Exhibit poster

[Montréal, Québec, Canada 17°C] Southern Sudan was a place I had not heard much about before my seven-week visit to the East African region of the continent’s largest country. It is a part of Sudan where over eight million people are now recovering from a 21-year civil war that ended six years ago after the Comprehensive Peace Agreement (CPA) was signed. The southern rebels fought Sudan’s army and its militias for a generation, trying to bring freedom to the south and end the military junta’s systematic repression of the Nilotic South. The war devastated the land and its people, leaving two million dead, four million internally displaced and one million refugees.

I arrived in Juba on February 26, 2009 during the dry season and met with temperatures that reached 45°C in the shade. I visited mine fields being cleared around the southern capital and observed mine risk education projects in villages still waiting for de-mining teams to remove the hidden danger. Farmers are still reluctent to till the land for fear of stepping on landmines that continue to kill and maim.

I flew to Aweil and visited dozens small villages in Northern Bahr el Ghazal. Here, people are returning to the homeland they ran from when they were attacked with a cruelty more recently witnessed in neighbouring Darfur. I interviewed men, women and children under their villages’ biggest trees. Here, up to 90% of the population have returned in the previous two years after living in displacement camps for ten, fifteen, even twenty years. They arrived without enough wells to supply drinking water, without sufficent schools, without clinics. They are finally on land that is theirs and want to stay, despite the hardships.

In the state of Warrap, I accompanied a vaccination program to the village of Lurcuk. Two medical assistants spent five hours giving innoculations against measles, tuberculosis, polio, diphtheria and tetanus. In all, 276 children were vaccinated.

Later, before my flight back to Montréal, I revisited the youth from Sud Academy, a school for Sudanese refugees in Nairobi, Kenya. I met them before my journey to Sudan and promised to return with images of their homeland, a place they barely remember and dream of returning. Most of them haven’t seen their parents or siblings since they ran from their villages, scrambling to escape the killing.

The photographs represent some of the people I met and who generously shared their stories.

The vernissage is Thursday, June 10 from 16h00-19h00 at Café Rico 969, rue Rachel est, Montréal. Videos I took during my visit will be shown at the vernissage.

On January 20th, I returned for a Yellow Fever and Meningococcal Meningitis. A third visit was on February 10 for my only cholera shot and the second booster of Hepatitis B. I also had to decide whether or not to get a prescription for anti-malarial pills based on possible side-effects. Today was my last visit to get final boosters for Hepatitis A (second of two) and Hepatitis B (third of three).

Below are images of the pages in my Travel Immunization Record that testify to my vaccination diet over the last little while.

One Yellow Fever vaccine is good for ten years.

One polio shot is for life. One Tetanus Diphtheria shot is good for 10 years.

Two Hepatitis A shots are good for 20 years or more.

Santé Voyage Clinic

She was very helpful, detailing the various illnesses prevalent in Sudan and East Africa that I already listed in a previous post. Now I have a vaccination schedule that started during my visit, which started with five needles and a set of pills. It started with a 0.5mL vaccination of Hepatitis A ($58 each injection)  in my left arm. My second and last shot is next week. 1mL of the Hepatitis B vaccination ($34 each injection) was injected into the upper part of my right arm. I need to get a second dose in one month right before I leave and a third a few months after my return; or if I leave earlier than one month from now, I need to get a three doses before I leave every week.

I was then given a Tuberculin Skin Test ($5 each time) that consists of having a 0.1mL injection just under the skin of my left forearm, creating a small bump (see photo of red spot circled in ink. The bump injection had been absorbed). Next week, I get a second shot. this is to provide a sample of the level of TB in my system before I leave. Three months after returning to Montréal, I need to do it again to see if I was exposed to TB while in Sudan.

That was it for my arms. the nurse then asked me to pull down my pants (which I obliged) to give me my last two shots: a Polio vaccine (free) in my left thigh that offers protection for life, followed by the Tetanus/Diptheria (free) combined vaccinatio in my right thigh, which is covers me for 10 years.

I came home with a packet of 4 pills as a oral vaccination against Typhoid Fever ($46). These I need to take in the morning one hour before eating, with water, every second day. I will be good for 7 years.

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The nurse offered my a vaccination against Rabies. It was very expensive ($350) and due to my impending departure date, I was not able to take it in time, stictly due to the rabies vaccine shortage. Because of the shortage, vaccination methods have changed. Rather than get a vaccination of 1mL, the clinic offered three small doses of 0.1mL, I think once a week, followed by a blood test two weeks after the third injection to verify if the vaccination worked. The blood test results, I was told, would take two months to be sent to me, so even if I was bitten by a rabid animal, I would still have to be treated as if I hadn’t received any vaccination therapy. Decidedly, I said no to the expensive vaccine. I’ll avoid the petting zoo.

I then had a short visit with a doctor who told me about the malaria options. He seemd very confidant about prescribing me whichever Malaria pills I chose, based on the options for Sudan. He recommended Mefloquine (($20/month) to be taken once a week, Doxycycline, (once a day – $30/month), or or Primaquine (also once a day – $35/month). There was another option for Atovaquone/Proguanil, but it is very expensive ($160/month). I decided to wait and do more research before deciding, IF I want to take malaria pills and if so, which ones.

Next week, I have my second of three appointments to get my Yellow Fever and Meningitis Vaccinations and continue with above.

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.