Preventing further MALARIA madness

I am not a Dr. and I do not pretend to be one. Prior to leaving the U.S., I visited 3 different medical professionals and institutions for proper medical travel preparation. I was prescribed Mefloquin- generic of Lariam but not one medical professional asked me about any prior psychological history. On the plane over here, my seat neighbor expressed great shock that Mefloquin is still legally on the market. Upon arrival in Senegal, I began to have bizarre and frequent dreams. I asked around and found it common knowledge that mefloquin is, “scary.” Now, three months into travel I have not slept an entire night without disturbing dreams/neurotic thought processes. This week I stopped taking it and now I search for a new med.

I am scared about the lack of info I found in the States. So I've taken some time to compile some info. There needs to be more options and discussion for other people going abroad. The following information is by no means comprehensive nor should it be taken for medical advice. It is a starting block for further education and discussion and is actually snipets of a flier I plan on emailing to the medical institutions I visited. If you know someone who would benefit from it, please contact me at ellenk_miller@yahoo.com or check out the sources listed below.

Malaria is a serious and sometimes fatal disease caused by a parasite that commonly infects a certain type of mosquito which feeds on humans.

Usually, people get malaria by being bitten by an infective female Anopheles mosquito. Only Anopheles mosquitoes can transmit malaria and they must have been infected through a previous blood meal taken on an infected person. When a mosquito bites an infected person, a small amount of blood is taken in which contains microscopic malaria parasites. About 1 week later, when the mosquito takes its next blood meal, these parasites mix with the mosquito's saliva and are injected into the person being bitten.

Signs and symptoms of malaria
Symptoms include fever and flu-like illness, including shaking chills, headache, muscle aches, and tiredness. Nausea, vomiting, and diarrhea may also occur. Malaria may cause anemia and jaundice (yellow coloring of the skin and eyes) because of the loss of red blood cells. Infection with one type of malaria, Plasmodium falciparum, if not promptly treated, may cause kidney failure, seizures, mental confusion, coma, and death.
How soon will a person feel sick after being bitten by an infected mosquito?
For most people, symptoms begin 10 days to 4 weeks after infection, although a person may feel ill as early as 7 days or as late as 1 year later. Two kinds of malaria, P. vivax and P. ovale, can occur again (relapsing malaria). In P. vivax and P. ovale infections, some parasites can remain dormant in the liver for several months up to about 4 years after a person is bitten by an infected mosquito. When these parasites come out of hibernation and begin invading red blood cells ("relapse"), the person will become sick.
When and where does a person stand the most risk of contracting malaria?
Dusk: Mosquitoes are most active in the early evening. The best way of avoiding malaria is not to get bitten, so take precautions.

THE DRUGS
Preventative Drugs:
Chloroquine Aralen, Avloclor, Nivaquine, Resochin
Chloroquine/proguanil Savarine
Doxycycline Vibramvcin
Atovaquone/proguanil Malarone

Drugs for Treatment: (uncomplicated)
Amodiaquine Camoquine
Artemether/lumefantrine Riament, Coartem
Chloroquine Aralen, Avloclor
Mefloquine Eloquine, Larium, Mephaquin
Atovaquone/roguanil Malarone

Chloroquine/Paludrine Two chloroquine tablets weekly, plus two tablets of Paludrine daily is the traditional regimen, starting one week before travel and continuing for four weeks after return. It is safe and licensed, but is not effective in much of sub-Saharan Africa, Amazonia and South-East Asia.
Lariam One tablet weekly, starting two-and-a-half weeks before travel and continuing for three to four weeks after return. Effective in most parts of the world, except for northern Thailand, the "Golden Triangle" (parts of Burma, Laos, Thailand) and other parts of South-East Asia. Unpopular, on account of relatively high rates of side-effects compared with other drugs.
Doxycycline One tablet daily, starting one week before travel and continuing for four weeks after return. Carries a risk of an exaggerated sunburn reaction that ranges from three to 10 per cent, and has a tendency to cause thrush in women. Unsuitable for children or during pregnancy.
Malarone One tablet daily. Fully licensed for treatment of malaria (in at least 32 countries), but not yet licensed for prevention. In trials, the rate of side-effects was no greater in people taking Malarone than in those taking a placebo. It is believed to be the most effective of all of the options. Expensive.
Savarine One tablet daily, starting one week before travel and continuing for four weeks after return. Each tablet contains both chloroquine and Paludrine. The total dose of chloroquine is higher than with the weekly regimen and there is strong evidence that this is a more effective option. Savarine is licensed throughout the EU, with the exception of the UK and Germany. Expensive.
http://www.telegraph.co.uk/travel/722068/Malaria-why-you-are-denied-the-drugs-that-could-save-your-life.html

