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Guyettes and Guys,
As expected the response was fairly startling (although I was this time
more used to it seeing as the same thing happened on the Camera Forum)
and so I thought I'd post it directly. Right now, a little less than 24
hours later, the response count is 27 posts. For those of you not
interested, you can always hit the Delete key and if I offend some of
you because it is not strictly topical, I apologise.
Understand please that it was written for the U/W Camera Forum and I
have not deleted any of the stuff pertinent only to that list.
Cheers, HTH,
Christian
OK: Caveats, Disclaimers and Warnings: I am not a doctor of any kind nor
am I a scientist of any kind. ANY opinion here written by ME is MY
opinion based, quite simply, on my common sense or lack thereof. You
choose to use what I say at YOUR risk. Equally if you choose to use the
methods of other people that I might quote, then you do that at YOUR
risk. As well I will refrain from those legalese platitudes like "I
understand", "as far as I am aware", etc. Please consider those as read.
Nor will I emphasise any point in quoted material I consider important.
If you are that interested you should be able to establish those for your=
self.
This is a broadcast message, available to the novices as well as the
experts. Thus I have catered for the novices and if the experts consider
some (?) of what I say here as tiresome (bin there, dun that kind of
stuff) so be it. My apologies nevertheless.
Sorry about all that. :-7
Some may want to on-forward this, or some of this, material. Therefore I
have purposely avoided conventional quote marks since they can be a
PITA. If I quote another I will start, and end, with the following:
I QUOTE:
END OF QUOTE
First off, URL's. I have purposely not shown those of the likes of DAN,
we all know those:
http://www.suggskelly.com/lariam/
This URL is lawyer based. Seems as if this group of lawyers is doing a
class action. The page takes a devilishly long time to come up
(typical?) but if you are remotely considering taking this prophylactic
you owe it to yourself to persist. There are also some great links.
http://www.who.int/inf-fs/en/fact094.html
http://www.cdc.gov/travel/malinfo.htm
http://www.idrc.ca/books/reports/1996/01-08e.html
http://www.cdc.gov/ncidod/publications/brochures/malaria.htm
If after that lot (and their links) you can't become reasonably informed =
=2E..
So, to the practical side.
What follows comes, very practically, from PNG:
I QUOTE:
CHEMCARE
Morobe Pharmacy
P.O. Box 349, Lae, Papua New Guinea
Phone (675) 4726195 Fax (675) 4726590
Email: 4thst.pharma@gl*.ne*.pg*
09 November, 1999
RE: Malaria in the Highlands of Papua New Guinea
Christian,
I am making contact with you on behalf of Rodney Pearce of =91BARBARIAN=92=
regarding your email about malaria in the highlands.
In short, malaria has become a recognised problem in the highlands in
recent years although I have seen data available through the MALARIA
SURVEILLANCE UNIT based in Goroka suggesting that there have always been
some malaria problems up off the coastal regions.
The growth in the problem is attributed to a number of factors:
1) Increased movement of the population between the coast and the
highlands because of improved transport facilities and roads and
increased economic activity in the population
2) Movement of the Anopheles Mosquito (carrier of malaria) into the
region, presumably due to the environmental changes, namely a general
warming of the climatic conditions in the highlands caused by
deforestation and global warming.
The combination of the above has resulted in more people who are
infected with the malaria parasite on the coast travelling to the
highlands, where having been bitten by existing populations of the
Anopheles Mosquito, they then transmit the infection throughout the rest
of the population.
Note:
-The Anopheles Mosquito has been clearly identified as existing in the
Goroka, Mt Hagen and other various Southern Highlands regions, by the
Malaria Surveillance Unit in Goroka
-Your are quite correct in assuming that the spread of malaria is
altitude and thus temperature dependent, however, these factors are not
absolute barriers to the spread of the infection ... for example, if a
client was to fly direct to Mt Hagen to attempt an ascent of Mt Wilhem,
avoiding any lengthy stay on the coast, there would be no guarantee that
the person would not be bitten by a malaria-carrying mosquito.
