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.

Four Considerations

Consideration One: Given round one of me vs. Liberian malaria, how do I wish to position myself vis a vis Liberian malaria from this point forward. It is normal for expatriates in malarial reasons to swap information about their strategies for dealing with the threat or the experience of malaria. These conversations never really get old because each person's unique budgetary, risk and health calculations are often quite revealing. I considered myself an old hand at malaria, having caught it at least four times and having been dealt progressively milder and more predictable iterations. But they changed up the meds and while I caught this last batch of plasmodium earlier than ever before, the course of treatment rendered me inert and dysfunctional for three days, with a buffer of weakness and sudden exhaustion swelling the impact to nearly a week. My calculation was always that malaria was easy to spot, cheap to treat and quick to get over. But that is not true any longer and so now I am considering going back on constant drugs, which is an option that I dislike for many reasons. Since the best, designer anti-malarial option is hundreds of dollars a year and since the cheapest version can make you psychotic, I may just be on time sensitive broad spectrum antibiotics for a pile of months. I do not wish to submit to the amodiaquine lethargy again.

Consideration Two: Is it advisable to foster tiny instances of industrial revolution? As Elie and I spec out a community sewing project that seems more and more likely to merit and receive funding and support, the inclusion of a sewing machine (or sewing machines) must be considered. If there are no sewing machines, many women can work (laboriously) on an individual, hassle-free basis to produce various goods, which means a small amount of extra money spread broadly across the community. If there is a sewing machine, it must be housed, protected, paid for and equitably used. This is an interesting logistical puzzle: do we incentivize use of the sewing machine? What is a fair way to determine who uses the sewing machine and when? Since the machine would likely be purchased with a micro-finance loan, how would we determine whose efforts contribute what percentage to the paying back the financiers? Etc. The miniature industrial revolution of this machine seems likely to concentrate power in the hands of a few women and to sew dissent across the land. Pun intended, of course.

Consideration Three: How do we set up a positive sustainable model of sponsoring Liberian surfers? In most places, surfing has the reputation of distracting young people from school and academic pursuits. Here, we are in the unique position of having talented surfers asking for help with their school fees. Once we figure out how to raise the money, our first tactic, will be to show that talented surfers in Liberia can be sponsored students, receiving help towards their learning expenses and potentially receiving bonuses for good grades rather than contest performances. When the quality of talent rises to a contest level, which it will, we'll start diversifying this model. But for now, I think it's a good place to start.

Consideration Four: When do I carve time out of the upcoming week to surf? The fabled onshores of rainy season have finally switched on and begun to mow down our consistent swell with dependable heartlessness. More early mornings. Malaria and other bad winds have kept me out of the water for the longest amount of time since deplaning at Robertsfield airport and I can't wait to get wet. 

Various

Town: living near the summit of Monrovia's tallest hill with easy access to a fifth floor roof, makes the city feel a bit more pocket-sized. So does realizing that roads I thought were crawling off in different directions turn a corner and join ends. Fortunately, it's easy to maneuver Monrovia on foot without feeling threatened, being followed or even being too aggressively whistled, hissed or kissed at. It's been raining and gray for a week; whenever that lets up, I hope to get some rooftop shots.

Malaria: I don't think I've ever caught malaria so far in advance of its own thriving. Everyone I've spoken with gauges with different indicators. I have about 3-5% too much energy, around my whole system that doesn't come from exercise, caffeine or enthusiasm and that I do not control. If it holds steady for more than four hours or if it ratchets up a little bit; I'll go to a lab. So, yesterday, in a lab smaller than our bedroom, I got my unremarkable diagnosis. The only difference this time, is that I'm doing the responsible thing, public health wise. Whereas I'm accustomed to taking Fansidar or Artesunate--easy, painless, no-fuss treatments for Malaria, which also contribute to drug-resistant malaria--I'm now taking the combined treatment which includes Amodiaquine, a drug with a reputation for draining and unpleasant side-effects. So far so good.