EDUCATE YOURSELF!!
http://www.cdc.org/
www.who.org
http://www.malariaandhealth.com/
http://www.malaria.org/
www.malaria.com

Travel Part 2...Kedougou and Basari Co.

The second part of the trip I like to think of as first hand “cultural ambassadorial experience”. There are no words to describe all of the smells, dirt, smiles, sweat, basic human need and emotions that swarmed the group, but I’ll try…
Our first night out of the park we stayed in Dar Salaam Village. We were greeted with the luxury of a toilet and an actual shower head in each hut and two choices for dinner! WOW! During dinner we heard chants and drum beats from the neighboring village. The guide gained us entry into the village where we witnessed an anthropologists dream. Illuminated by an almost full moon, women chanted and danced in a circle to the beat of 4 drums. The male leaders of the village sat to one side and interjected some sort of story during the change of the chants. Encompassed by a collection of huts, warm bodies and the swarm of music- it was like being in another world. I was entranced, with a barebreasted woman sitting next to me, when I felt a tug on my pony tail followed by girlish giggles. Taking the hint, I released my pony tale to let my hair fall across my back. Not thirty seconds later, no less then 10 little hands were stroking my ‘white-girl’ hair with amazement and more giggles. With my permission, my whole head was quickly transformed to braids. An unforgettably intimate and truly blessed experience. (photo: me w/ girls who braided my hair)
The next day we left our truck and rented two 4x4s to travel to Kedougou, a village further SE in Senegal. A lot more dust, rutty roads, and sweat later we arrived to meet our next guide and buy cadeaux (presents) for the villagers. In order to enter the villages, it’s recommended to present soap, candles, matches, candies for the kids and kola nuts. We also stocked about 50 liters of water—6 days, 7 people-- you do the math.
That afternoon we each packed a small overnight sack and enough water to climb a mountain, spend the night and descend the next day—about 2L a person. It was around 85-90 degrees and dry heat. After about 40 minutes of climbing we were joined by shoeless little kids in pieces of cloth, with snotty noses and crusty hands, their mothers with big bundles of sticks or buckets of water balanced on their head were not far behind. We quickly distributed our first candies and climbed the rest of the way with a brown eyed children holding each hand. More children with bloated bellies, from malnutrion, soon surrounded us beseeching our cadeaux and the realities of an isolated, mountain life quickly assaulted the group.
The village of Iwol, established in the 15century, was the first Bedick village in Senegal. They speak Bedik and thanks to 17th century colonists are Christian- though like most Senegalese, are also Animist. Approximately 530 people live in the village.
After the sun went to sleep and we were formally welcomed by Jean Baptist the village tourguide-pharmacist-religious leader-school teacher we found ourselves face to face with lots of curious kids. One of the most beautiful traditions of the trip started then; we sang “Head, Shoulders, Knees and Toes” and “If You’re Happy and You Know It” in no less than 4 languages in each village! We couldn’t really talk about anything and there was no electricity to interrupt our attention so we shared what all humans share—children’s songs and smiles!
The next morning after sleep on uneven, hard bamboo mats covered by plastic-y prayer rugs, the 7 of us shared a fifth of a bucket of well water to wash our hands, face and feet. Do we use our precious potable water to wash hands, and brush teeth before we have to climb down the mountain in the heat? …Our more than rustic accommodations were further stretched as some female members of the group were afforded the “opportunity” to ponder what African mountain women do during menstruation. There are no toilets- only wholes in the ground, no water to wash, no waste baskets, no chocolate and no place to buy feminine products. We didn’t have the language abilities nor the established relationships to ask our questions—so we “adapted.”
The next village was Ibel, home of our guide. Upon arrival we basically waited out the heat of the day under the shade, on another hard, uneven bamboo bed. Ibel was a larger village with a rather developed school. Close to Ibel was a marble mine. As our guide, born in this region, proudly showed us the beauty of un-treated marble I, as innocently as possible, asked, “So, who manages these mines?” “Italians and French” he responded. I followed up with, “who owns the land? Or, who do they pay to access the mines?” A bit perplexed by my questions, he explained that they pay the workers who cut the marble. I insisted, but do they pay for the natural resources and opportunity to use the land? He didn’t know for sure, but was pretty sure they just paid the workers. I then gently asked, “What are the people going to do once all the marble is gone?” He didn’t have an answer…I remained silent in frustration…I later found out, he doesn’t even know what marble is used for or how expensive it is in the Western world... (photo: me checkin out the marble w/a saying from the current President)
