Malarial Muddle

Worldwide distribution of malaria: green is malaria-free, blue is eliminating malaria, red is controlling malaria. Image source: thelancet.com

 

 

If you’ve been following this blog for a while, you might be inspired to think about travelling to destinations like Thailand, Cambodia, Ecuador, or South Africa. All wonderful places to visit, but all home turf for malaria.

Malaria is nothing to take lightly; the World Health Organization estimates that in 2016 there were 216 million new cases of malaria worldwide resulting in 445,000 deaths. Thank you, Wikipedia, for those uplifting statistics. I got to witness the effects of this disease first-hand in 1972, when my mother was infected somewhere along the journey from Lebanon to Yemen. Luckily, she contracted a non-recurring form of malaria and recovered.

So when we travel to places where malaria hangs out, we always err on the side of caution. We get the best anti-malarial prophylactics we can buy and we take them religiously, even in zones where there is minimal risk. Any risk, I say, is too much.

In the early 1980s, Mark, my husband, travelled to South America. He planned to visit the Amazon and consulted a doctor here at home about malaria prevention. The doctor told him that the medication was much cheaper if you bought it in South America, and recommended he pick it up in one of the cities before he ventured into the jungle. When Mark arrived in Lima, Peru, he went to a number of pharmacies to buy the pills, but none of them had even heard of the drug, either by its common name or by its chemical name. He ended up cancelling the Amazon portion of his trip because he couldn’t get the necessary malarial protection.

Fast forward to a couple of months ago, when we went to a specialty travel medical clinic to get a prescription for Malarone, the current drug of choice for preventing malaria. We each needed 13 days of pills to cover the time we’d be in the Amazon region, plus a week afterward (as prescribed). When we arrived in Quito and prepared to take the first dose, we discovered that we had only 13 pills in total; either the doctor ordered the wrong amount or the pharmacy dispensed the wrong amount. In my busyness before departure, I hadn’t bothered to count the pills in the bottle. My mistake.

Well, we figure, no big deal, we can just go to a local pharmacy and buy more. Surely, people go in and out of the Amazon through Quito every day, so they must sell Malarone. Nope. Once again, the pharmacists looked completely baffled when we asked for Malarone. We tried the chemical name. Nada. We explained where we were going and that we needed something against malaria and they just shook their heads. We used the Web to try to find a source for Malarone in Quito and discovered to our dismay that the drug is not sold in many countries, particularly the countries where malaria is common. What the heck?? Apparently, the company that makes Malarone is restricting where they sell it in order to stave off drug-resistance and keep the medicine effective for as long as possible.

Whatever. The hard fact remained that we were in a pickle. Only enough pills to protect one person, no way to get any more. Options: travel unprotected or cancel our jungle excursion. After discussing it, we decided to proceed. The area we would be visiting wasn’t high risk and we both had waited a long time to visit the Amazon.

So who got the pills? Well, with half my internal organs either missing or severely diminished and a depressed immune system, I could not chance being infected, whereas, we reasoned, Mark’s more robust constitution should see him through in the unlikely event he did get malaria. Not a happy choice but one that seems to have worked out: a month after returning from our trip now, we are both feeling fine, and, in fact, we didn’t run into a lot of mosquitos in the Amazon.

Lesson learned: always buy your travel health prescriptions before you leave home and count your pills!

Afterword: Now I read that counterfeit antimalarial drugs are commonly sold in some Asian countries, including Thailand and Cambodia. Yet another reason to buy at home.

What would you have done in our shoes? Take the risk or cancel? Let me know in a comment.

A is for Apsaras

The following is a whimsical summary of my recent trip to Thailand and Cambodia, in the form of rhyming couplets and photos. Any groans elicited at improbable rhymes or tortured scansion are purely intentional.

A is for apsaras carved in the rock

 

 

 

 

 

 

 

B for buffet where we ate lots of choc

 

 

 

 

 

 

C is for clown fish we saw in the sea

 

 

 

 

 

 

D is for dog, her name is Mutley

 

 

 

 

 

 

 

E is for eagle with imperial eye

 

 

 

 

 

 

 

F is for food we loved, especially Pad Thai!

 

 

 

 

 

 

G is for guards (we saw quite a few)

 

 

 

 

 

 

H is hotel rooms with fabulous views

 

 

 

 

 

 

 

I is for idols in black and white stripes

 

 

 

 

 

 

 

J is for journeys on boats of all types

 

 

 

 

 

 

K is for kohn dancers covered with jewels

 

 

 

 

 

 

 

 

L is for lounge chairs close by the pool

 

 

 

 

 

 

 

M is the mist on Cambodian fields

 

 

 

 

 

 

N is for nightfall with sunset revealed

 

 

 

 

 

 

O is for owls with gazes serene

 

 

 

 

 

 

 

P is for pitta—the first one we’ve seen!

