Thursday, November 19, 2009

Malaria, again

For the last week, Nate has had malaria. No, we're not on prophylaxis like I said we were. Taking doxycycline, even at low dosages of 100 mg a day, was enough to make both of us so photosensitive we prioritized minimizing skin damage and avoiding cancer to getting the blood borne pathogen. Seriously, it was the better public health call. Four hours on an overcast day had us both pink and peeling, despite a mask of zinc oxide, and we surf a lot. That kind of thing can't happen.

So, three months after our last bout, here we are. It's extra bad because the rapid test Nate got at our City Laboratories (motto: "Insist on knowing your medical problems.") showed negative, although a microscope slide test would've showed positive. We caught it about three days late.

By "caught it," I mean we went to the Ahmadiya Muslim Clinic (no motto, sadly) between 10th and 11th Street in Sinkor. It was, at 11 am in the morning, what you would expect of a private African clinic: wooden benches with people patiently waiting, a large fan, and a file system of stacked, well-thumbed papers in wooden cubicles stacked on top of each other against the wall. Nate paid $10 to register and waited almost an hour to see the doctor. Not horrible, but not great. They ran the usual gamut of tests, and he showed positive on the one that takes an hour, where you use a stain and a microscope, old school-like.

True to African fashion, we were coming for treatment a bit late. So the doctor prescribed a cipro drip and a 2 mg/ml suspension of artesenate, the Chinese herbal-based wonder drug which every uses now because it's so effective. I might mention here that because artesenate is so effective, the malaria parasite it fast becoming resistant to it in monodrug form and dual treatment, just like for HIV and TB, is the public health norm.

While this had been going on, I'd been sitting patiently in the waiting room next to the water cooler, watching mothers encourage forlorn looking children to take their pills. Nate came to get me so we could hang out while he was getting his treatment, and we passed a small pharmacy, private rooms where people were receiving similar drip treatments, and other people waiting quietly in the hall.

The treatment room was a hot, airless little box with two beds and clean sheets. An Indian man lay napping on one of the beds, a needle in his hand and another drip suspended from nails hammered into a make-shift coatrack. I was starting to see a trend in the doctor's treatments and started to mention to Nate that maybe we should get a second opinion on monodrug treatment when I was reminded that, well, we were already here and things were already a bit decided.

I was keeping a hawk's eye on all hygenic procedures, and aside from the fact that the clinic had some innovative adaptations for medical equipment, things looked passable. I was happy to get out of there, and -- aside from a feverish evening after Nate insisted on going bodysurfing in Robertsport ("I only bodysurfed for 20 minutes!"), he's getting better.

Still, we're more committed to getting on prophylaxis now and have heard that cotrimoxazole (spell that), the broad-spectrum antibiotic that children living with HIV take to keep infections down, can be used to keep the parasite away. We're not sure of dosage, but I have a pack of them on my desk. I don't want to do this again.

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