was probably taking mefloquine based on the CDC’s list of side-effects and warnings:

The most common side effects reported by travelers taking mefloquine include headache, nausea, dizziness, difficulty sleeping, anxiety, vivid dreams, and visual disturbances. Mefloquine has rarely been reported to cause serious side effects, such as seizures, depression, and psychosis. These serious side effects are more frequent with the higher doses used to treat malaria; fewer occurred at the weekly doses used to prevent malaria.

Mefloquine is eliminated slowly by the body and thus may stay in the body for a while even after the drug is discontinued. Therefore, side effects caused by mefloquine may persist weeks to months after the drug has been stopped.

Most travelers taking mefloquine do not have side effects serious enough to stop taking the drug. (Other antimalarial drugs are available if you cannot tolerate mefloquine; see your health care provider.)

Travelers Who Should Not Take Mefloquine

The following travelers should not take mefloquine and should ask their health care provider for a different antimalarial drug:

• persons with active depression or a recent history of depression
• persons with a history of psychosis, generalized anxiety disorder, schizophrenia, or other major psychiatric disorder
• persons with a history of seizures (does not include the type of seizure caused by high fever in childhood)
• persons allergic to mefloquine
• Mefloquine is not recommended for persons with cardiac conduction abnormalities (for example, an irregular heartbeat).
• persons traveling to areas where mefloquine-resistant malaria exists

(source: Centers for Disease Control and Prevention, US Department of Health and Human Services)

During an extensive cycling trip to eastern Asia in the 1990s, I took chloroquine as my anti-malarial preventative treatment. Once I ran out after three months, I decided not to renew my supply after hearing of side-effect stories. I spoke to a doctor in Hong Kong who suggested I carry mefloquine with me in a two-pill doze as a self-treatment. He suggested that if I get the symptoms: extreme flu-like sypmtoms that may include fever, shaking chills, headache, muscle aches, tiredness, nausea, vomiting, and diarrhea. He suggested that if I got anyof these symptoms and did not have access to a doctor, to take the two pills to stop the disease from progressing while I sought a doctor to diagnose and treat my symptoms. The doctor told me that mefloquine was very strong, and after reading the above warnings, it seems as though it is.

After visiting the Medecins sans frontières/Doctors Without Borders (MSF) website, I came across their Malaria Overview page, that begins with, “Every year, nearly 2 millions people die of malaria.” MSF discusses diagnosis, treatment and prevention. They have been treating patients with malaria in Africa, Asia, and Latin America since 1985 and have conducted many drug resistance studies in collaboration with national health ministries and Epicentre, MSF’s epidemiological research institute.

Another organiztion, The Global Fund is also mandated to support large-scale international prevention, treatment and care programs to to Fight AIDS, Tuberculosis and Malaria. To date, it has inveted 149$ billion in 140 countries in their program.

The organization Roll Back Malaria Partnership, whose self-proclaimed vision is “by 2015 [...] malaria is no longer a major cause of mortality and no longer a barrier to social and economic development and growth anywhere in the world.” They discuss their goals of their Global Malaria Action Plan for a malaria-free world. Their website has a great segment of frequently asked questions commonly asked about the disease that are reviewed and answered by Aafje Rietveld from the World Health Organization, that has published the International Travel and Health guide to get “informed about the potential hazards of the countries they are travelling to and learn how to minimize any risk to their health.” Individual chapters of the guide can be downloaded directly from the site.

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Other than the predeparture vaccinations, I will look into some naturopathic approaches to boosting my immune system prior to leaving as well as some alternative options to vaccinations.