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.