To conclude, our best advice to all travellers to PNG, is to take all
precautions against malaria infection no matter where they intend to go
=2E.. coast, highlands and all in between.
The level of protection required will depend on a number of factors:
-For example, someone staying just in Port Moresby for a couple of days
will have an extremely low risk of contracting malaria due to the
dryness of the climate there and the lack of breeding habitat for the mos=
quito.
-Someone staying in one of the coastal provincial centres, e.g. Lae,
Madang , Wewak etc, going on bushwalks around the centre and say off the
dive boat during the course of a charter would have to look at maximum
protection both externally (clothing, repellents etc) and with oral medic=
ation.
Preventative Medication ... in order of effectiveness and increasing
side effects: Adult doseage only
a) DOXYCYCLINE 100mg Tablets: One tablet daily with food,take at the
same time each day. (This drug is ONLY for prevention,it has NO
efficacy when taken on it=92s own in treatment=85must be combined with ot=
her
drugs during treatment)
b) PALUDRINE 100MG Tablets: Take TWO tablets daily with food, take on
the same day each week, at the same time. **This drug has only recently
re-emerged for use ... in the 1960=92s and 1970=92s, the excessive usage =
of
the drug lead to high resistance in malaria strains, resulting in a
virtual zero effectiveness as a preventative treatment ... the lack of
use over the 1980=92s and early 1990=92s has allowed the resistant strain=
s
to dissipate and allow the use of the drug once again ... especially in
children who have allergic problems with Chloroquine.
c) CHLOROQUINE 250MG Tablets: TWO tablets ONCE a week with food. Take on
the same day each week, at the same time. **Chloroquine 250mg
Tablets=3DChloroquine BASE 150mg Tablets
d) CHLOROQUINE 250MG TABLETS x 2 plus MALOPRIM TABLET x 1: Take this
combination ONCE a week, with food. Take on the same day each week, at
the same time. ***This particular combination (Chloroquine plus
Maloprim) has fallen out of recent recommendations due to the adverse
effect of Maloprim on liver function and blood counts =
=
e) MEFLOQUINE (Lariam) 250mg Tablets: Take ONE tablet ONCE a week, with
food. Take on the same day each week, at the same time. **This drug is
recognized as the strongest preventative treatment currently available,
however, Health Department recommendations here are that the drug only
be used in the short term by transient travellers and is not to be used
in the long term (longer than 3 months =3D 12 doses) to avoid possible
resistance developing and adverse effects caused by extended use ...
sleep disorders, liver function/blood count abnormalities.
****Regardless of which drugs above are used, the schedule must begin at
least two weeks prior to departure (to make sure there are no immediate
allergy or adverse effect problems), while in the exposed region, and
for at least 4 weeks after leaving the region (malaria can have up to 7
days of incubation prior to onset, thus medication must be continued to
eliminate any primary stages of the disease).
The major adverse effects associated with all of the above are basically
two areas: gastrointestinal ... stomach discomfort, cramps, diarrhoea,
some skin disorders ... most common in short term use, typically
holidaymakers and travellers. The effects of greater concern ... organ
function, blood counts ... are usually associated with the long term use
by residents and contract workers etc.
In conclusion, one must remember that not every person who visits PNG
contracts malaria ... yes they do get bitten, sheer mosquito numbers
dictate that especially on the coast, however every bite is NOT
necessarily a transmission ... the key to a safe holiday is sensible
prevention, namely appropriate clothing, repellents and medication
suitable for the age and medical history of the person (hence a need for
consultation with a qualified medical practitioner).
=
The above information has been developed through my experience of
operating in retail pharmacies in PNG over the last six years, dealing
with the national population, expatriates and tourists ... I have
worked in Alotau, Port Moresby and, currently, Lae ... I work for a
company operating fourteen pharmacies throughout PNG, from the coast to
the highlands.