That night our guide arranged for a village dance. All of us were sat on a bench and 5 musicians with instruments I’ve never seen before cordially entertained us. At first a local woman would pull one of us gently in the middle of the circle and let us humiliate ourselves with our white-person lack of rhythm. Well, there’s no way in heck that I’m going to just sit in a village in the middle of nowhere with drum beats swirling and amazing African dancers letting it all loose and not jump in the middle. So, Lies (Belgian buddy) and I grabbed two local kids and jumped in the middle of the circle. The circle quickly collapsed into a mess of flailing arms, legs and smiles! I’m proud to report that my Brazilian dance skills definitely let me hold my own with the best ‘em. There’s nothing like dancing under a full moon with a bunch of locals in the middle of an African village! (photo: Ibel's cheif and top counsel members)
The next day we ventured further south to Basari Country to visit the villages of Dindefelo and Dande. At one point we thought we had crossed into Guinea—but I think it was a fake border crossing that allows the locals to earn some extra income… We took a late morning hike through some rather dense forest/bush. Now almost a normal occurrence, we passed groups of topless women with interesting facial piercings washing clothes or themselves in the river. About 35 minutes into the hike, a chorus of chimpanzees announced our arrival to the cascade (waterfall)!! Hot and dirty we all gasped at beauty this 100-150 story high waterfall—and the opportunity to get in the water and cool down (yes, also possibly parasitic waters, but there’s no way we could resist!) ahhhhhhhhhh.
After lunch and again waiting out the worst of the heat, our guide told us we were going to visit one last village—on top of the mountain. So late afternoon we sweated up an extremely steep climb. We saw yet another village, the source of the waterfall and even a cave with bats. Then around dusk we started to get a bit nervous, we couldn’t stay the night up here…let’s just say if you really want to heighten your senses, climb down a steep mountain in the dark, with two flashlights for seven people. I’ll spare the details for all concerned; we all made it safely.
It was moments like those, however, where we really came together as a group. Sure some were extremely frustrated, and even terrified. But really, I’ve learned that I can waste my energies being peeved at the irresponsibility of the guide who lead us into the ridiculous situation and worried about the bug that made my leg bleed or I can take it step by step knowing that I have to get down somehow, at sometime. Why waste my energy being angry over something I can’t control or change at that moment. Similarly, (un)fortunately through my travels abroad and working with refugees/migrants I’ve established a rather absorbant emotional barrier. It has helped to digest great emotional shock and has allowed me to witness many things without judgment or qualifications but just to accept that they exist. It came very handy throughout the week... (photo: helping ladies in Dande crush millet for the night's meal)
This trip was an escape from city life in Dakar, but it was hardly a vacation. As difficult as it got, not one person complained the entire week! When the holes in the roads got bigger, we sang louder. When we didn’t see an elephant we rejoiced in seeing a family of monkeys. When the mountain got steeper we simply waited to catch our breath to start again. And as Jamie cried one night, “I’m so dirty, I have to wash my soap!” I couldn’t count the layers of dirt, sweat, bug spray, sunscreen and whatever else was out there. Yet at the same time, through all of the layers, I’ll never forget the laughter of the kids, the singing and the dancing. As I’ve felt in numerous countries/cultures, life can be hard—but it’s what you make of it—and it can be simply beautiful.
(photo: that's not a wicked sandal tan, it's dirt!)
Now I’m back to long days but productive days in Dakar. I have a new French tutor who I consider to be the Goddess of French Grammar. My French capabilities are going to skyrocket!! There are local elections this weekend. It’s nothing compared to Presidential elections nonetheless one never knows. We appreciate your prayers for a peaceful democratic weekend in Dakar. If you have questions or requests for pics feel free to email at ellenk_miller@yahoo.com

