Malaria, Insights on The Traveler's Plague
Copyright 2000 story by Jean-Philippe Soule
Within ten minutes, my light headache had increased significantly. All the muscles around my spine, from my lower back to the top of my neck cramped with excruciating pain. Wrapped under blankets and warm sleeping bags in a room with the temperature of a sauna, I was so cold my teeth were clattering. The pain was unbearable and all I could do was shiver and cry. In a desperate effort, I called for help.
When my friend Luke appeared, I could read the worry on his face. He couldn’t help but say, “Geez, you look terrible! What can I do?”
I had malaria, I knew it too well as this was my fourteenth attack in seven years. I needed medicine, and I needed more clothes. Luke brought me a hat, socks, and more blankets. On the second floor, under the tin roof baked by the mid-day tropical sun of Honduras, he could barely stand the heat and didn’t understand how I could be so cold. My hands were numb and I had to stick them in a pair of socks under the blankets to warm them up.
Luke was alarmed at the speed with which the disease hit. Ten minutes earlier, I had been sitting in the office room working on a computer. I felt tired and had just a slight headache when I told him I would go lie down for a few minutes. A malaria attack can come on that quickly. The parasites take refuge in the liver and reproduce after entering the blood stream via a mosquito sting. When they break out of the liver, they hit hard and fast. This case was no different, and even though I felt, and probably looked like I was going to die, I knew I would be fine. We carried all the most potent medicines in our first aid kit.
Years ago when I read about malaria to prepare for my first jungle travels, it struck me as an exotic disease which is easily warded off by taking preventative medicine. I took my prophylactic medicine religiously and never worried much. Much to my surprise, I was later hospitalized in a comatose state. I was put under intra-venous fluid treatment in addition to a high dosage of Larium and Primaquine. Other tropical diseases and the preventive medicine had hidden the symptoms of a rare and vicious strain of malaria until the last moment. Doctors said I was lucky to be alive. It was a Vivax strain I caught in Irian Jaya, Indonesia and was resistant to most known medicines. I was told that relapses would occur and that I would have to be treated with a dosage of 5 pills of Larium each time I suffered an attack. My body would be in constant struggle against the drug’s terrible toxic side effects. Primaquine, which is supposed to kill the malaria in the liver to prevent relapses, was ineffective and I was told by numerous specialists that I would probably have to live with malaria all my life. The good news was that I survived the first attack, so I probably wouldn’t die during relapses.
After that experience, malaria lost its distant, exotic mystique. It became a part of my life, like a bad karma I had to live with. I was paying the price of my blind trust in modern medicine. I was paying for my ignorance of one of the deadliest diseases. Every three months, painful chills followed by high fevers and pounding migraines kept me in bed for a day or two. The attacks were followed by three days in a zombie-like state as a result of the side effects of the medicine. Larium, also called Mefloquine, remains the most effective, yet toxic, FDA approved medicine to fight malaria. During the subsequent two and half years following my diagnosis I spent the first two weeks after each attack in bed, and the next two and half months trying to get back in shape. I consulted many tropical disease specialists from the States, France, and Japan. All told me the same, there was no hope.
I did much research on the disease and eventually decided that my next step would be to go to China to seek treatment using a plant called Artemesinin. Chinese have used the plant for over a thousand years to treat migraines, fevers, heart problems, and malaria. By some minor miracle, my relapses faded and I didn’t need to go. It had taken nearly three years, a radical change in diet, continuous physical training, and a staunch belief that I would someday experience a full recovery for the attacks to cease. I kept researching though, knowing that one day I would return to tropical rainforests and would be exposed to malaria again.To my great surprise I have since learned that malaria is the disease affecting the largest number of people worldwide and one of the leading causes of death. The World Health Organization estimates that 270 million new malaria infections occur worldwide annually. 25% of childhood deaths in Africa are attributed to malaria. It is a mosquito-borne protozoal disease that is endemic throughout most of the tropical and semi-tropical regions of the world. The transmission occurs in an estimated 100 countries where 2 billion people are at risk of malaria infection. These numbers are staggering and today new strains of malaria are spreading and could even re-appear in countries that have been free from the disease for decades. Some scientists even believe that breakouts could happen in the United States.
