a quandary


Note: No one cares about the stuff I drone on and on about below, except for me and perhaps a few other frustrated people searching the Internet for answers to their paludisme prevention pains. So feel free to stop reading right here, I won’t mind.

Commence rant:

Apart from endless sexual and other harassment, which I will write about when I have the energy to channel all the rage and frustration it inspires, my biggest issue here is self-made, in a manner of speaking. The doxycycline that I was taking as a malaria prophylactic was making me nauseous and giving me terrible acid reflux every single day. If my stomach was anything less than 100% full of 100% non-greasy food (which is pretty hard to find here), my gag reflex would go off apropos of nothing. I was in the middle of filming an interview, for example, when a wave of nausea washed over me and in order to fight it back, I had to turn away from the interview subject as she was speaking, and just stare at the ground while gripping my chair for a few minutes. Not great. I felt like a pregnant woman because I was always snacking and always suffering from something akin to morning sickness, a queasiness that was more in my head than my stomach. 

When my two month doxy supply ran out, I decided to switch to the much more expensive but supposedly much less problematic malarone. I spoke to several people who advised me to just get off the meds altogether because malaria is not a big problem in Dakar. But because I’m filming all over the place and also intend to travel to even more malarial areas and also am the world’s biggest worrier, I wanted to give malarone a go before calling it quits.

I was on malarone for five days before I said enough is enough and stopped taking them. I was still queasy, still had a lump in my throat from constant acid reflux, and also had increasingly terrible stomach issues unlike anything I have had here before. I decided it would be better to go through a three-day spell of malaria than a three-month spell of severe, constant discomfort (not to mention the long-term liver damage both doxy and malarone cause).

That’s what pretty much every ex-pat I’ve spoken to who’s in Africa long-term has preferred as well. The problem with going off drugs and just using lots of DEET, though, is that I’m horrified at the thought I might get the really serious kind of cerebral malaria that kills you. Before I went to the Philippines I saw a travel doctor who looked at the CDC website and told me I only needed a Japanese encephalitis shot if I would be spending a lot of time in rice paddies or other standing water. I told her I’d be filming fishermen on a bay but that was not standing water so we decided I could forego the inoculation. Then I got to the Philippines and realized that both islands where I was based were covered with rice patties. I became obsessed with avoiding mosquito bites since I wasn’t protected from this horrible mosquito-borne disease that apparently only shows symptoms in ten percent of the infected, but kills half those people and leaves another third with permanent brain damage.

The last day of the shoot, I opted to pee along the side of the road rather than bucket flush in a decrepit gas station. I thought it was hilarious and was joking about flashing random Filipino drivers… until I got to the airport and noticed four itchy welts on my butt. I realized that my aversion to germs literally bit me in the ass, and I spent the next ten days – the Japanese encephalitis incubation period – convinced I was going to die a miserable death because of one idiotic choice.

So that’s why even though everyone is telling me that malaria is barely an issue in Dakar, I’m still uneasy being off meds. I emailed my travel doctor to ask whether I might be able to try a lower dose of doxy, like a kid’s dose, since I’m practically kid-sized, and maybe that would help me to handle it. I also asked whether barring that, it would be okay to go on and off doxy every time I travel to more malarial areas. This man was raised in Haiti, but he has obviously drunk the American doctor Kool-Aid because he wrote back that he cannot advise me to take anything other than what is indicated, and that what is indicated for all of Senegal including Dakar is 100mg of doxy per day.

I also noticed that you are supposed to start taking doxy two days before you travel and stop taking it a whopping four weeks after, so going on and off doxy every time I go to more malarial areas would effectively mean just taking it permanently.

I feel like I have one option left, which is to get a whole bunch of probiotics from the American friend I’ll be seeing next week, take those for a month, and start up the malarone again in the hopes that my stomach issues were not from malarone itself but from getting off two months of antibiotics and letting my unarmed stomach fend for itself against a tidal wave of foreign food that wasn’t a problem when doxy was killing everything. Once my stomach is appropriately fortified maybe it will react better to another onslaught of strong medicine. And if not – if I go through another bout of sickness – I guess I will have to call  doxy the least terrible of several very terrible options and suck it up.

In short: fuck mosquitos. Or as the Dalai Lama so cutely puts it: mosquitos are ungrateful. They live off your blood; you’d think they could show some thanks or at the very least not infect you and/or your baby with terrible illnesses.


(Photo above: another reason I am hesitant to go off malaria medication. Mosquitos love me. This is the result of one night wearing sandals and forgetting to apply bug spray. It appears as though one enterprising mosquito created a literal constellation on my foot – the Big Dipper in bug bites. The other foot was not spared. I counted more than twenty bites between them but couldn’t be exactly sure where one hive ended and the next began.)

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