Travels to Tamba...Part 1.

My host mom has told me that if I sit up straight while I eat, then all the food will go straight to making a more plump—and thus more desirable—derriere. Well, I just flattened my best efforts in a 20 hour trip across Senegal! Last week I rejoined my travel buddies for an unforgettable trip to SE Senegal.
Our trip started at 5am with 7 adults crammed in a 1970s station wagon called a septplace. Upon mention that I was going to Tambacounda, everybody responded: “ooo, the road is awful” Well, I fully agree. About 2.5 hrs out of Dakar, the road turned into a sand pit that sometimes traveled in a straight line. Everything and everyone quickly turned sweaty and covered in dust.
Around 4pm we arrived in Tambacounda, affectionately referred to as “Tamba.” In Tamba we transferred our sweaty, dirty—but excited-- bodies to a 4x4 truck. We then traveled 3.5 more hours into la Parc National du Niokolo Koba, welcoming the fresh air. (photo: Jamie, Jonathan and I finally in fresh air)
We arrived to the campement de leon around 10:30pm and finally got to eat. Throughout the trip we often times arrived at the table where there is no menu and you eat what you are served. Everyone gets the same plate and it’s usually some sort of meat—I stopped asking what it was, which means, I often times had no idea what I was eating. Always an interesting experience! We quickly retired to our double bedded huts and were sung to sleep by hippos!!! Hippos sing!!! Well, kind of groan—nonetheless super cool!
The park is notorious for its wild animals and even though we didn’t see any lions, we had a rooaaring great luck with hippos, crocodiles, warthogs, birds, antelopes, and multiple kinds of monkeys! Our two days in the park consisted of early morning rides through the park spotting animals. Returning to cool off in possibly parasitic waters—it was so hot, that we really couldn’t care (I’m not dead yet, but I will get a blood test when I get home). We then waited out the hottest part of the afternoon and finished the day with another ride see the animals retreat for the evening.
During the first day, we came to a bridge which our driver insisted that it was too dangerous and instable to cross. He persisted for probably five minutes with us females, then quickly turned to Jonathan with the challenge to cross. Astonished at the quick change in opinion, I challenged why it was ok for Jonathan to cross and as expected his response: “It’s just to dangerous for females…” Well, of course, I was the first female to cross, and after all of the females crossed he practically crawled across in fear, only to defend his masculinity. Oh, the hilarity of machismo!
The second morning, four of us climbed in a boat to look for hippos and crocs. Yes, we intentionally searched for extremely dangerous animals in their natural habitats. We didn’t sit too near the edge of the boat. Not only do hippos sing, but they live in family groups, are very territorial, stay under water all day but come up approx every 10 mins for air. They are huge, powerful but beautiful.
We also saw a croc that we were sure was dead because he was so far from the water. After our guide threw some rocks at it, he descended from the truck to poke the croc with a stick (we all stayed, tight in suspense, in the truck). The croc quickly came back to life with a huge snap of the jaw and luckily he ran in the opposite direction of the guide. Our screams probably scarred the croc into never again leaving the water! Lesson to learn if you ever come across a croc: its their strategy to wait out prey. It waits, and waits and waits then in a flash can jump to attack. Incredible first hand experience—that I never want to see again!
We also saw a leopard- but it was encaged because it was abandoned in infancy by poachers then raised by humans. Still nothing to be messed with….