 

 

 

 

 

 

 

Q is for quiet walks down on the beach

 

 

 

 

 

 

R is for tree roots that ancient walls breach

 

 

 

 

 

 

 

S is for stupas, gleaming and gold

 

 

 

 

 

 

 

T is for temples with faces so old

 

 

 

 

 

 

 

U is for up, where we see hornbills pass

 

 

 

 

 

 

V is for village with walls made of grass

 

 

 

 

 

 

W for waters with colour sublime

 

 

 

 

 

 

X is xpensive but worth every dime

 

 

 

 

 

 

Y is for yawning in elephant style

 

 

 

 

 

 

Zzzz is for sleeping while earning air miles

 

Calidris Reads: Cambodia

Reading and traveling are two of my favorite things, so it’s a joy to combine the two. Aside from being a voracious reader of travel guides, I also love to read novels written by authors from places that I visit, or set in those countries. In Calidris Reads, I will briefly introduce you to these books and provide my personal rating from 1 to 5 knots (Terrible to Must-read).

For our trip to Asia this winter, my companion and I each brought a novel set in Cambodia. As often happens, we read our own books and then swapped. The two books were similar in many ways: historical fiction set in the same general time period, focused on the Angkor area, and written by outsiders. I found both to be light, pleasant introductions to this era and place.

A Woman of Angkor by John Burgess

First sentence: “What if I’d told my husband no, no, we must reject the priest’s command, we must take the children and run away.”

The life of one rather extraordinary Khmer woman at the time of the building of the great complex at Angkor. While the main character is a bit too virtuous to be really sympathetic (Where are those likeable fatal flaws?), I still enjoyed reading about her challenges and everyday accomplishments.

That first sentence tells you everything you need to know about the writing style.

Temple of a Thousand Faces by John Shors

First sentence: “The temple of Angkor Wat had been designed to house the Hindu Gods but looked as if it had been built by them.”

Engaging novel that follows a range of characters from prince to fisherman through a period of conflict between the Khmer Empire and the Cham people. The writing is perhaps a bit more sophisticated than Burgess’. Forbidden love, heroism, cruelty, battles, it’s all here.

Perfect plane read en route to Angkor.

Both books: 4 knots (Recommended)

What do you read when you travel? I’d love to hear about it in a comment.

 

Healing a Wounded Country Through Art

Photo source: https://pharecircus.org/

They call it Cambodian traditional circus, but slapstick clowns and trained poodles, this ain’t.

It’s a steaming hot night in Siem Reap, the tourist town built on the doorstep of one of the world’s great heritage sites: Angkor. Visitors from across the globe fill the neon-lit bars and restaurants on Pub Street, where vendors hawk everything from “Fear Factor” fried scorpions on a stick to toe-tickling foot massages delivered by nibbling aquarium fish. There are only two kinds of people in Siem Reap: those who are there to see the temple ruins and those who are there to extract money from the first group. And who can blame them? This is a poor area in a poor country. Foreigners throw away big money on lodging, food, transport, and fun. Every local desperately needs a piece of that largesse and most work extremely hard to earn it.

In a dusty lot on the dark outskirts of town, far from the hustlers and the massage parlours, stands a tent. Inside, a simple, mostly empty performance space is surrounded by tiers of wooden benches. It’s well organized: young people in bright red t-shirts deal out tickets, hand out bamboo fans to keep the sultry air moving inside the tent, usher patrons to their seats, and sell snacks and merchandise. The place is packed and when everyone is seated, two musicians enter, bow, and take their places. The performance begins.

Sokha is nothing less than a retelling of the horrors that engulfed Cambodia under the Khmer Rouge in the 1970s and the struggles of the people to come to terms with this period when between one and three million Cambodians were executed or died from starvation and disease. The story is based on the experiences of the founders of the Phare Ponleu Selpak School, who lived through that time. The school’s mandate is to provide free education in academics and the arts and to train young artists for professional careers in visual arts, theatre, music, dance, and circus (two of their graduates were recently hired by the Cirque du Soleil). The Phare also strives to create opportunities for local artists and help to revitalize the arts in a country where most artists were targeted for death under the former regime.

The performance is a skillful blending of music, mime, visual art, dance, and acrobatics. With minimal props and basic costumes—a far cry from the elaborate trappings of the Cirque—the artists evoke laughter, tears, amazement, and total engagement from the audience. The story could not be more powerful, and knowing that the performers were all personally affected by the events referenced makes it incredibly moving. The use of masks to dehumanize the persecutors is chilling; you see that the ordinary people were under those masks and participated in the killing.

As the show progresses, we see Cambodia’s slow, courageous steps toward recovery after the end of the Khmer Rouge. Despite the trauma still felt today, the people are acknowledging and healing from their past. They are celebrating the rebirth of the arts through performances such as the Phare.

Near the end of the show, during an emotionally charged scene in which a teacher helps a shattered child to see the healing power of art, the electricity in the tent suddenly went out. The performers froze and did not move for many long minutes while crew scrambled to get the generator restarted. It was like Cambodia herself held her breath through her long darkness, balanced on the knife edge between annihilation and hope. When the lights came on again, the audience cheered and the actors moved forward to the end of the scene and toward a brighter future.

The day after the circus, we went on a nature tour to a manmade wetland in the countryside. It was filled with birds and fisherman poled their dugouts across the serene waters. As we commented on the beauty of the place, our guide said quietly in his broken English: “Built by Khmer Rouge. Three thousand people die.”

More information and tickets for the Phare are available at https://pharecircus.org/. Advance purchase during the high season is recommend; the performance was sold out the night we attended.
Have you seen a local performance during your travels that is a must-see for visitors? Let me know in a comment.