Oh Sorry Sorry, Is it Malaria?

I haven’t been feeling well for the past couple of weeks. Unfortunately, it coincided with the arrival of cement for DEB. I could opt not to work, as I don’t get paid for it, but it would reflect poorly on my abilities in the community. Plus, I’ve learned that I’m not one to sit and watch someone else do the work. For some reason it makes me feel incredibly uncomfortable, even if I’m paying for the labor. I feel obligated to help in some way, to do something.

So the sickness only worsened due to the building work, face full of cement and dirt all day, and the freezing temperatures of the dry season, all equally contributing. Everything has become twice as hard to do and I find myself without energy. People ask why they haven’t seen me around or if I’m alright, and I tell them I have been very sick. They respond with:”Oh sorry, sorry, is it malaria?”

Malaria is very common here and the most common ailment that people get sick from. The health center, fortunately, gives out Coartem, but not everyone is so lucky. After briefly doubting my own memory of taking my weekly anti-malarial, I was reminded of our extended health sessions on malaria.

Malaria is taken very seriously in Peace Corps. Anyone that contracts it, and is discovered not to have taken their anti-malarials, will be medically separated and sent home. We are required to carry a supply of pills (Meflaquin for me) along with a regiment of Coartem. All of us probably already have malaria, as there were plenty of mosquitoes in Dedza, but the anti-malarials ensure that the virus stays in the liver, containing it. Thus, we have to take the pills regularly, so it can keep containing it for our time here. At the end of service we are given pills that will kill the virus in our system. If at any time the anti-malarials wear off and new doses aren’t ingested, the virus leaves the liver and enters the blood stream.

There are three types of anti-malarials Peace Corps offers, depending on the drug’s side effects for each volunteer. Meflaquin is the most common and lowest cost. It is taken once a week, but lasts in the system for 14 days. So even if you forget to take it for a few days you will still be alright. The only problem with Meflaquin is that it has a lot of mental side effects. It not only causes the sharpening of every emotion, but also severe depression. Regular anger turns to fury; you may become moody, easily irritable. Sometimes these symptoms take time to manifest.

The other two drugs do not have such side effects and generally cost more: Doxy and Malarone. The most common anti-malarial in Malawi is Doxy. The only pain with Doxy is that you have to take it every day. Granted it has none of the mental side effects of Meflaquin, it does cause skin sensitivity to the sun, leading to sun burn. And there is little leeway; if you forget to take the pill for a few days you will probably contract malaria.

Once we do contract malaria, or are very ill and assume we have malaria, Peace Corps has specific procedures to follow. First is to call the medical office from the nearest phone/network you have available. After informing them of your symptoms, if they believe it may be malaria, they will ask you to send a blood sample. This is the fun part. We had an entire session in training dedicated to taking our own blood samples. We spent an hour pricking ourselves and squeezing blood out of our fingers and preparing two slides.

In each of our med kits is a set of slides and a little needle contraption to prick ourselves. Unfortunately, if one does have malaria, this entire operation will prove to be quite tricky. First, we clean the area on our fingers with a sanitizing wipe. Then we prick the area with a needle. After pricking ourselves, ensuring it’s deep enough to get the blood out, we squeeze our fingers until the blood starts to come out. We have to make two slides for the medical office: one thin and one thick. So, we squeeze one or two drops of blood on one slide, spread it thinly using the glass plate as a brush, and cover it with the plate. Then we squeeze a pool of drops on the second slide, a thick layer, and cover it with a plate. We store the two slides in a zip lock bag and put it in a cardboard tube. The tube then, somehow, needs to be sent to the medical office in Lilongwe for analysis.

If you have a health center in your area, sometimes the medical office approves for diagnosis there. If it turns out you have malaria, then you start Coartem. But as always, here transport and communication are difficult to come by, so the process has an added layer of difficulty.

In training it took a while to get a good prick in my finger, surprising how tough the skin layer is. It took several painful tries, but eventually I managed to get enough blood out.