Lariam Dreams

I am asked periodically whether I am taking a Malaria prophylaxis. The answer is both yes and no.

Marlaria is endemic to Cameroon, with common varieties being of the kind that burrow deep into your liver and stay with you for the rest of your life. Needless to say, the prospect of having a parasite holing up in my vital organs for any length of time wasn’t too appealing, so before I came I went on Mefloquine (also known by its brand name Lariam). Mefloquine has gotten a bad rap for having side effects ranging from violent dreams to psychosis. The other options presented to me were A.) Long term antibiotics – not an option in my book or B.) a new drug (Malarone, I think) said to be effective with fewer side effects, but taken daily at $US 5 a pop, and so not in my budget.

Anyway, I get here and discover that the only foreigners taking prophylaxis are employees, either directly or indirectly of the US government. (and to be fair, those attached to agencies of other governments take it as well.) It seemed that nobody at my school was taking any special precautions. Certainly people who live here for any length of time don’t take any. A popular opinion was: “the prophylaxis is worse than the parasite. Better to get it and treat it.” And there do seem to be drugs that treat malaria effectively, as long as you catch it early. Coartem® was the emergency pack handed to me after I stopped taking Mefloquine. Yes, about a month after coming to Cameroon, I stopped taking prophylaxis.

Then, several things happened. More accurately, one thing happened again and again: one by one, all of my fellow foreign hire teachers got Malaria. Yes, this was inevitable, you say, and perhaps it was, given the odds. I had the chance to experience vicariously what the disease was like. Consensus: “I was ready to die.” One of the teachers had such a bad experience that she went on prophylaxis after she recovered (of course, she’s leaving in a couple of months.) I did notice, however that all of the bad cases of Malaria seemed to come after trips to Kribi, Duala or Limbe, destinations at lower elevations where Malaria is both stronger and more prevalent than up here in Yaounde. So back in November I decided to compromise. Before and after I leave Yaounde for warmer climes, I go back on Mefloquine, as a tourist might. In fact, I’m on it right now, having just returned from a trip to Duala. This strategy seems to have worked for me so far.

Have I enjoyed any psychosis as a side effect of taking Mefloquine? No, I haven’t, at least not that I’m aware of. I have had a couple of strange dreams, though. One I am sure was directly caused by the medicine because it came the night I took my weekly dose and is too unusual. In the spirit of the blog, I relay it to you now, as it was recorded in my journal the next morning.

I wake up in the morning and find a long nail hammered deep into my forehead. I stand in front of the bathroom mirror and slowly pull it out, realizing only as it comes out how improbably long it really is. A little blood comes out of the hole as the nail pops out. I feel no pain whatsoever, only the dull sensation of pressure. I become anxious. How did this nail get into my forehead? Who would want to do this? How was a nail hammered into my head without my waking up? I must have been drugged. How can I sleep again knowing that someone is after me? At this point I wake up, shaken but without nail.