I hope this helps ... if you require any detailed information regarding
TREATMENT of malaria, please let me know and I shall send you the
relevant information.
Homer Caris B.Pharm
Manager
END QUOTE
Uhh, the Barbarian? Been on her three times. Serious diving and
photography, serious results. Check with me (privately) if interested.
Yep, always paid my way.
LIVEABOARD DIVING:
In recent days we've heard of DEET from a number of listmembers and I
quote my response to someone else who inquired:
I QUOTE:
Thanks for the warning, OK I've traveled quite a bit but I've never had
to prepare for this. Just what do I need to take
1) A ***SERIOUSLY*** neurotic attitude towards mosquitoes, and if you're
laughed at you just might have the last laugh!!! I can't emphasise this
enough, I *used* to know some Oz divers.
2) RID insect repellent (available in Oz, made in Oz). Liberally applied
to exposed areas (including socks and a bit above them).
Active 160g/L N,N-Diethyl-M-Toluamide (DEET)
constituents: 20g/L N-Octyl Bicycloheptene Dicarboximide
10g/L Di-N-Propyl Isocinchomeronate
1g/L Tricolsan
(g/L =3D grammes per Litre, (sorry, can't do th=
e
conversions from home)
You probably have an equivalent in the US but if the worst comes to the
worst, I'll mail you some. Conventional insect repellents *don't* do the
trick. You'll only really need all this between dawn and dusk (and
thereabouts). Dark(ish) coloured long sleeves, long trousers, shoes (not
sandals) with longish socks. You'll also only need it on land. Why?
3) Because once at sea you spray (take it with you), thoroughly, all the
nooks and crannies, *all* the indoor areas with insect spray. Feel
stupid doing this? You'll feel infinitely more stupid if you don't and
then get malaria. After that provided all the mosquitoes, if any, have
been killed you don't have worry any more until you reach land again.
If, however, the natives paddle out in their dugouts, as they're likely
to do if you are close enough to land, they can bring them with them.
4) Back home if you feel at all out of sorts for the next couple of
months, *immediately* go see a doctor with some knowledge of tropical
diseases and explain where you've been. The important thing here is that
they take blood tests *whilst* you are feeling feverish which is when
the bug is in the bloodstream and not secreted away.
END QUOTE
These sentiments are also shared by Deb Fuggitt for one.
LAND BASED DIVING:
is another kettle if fish entirely and I consider that the most
important thing you need here is a mosquito net (closely followed by
Deet) ... oh and a sufficiently large bed such that you do not end up
hard against the net. If it is not a conventional hotel with air
conditioning etc, if, for example, it is a bure, it would be nice if the
windows and doors are also mesh covered (in addition to that mosquito
net). Means that you can hose the place down with insect spray EVERY
late afternoon (or whenever later that you get home) and then keep
everything closed.
If you _must_ look at that gorgeous sunset whilst sipping a cocktail or
whatever, I strongly urge you to do it from behind glass.
PROPHYLACTICS:
They are NOT a panacea.
I do not believe in prophylactics. I consider that none of the experts
can agree on which one is effective (if any) in any given area. The
Anopheles mosquito has been established as being resistant to many of
them. I think dependence on _any_ prophylactic is a lottery, one that
you are most unlikely to win. Then there are the known (and unknown)
contraindications to these things particularly when it comes to divers.
I went, many years ago now, to the Solomons (Spirit of Solomons, great
boat at least in those days, very photog friendly) with my Club and my
roommate, a good friend, took Lariam. He was off the planet for half of
the trip, until I finally persuaded him to stop taking the wretched drug.=
I make no apologies for the possible effects of (strong applications of)
Deet. I point out that it is an application which will usually be used
during a very narrow timescale (in the instance, usually, of this Forum).=
My final piece of advice: be paranoid, be VERY paranoid and if you're
laughed at, why, you might just have the last laugh albeit a very ironic =
one.
--
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