I was having a conversation with my dear friend Rachael the other day, who is in Colorado but lived in Nairobi, and after telling her a story she said, "You just gotta Trust In Africa, it's the new TIA!"
I love Rachael. And I love this reformulation of TIA.
Things don't often work out the way you planned or hoped or wanted, but if you give it space and time, it does work out. That's true anywhere, but for an expat in a place like Uganda it's just more in your face. The story I had told Rachael was about my quest for Mefloquine/Lariam, a drug taken once a week to prevent malaria. Which is pretty great. But it has its downfalls. Common side effects (which can happen at any point, even with the first dose) include bad dreams, depression, suicidal thoughts, and psychosis (which I fortunately have never experienced while taking this), as well as fever, nausea, vomiting, headaches (which I have experienced on occasion and suspect Mefloquine to be the culprit), and a very very long list of other things. Sometimes it's hard to distinguish the side effects from the symptoms of an actual malaria infection, which happened to me just after I left Uganda the last time. Taken long term it can also cause liver damage. Awesome.
Taking all that in consideration, I don't plan to take mefloquine long term (although I have not decided yet how long I will continue to take it). I can take other measures to prevent mosquito bites as much as possible, and to keep my immune system strong so I'm in a good position to fight off a possible infection. I basically equate malaria to the flu (for which I have never been vaccinated): take care of yourself, take obvious precautions, and get treatment if you get it. Malaria is very common here (although I sometimes question the diagnosis as I think it's often times a default diagnosis, especially because diagnosis can be tricky if antigens from previous infections are present, and a host of other complications). And it's ugly. But if you do not have a weak or compromised immune system and you get treatment right away, you'll recover. I've read that 90% of the deaths caused by malaria are in children, and I suspect a large percentage of those children were probably malnourished or otherwise compromised, and many of them probably couldn't access adequate treatment quickly enough. I don't mean to downplay how serious malaria is, I just want to put my decision making process in perspective for those of you who would worry about my wellbeing.
So, back to my story. I was out of mefloquine and went to a pharmacy here in Gulu to get more. They were out. I was surprised, but ok, there's lots of pharmacies, I'll just go to another one. I did, and they were also out. I asked what's going on and just got a vague answer about there being a shortage everywhere at the moment. It's not uncommon to not be able to find something in stock at the supermarket that was there a week ago. There is little consistency to the things that get shipped into town. But I somehow expected this drug to be readily available and in stock. Obviously I should not have waited until I was out to look for more! I went to another pharmacy, they also didn't have any. I asked if they could recommend a place that might be more likely to have it (since until now I was just walking around and going into any pharmacy I came across). They recommended a place but it was not nearby and I still needed to go to the market, so I decided I would check another day. The decision about how long I should take mefloquine may have been made for me. Lack of supply may mean now is the time I stop.
Later that week on my lunch break I just happened to walk past the pharmacy that had been recommended to me, so I go in to ask about mefloquine. Turns out they have it! So I guess that means I'll continue taking it for now.
I have another great Trust in Africa story about termites and power outages, but I'll save it for another blog.
I love Rachael. And I love this reformulation of TIA.
Things don't often work out the way you planned or hoped or wanted, but if you give it space and time, it does work out. That's true anywhere, but for an expat in a place like Uganda it's just more in your face. The story I had told Rachael was about my quest for Mefloquine/Lariam, a drug taken once a week to prevent malaria. Which is pretty great. But it has its downfalls. Common side effects (which can happen at any point, even with the first dose) include bad dreams, depression, suicidal thoughts, and psychosis (which I fortunately have never experienced while taking this), as well as fever, nausea, vomiting, headaches (which I have experienced on occasion and suspect Mefloquine to be the culprit), and a very very long list of other things. Sometimes it's hard to distinguish the side effects from the symptoms of an actual malaria infection, which happened to me just after I left Uganda the last time. Taken long term it can also cause liver damage. Awesome.
Taking all that in consideration, I don't plan to take mefloquine long term (although I have not decided yet how long I will continue to take it). I can take other measures to prevent mosquito bites as much as possible, and to keep my immune system strong so I'm in a good position to fight off a possible infection. I basically equate malaria to the flu (for which I have never been vaccinated): take care of yourself, take obvious precautions, and get treatment if you get it. Malaria is very common here (although I sometimes question the diagnosis as I think it's often times a default diagnosis, especially because diagnosis can be tricky if antigens from previous infections are present, and a host of other complications). And it's ugly. But if you do not have a weak or compromised immune system and you get treatment right away, you'll recover. I've read that 90% of the deaths caused by malaria are in children, and I suspect a large percentage of those children were probably malnourished or otherwise compromised, and many of them probably couldn't access adequate treatment quickly enough. I don't mean to downplay how serious malaria is, I just want to put my decision making process in perspective for those of you who would worry about my wellbeing.
So, back to my story. I was out of mefloquine and went to a pharmacy here in Gulu to get more. They were out. I was surprised, but ok, there's lots of pharmacies, I'll just go to another one. I did, and they were also out. I asked what's going on and just got a vague answer about there being a shortage everywhere at the moment. It's not uncommon to not be able to find something in stock at the supermarket that was there a week ago. There is little consistency to the things that get shipped into town. But I somehow expected this drug to be readily available and in stock. Obviously I should not have waited until I was out to look for more! I went to another pharmacy, they also didn't have any. I asked if they could recommend a place that might be more likely to have it (since until now I was just walking around and going into any pharmacy I came across). They recommended a place but it was not nearby and I still needed to go to the market, so I decided I would check another day. The decision about how long I should take mefloquine may have been made for me. Lack of supply may mean now is the time I stop.
Later that week on my lunch break I just happened to walk past the pharmacy that had been recommended to me, so I go in to ask about mefloquine. Turns out they have it! So I guess that means I'll continue taking it for now.
I have another great Trust in Africa story about termites and power outages, but I'll save it for another blog.
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