PUMBA!!! Disney made him out to be much better looking than he is in real life. He has a mullet.

Lots of baboons running across the terrain. I had hoped it was a lion that had made them run-- nope.

Our group, immitating animals.

ahhh...shopping...

After 6 ridiculously full days of class, projects and meetings, Sunday was a much needed day of fun in the sun. Lucie, Jamie and I started our day of relaxation and exploration with a decadent pastry from the European bakery. Deeelicious! After strolling the length of the beach taking random pictures of goats and perogues (long boats) we crossed to Island Ngor. Ngor is a very affluent part of Dakar where there is a large concentration of Europeans, Americans and resort vacationers.
Not really knowing what to expect of the island we just wandered. The sun was strong but not overwhelming. The ocean waves were rolling and once past all the tourists, the island was beautiful. (We’re not really tourists, by the way, because we ‘live’ here—it’s a pride thing for exchange students). So, enjoying a day on a rather tropical island—there are palm trees and even a monkey-- without commitments and responsibilities what do three women do? …Go shopping!!

Shopping in foreign countries can be overwhelming and in Dakar it can be a war zone! Normally you arrive to the markets and a merchant opens your taxi door already insisting you visit his/her shop. A lot of times you don’t even have to leave the taxi because anytime you stop someone is at your window telling you that you need their product. In Dakar, men sell phone cards at every corner. People escort you down the market ways showing you their portable wares: sunglasses, socks, wood carvings, bras, you name it. Simultaneously, shop keepers, or perhaps a better description is hut-keepers, sing/chant/whistle at you calling you madam, mignon (cutie), lovely lady and also try to convince you that their product is the best even though all their neighbors are selling the exact same thing. At the same, guard your purse like it’s your passport! On top of it all, everything is negotiable. Rule of thumb is that the real price is a quarter of the asked price. By the time you get through the whole Wolof greeting and the bargaining every item takes at least a 5 minutes.

Today however was different. While overlooking an ocean cliff we were approached by a local artisan with a typical basket of wares on her head. Normally, we would walk away quickly and slightly annoyed. She was jolly, friendly and surprisingly, not overly assertive. She started a conversation and we were soon digging through her basket of goodies with shrills of oohs and aahs. We sat, talked awhile and came away with beaded necklaces, bracelets and earrings. Nothing like a little retail therapy to add extra spring to our step!
On our way back to the boat Jamie spotted a small sign for a local gallery. Again not knowing what to expect, we wandered in. Unlike a normal market we were greeted by no one but a little monkey! We continued to wander through the normal paintings of all colors and sizes, carvings, drums and finally purses/bags! The owner eventually arrived to assist with our choices. Lucie and I picked up a local cloth bag, Jamie got a little traditional painting and then we all got invited to tea by the shop keeper. Porquoi pas? (why not?)
We chatted with Lu for a while about Senegal and life in general. He even invited us to come back for a weekend b-b-q!
(pic of Lu and Lucie in the gallery)
Walking away from it all we somehow always feel the need to justify our purchases. As previously stated, all prices are negotiable. We know that they are trying to rip us off because we are white. My bargaining and language capabilities are now getting to where I can get down to the real prices. However, if I was to buy a necklace in the States, it could easily cost $10USD. Should I insist on playing the rigid game to pay only $1.50 when I know this is the lady’s only income and she has five kids to feed? Rich is relative. What is our responsibility to just prices?
Also, there are so many beautiful things to be desired. Alligator purses, exotic wooden drums, and delicately crafted bracelets; however I don’t know anything about animal rights laws in Senegal, I know a lot of specialty wood is endangered, almost extinct and I just can’t wear ivory, knowing its also endangered. On the other hand, the guy is just trying to make a living, he only has access to certain resources and is trying to compete in the local market. What is our responsibility to sustainable products?
So we do pay a bit more than the locals and I have sorely denied myself beautiful local artisan jewelry. Decisions. All considered, we are ecstatic about our purchases and the fact that we could buy in a calm and personal market. It was a refreshing day in the sun and fresh air! I'm now revived and ready to take on another week...