Eradicating malaria is easy, many countries have done it by spraying their land with an insecticide that kills the carrier, a mosquito called anopheles. There are problems, however, if the mosquitoes aren’t killed in all the surrounding malaria-infected countries. The infectious carriers keep coming back to the areas that have been treated, and the mosquitoes are building resistance against insecticides. The spraying costs remain high for many developing countries prohibiting a comprehensive eradication process in many parts of the world.
Ellen Rippel Shell best described why science is currently losing the war against the spread of malaria in her article "Resurgence of a Deadly Disease” published in the American magazine The Atlantic Monthly, August 97. An excerpt from her last paragraph states:
“...But in the West early success in controlling infectious disease has bred arrogance and a belief in whopping big solutions--vaccines and antibiotics that wipe out rather than contain. We know successful pathogens to be highly evolved and clever creatures, but we bluster about, attacking them as though they were the dumb, plodding aggressors that perhaps we ourselves are. When a microbe mutates around our onslaught, we go off in search of a bigger weapon with which to blast it. But like all re-emerging diseases, malaria has managed not only to dodge the bullets but also to turn the revolver back at us. Our attacks have made the parasite not weaker and less certain but more virulent. Controlling this disease requires vigilance, patience, and, to a certain degree, sacrifice--there are places we might have to avoid. There are tradeoffs to be made, but so far we've shown ourselves reluctant to make them. Scientists pursue their quest for an effective vaccine or a more powerful drug while treasure hunters of another kind [miners mentioned previously in the article] in Thailand and Brazil help the disease find a new foothold. Whether the scientific adventures will eventually pay off is uncertain, but for now there's no question that a price is being paid. Malaria, an ancient disease, a controllable disease, is spreading.”
The spread of malaria has lead to controversial debates. Peter Singfield, an Iatrologist in Belize wrote, “Over-use of prophylactics in the war on malaria forced the malaria to evolve into a severe pathogenic instead of a symbiotic relation. People traveling while full of prophylactics through endemic malaria areas are only compounding the problem for the locals.” One of the main causes of the increasing epidemics and deaths is the mutation of the malaria plasmodium. New strains become resistant to known medicines. This is why neither Chloroquine, nor Fansidar protected me in Irian Jaya. This is why Primaquine, the only US medicine known to kill the parasite in the liver and prevent relapses, is becoming more obsolete every day. Stopping the development of new strains is necessary, but it requires a major social change from a body of people and governments who disregard these issues. Tourists, scholars, and immigrant workers from modern countries who use prophylactic medicines are the number one cause of mutations. A mosquito biting a person who is taking Chloroquine as a preventative treatment would extract some blood. The quantity of medicine might not be enough to kill the resident parasite but it might be enough to allow it to build resistance to it. Health departments in modern countries, in an effort to preserve the health of their people traveling abroad, have encouraged the use of prophylactic medicines. The people suffering most are the poor indigenous or local inhabitants who rely on Chloroquine as the only locally available cure once infected. Foreigners can always come back later with a new improved medicine against the resistant strains created by the prophylactics of previous visitors. This news surprises many people.
The research for a malaria vaccine has yet to lead to conclusive results, but a few discoveries could be the key to eradicating the disease. Some of the most promising is the work done by Researchers at the Alexander Von Humboldt Tropical Medicine Institute in Lima, Peru. They use Coconuts to incubate bacteria that successfully control the larva of the malaria-bearing mosquito. The bacillus Thuringiensis Var Israelensis H-14 (Bti) is a bacterium that effectively kills mosquito larvae. It is commercially available but its cost can be prohibitive for developing countries. Researchers have shown that it can be grown in coconuts and then released into ponds where mosquito larvae flourish. The coconuts are plentiful and free, growing in close proximity to the ponds infested with mosquito larvae. Such research could offer the answer to fight the spread of malaria, but small labs without major financing and international support have no means to implement their solution on a large scale. Our future still relies on the decisions of rich countries and their governing health organizations
During our three-year sea kayak expedition in the jungles of Central America, neither Luke nor I take any preventative medicines. Other travelers we meet are often shocked about our decision. When they ask why, I tell them that it puts local people at risk, the side effects over long periods of time are bad, and there is no guarantee that it will protect us entirely. People often reply that they never knew. They just followed the advice of their medical doctor back home. Educating the medical community and people traveling to countries at risk isn’t on top of the priority list of the modern countries’ Health departments. Education is important, but the decision is up to each of us. Malaria is a painful disease. If taken in time, medicines are effective to treat most cases. Responsible and knowledgeable travelers deciding to visit infected areas should either accept the risk and be ready to treat the disease, or change their travel plans and visit countries where they will not be putting themselves at risk.
