Tuesday, November 17, 2009

Malaria, Once Again

Why is there still such disagreement about what constitutes the best and most effective course of treatment against malaria? Since the shoddy, low-budget laboratory on which I usually depend for diagnosis failed to notice my parasites and gave me a false bill of health, I let my malaria develop more than usual. As a result, once I began to feel seriously ill, I went to an expensive clinic for diagnosis and treatment ($70) on the assumption that this was a more responsible act than self-medicating ($6).

The clinic decided that I needed a 2ml injection of artesunate (in my upper ass) and a 100ml drip of cipro. Its rooms were full of people receiving these shots and drips. On my second day the treatment was repeated (injection in other side of upper ass, drip in other hand). After that, I was put on a full treatment of artesunate pills and cipro pills. When I asked the doctor about the feasability of taking Clotromoxozol as a malaria prophylaxis, he said this would not be effective. Bear with me: I will not linger on details much longer.

The point is that everything that this man prescribed to me was pointedly rejected by one of the country's ranking malaria experts just two days ago: the only reason to take an injection is if you are unconscious, cipro has nothing to do with malaria (which I knew) and it will soon be illegal to use Artesunate as a monotreatment because it builds resistance to what is currently the best drug in the world's antimalarial arsenal. What else? Widespread disagreement about whether or not clotromoxozol is an adequate prophylaxis; rumors that amodiaquine is being abandoned as the second part of combination therapy; belief that it is nearly impossible to avoid counterfeit pills and mixed opinion about the effectiviness of prophylaxis' that are being taken after their first course of use.

As long as I've lived in malarial belts, I've sat through hours of debate about what drugs are necessary and what drugs are harmful or ineffective. Why so little harmony and accord? How hard would it be to develop a coherent national policy and messaging system?

And why am I starting to feel sick again? Is it because I didn't take combination therapy? Is artesunate no longer enough? Boo.

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