The conscientious traveler is the one who goes further than merely listening to and trusting his or her general practitioner. I learned that lesson the hard way. For most, malaria remains mysterious. The media often publish breaking news on cancer, diabetes, or aids research, but malaria is often ignored as it only occurs in the developing world. There is little research and few breakthroughs worth noting.
The most important breakthrough for people who plan on visiting places at risk is a medicine called Artenam derived from the Artemisin plant (Artemisia annua L.) known in China as "Qing Hao" or in the west as sweet wormwood or annual wormwood, and belonging to the family of Asteraccae. This medicine is produced by a Belgian company named Arenco, but isn’t yet FDA approved. It is the medicine I took to cure the malaria attack I described earlier. I was surprised by its efficiency. The attack stopped in half the time required by Mefloquine, and the next day I was up and as healthy as one could be after such trauma. I did not suffer any of the secondary effects I had become accustomed to with other medicines. I instantly became a strong believer. Artenam, unlike other medicines, doesn’t just kill the parasite in the blood to stop an attack. It also cleans the liver and protects against future relapses. I wish the medicine had been around years ago.
Travelers who have experienced the disease once don’t need a doctor’s diagnosis, you will know. For those who are unsure or have never had the experience, you might find the malaria test kits developed by Flow Inc. to be useful. Although I have not tried it myself, the company describes its OptiMAL® assay as a sensitive, simple-to-use dipstick that permits the detection of all major species of human malaria; and can distinguish between P. falciparum and P. vivax.
A bit of advice: some of the effects of malaria are nausea and vomiting. In Honduras I vomited the first dose of Artenam medicine I took. Unless you travel with a large quantity of medicine, you better not waste more than one treatment dose. My friend Peter Singfield, a medical healer living in Belize, advised me to crush the pills into powder and mix them with a little bit of water and insert them as a suppository. This alternative application is a good thing to remember if your digestive system doesn’t allow you oral ingestion. Untreated, malaria is one of the world’s deadliest diseases.
Artenam is difficult to obtain. It is only sold in a few countries and is still expensive. We were lucky to be able to buy two boxes from Peter Singfield. We could have used more. A month after my first attack in Honduras, Luke and I returned from the rainforest of La Moskitia to the town of Puerto Cortez. It was Luke’s turn to experience the disease. His chills were so mild; we thought he was suffering from Dengue fever. On the second day he was too weak to move. With no more Artenam, we put him on Chloroquine (recommended medicine in Honduras). A few hours after taking the medicine, his fever kept rising. At 107 degrees Fahrenheit we started to worry. Suddenly our host called me. Luke had lost sight and was about to pass out. Sweat dripped from all over his body. His face was so pale he looked like a ghost. Still blind, and with increasing breathing difficulties he told me, “You have to call my parents and tell them.”
I could feel that my friend was looking death right in the eyes. I called for bags of ice and massaged him with all the ice and wet towels we could find. We had to lower his body temperature. I was expecting him to lose consciousness at any instant. We could not transport him in that condition. If we had to start CPR, we needed a flat hard surface to lay him on. The rough dirt road leading to town wasn’t an option. We kept applying ice all over his chest, armpits, neck, and forehead and talked to him. After ten minutes of deep anxiety, his temperature slowly dropped back to a normal high fever. His skin remained a bit pale, but showed some color, and finally he recovered sight. Relieved, after an hour of rest we drove him to a local clinic where he was put on intra-venous fluids for 24 hours to compensate for the serious dehydration he had suffered. A few days later I took his place for my fifteenth attack and second one in Honduras. I started the Chloroquine early and was done with malaria in a couple of days, but the side effects left me with migraines for 3 more days.
People often ask us if we aren’t afraid of wild animals like sharks and crocodiles, or storms when we are far from the coast, or people. During our 3 years and 5000 mile paddle odyssey in Central America what we fear most are the diseases. Malaria is on top of the list, and it reminds us that we are just vulnerable humans. To continue our journey, we hope to find a way to obtain more Artenam. We will continue to paddle through the rainforests to meet indigenous people, and accept the risk of not using preventative medicine so as not to expose the ones we come to visit.