Malicious Mefloquine

The following is a letter I sent to Peace Corps prior to my departure for Togo, West Africa in September 2007. Some content has been edited for privacy reasons.

***************************************************************************************************************

It is my understanding that all Peace Corps Volunteers sent to Sub-Saharan Africa are to receive Antimalarials, also known as Malaria Prophylactics. For this particular region of the world, there are three currently used prophylactics that fight against the asexual blood stages of the malaria parasite: Mefloquine (Lariam), Doxycycline (Vibramycin), Malarone (Atovaquone and Proguanil). Mefloquine, the most widely prescribed prophylactic by the Peace Corps and worldwide, has proven to be 90% effective in the prevention of malaria. However, it has also proven to have the following side effects:

Ø Physiological reactions:

o Upset Stomach/Nausea

o Vomiting

o Diarrhea

o Stomach/Abdominal Pain

o Loss of Appetite

o Ringing in Ears

o Headache

o Sleepiness/Drowsiness/Fatigue

o Insomnia

o Tingling in Fingers/Toes

o Difficulty Walking/Driving/Operating Machinery

o Seizures/Convulsions/Shakes

o Sweating/Chills

o Liver Damage/Disturbed Function

o Eye Damage

o Hearing Impairment

o Malaise/Bodily Discomfort

o Fever

o Leucopenia/Low White Blood Cell Count

o Leucocytosis

o Thrombocytopenia/Low Platelet Count

Ø Musculoskeletal reactions:

o Muscle Cramping

o Asthenia/Lack of Strength/Muscle Weakness

o Myalgia/Muscle Pain

o Arthralgia/Joint Pain

Ø Skin Disorders:

o Rashes

o Exanthema/Skin Eruptions

o Erythema/Skin Redness

o Urticaria/Hives

o Pruritus/Itching

o Alopecia/Loss of Hair

o Stevens Johnson syndrome (rare)

Ø Neuro-Psychiatric reactions:

o Neuropathies – sensory & motor: Paresthesia, Tremor & Ataxia

o Tinnitus & Vestibular disorders – Dizziness/Loss of Balance

o Unusual/vivid Dreams/Nightmares

o Nervousness/Anxiety

o Mild-Severe Depression

o Changes in Mood

o Panic Attacks/Paranoia

o Forgetfulness/Memory Loss

o Confusion

o Hallucinations

o Agitation/Violent Behavior/Psychotic reactions

o Suicidal Ideation/Suicide

o Disruption of Neuronal Calcium Homeostasis causing Neuronal Cell Death & Injury

o Permanent Brain Stem Injury

o Overt Psychosis – losing touch with reality (reported 1:6,000-10,000 or 1:800 for treatment dosages)

Ø Cardiovascular/Circulatory reactions:

o Hypotension/Low Blood Pressure

o Hypertension/High Blood Pressure

o Tachycardia/Rapid Heart Rate

o Bradycardia/Slow Heart Rate

o Irregular Pulse

o Cardiac conduction disorders

o Cardiac Arrest (when combined with Quinine or Quinidine)

Many people experience little or no serious side effects when taking Mefloquine, however, there is NO guarantee as to who or who will not experience any or all of the above-mentioned side effects. Often times, those people that do experience the more serious side effects may experience them years (and sometimes permanently) after using the prophylactic. Studies also show an increased susceptibility to young women and users already under mental or physical stress. The FDA is currently investigating 600 reports of adverse reactions to Mefloquine, half of which include some kind of psychiatric side effect, such as 13 cases of suicidal thoughts, 4 attempted suicides and 1 actual suicide death. There are also several pending lawsuits, some initiated by former Peace Corps volunteers, against the use of Mefloquine as well as investigations in high-profile military incidences caused by Mefloquine use. Over and over, I have read and heard accounts from former Peace Corps volunteers and Military personnel who have experienced many of the above-mentioned side effects some of which have lasted for years after service. All too often those same Peace Corps volunteers have been made to feel guilty and ridiculed for complaining to their Medical Directors and Peace Corps Staff about their symptoms. Senator Chris Dodd, D-Conn & former Peace Corps volunteer, and Senator Dianne Feinstein, D-Cali, have both called for further investigation into the effects of Mefloquine. I have attached Senator Feinstein’s letter for your reference. In fact, even the pharmaceutical company Hoffmann-La Roche reissued warnings about the adverse effects of Lariam (Mefloquine); I have also attached their statement as well for your reference. The University of Edinburgh’s College of Medicine urges travelers taking Mefloquine to seek out alternative antimalarials. Even Wikipedia suggests using other vaccinations, like Malarone and Doxycycline, with less risk of severe side effects, which are equally effective in malaria prevention.

Malarone is probably the newest prophylactic on the market, and therefore, one of the most effective vaccinations against malaria. Studies show that there is a 98% prevention rate for Malarone verses Mefloquine’s 90% success rate. Malarone, while it does have side effects, including: headache, fever, dizziness, nausea, vomiting, insomnia, rash and hair loss, is substantially better tolerated than Mefloquine. Most notable is that Malarone does not report any Neuro-Psychiatric side effects. Malarone is just as available as Mefloquine since its approval in August of 2000; however, Malarone is more expensive than Mefloquine since the dosage is a pill taken once a day, whereas Mefloquine is a pill taken once a week. Dr. Patricia M. Young, M.D., Medical Director, International Travelers Clinic, Medical College of Wisconsin states this about Malarone, “I currently recommend this medication as the drug of choice for travelers entering areas with chloraquine-resistant malaria.”

The third alternative is Doxycycline. The most notable side effect, aside from diarrhea, fever, nausea, vomiting, rashes, blurred vision, hypertension, GERD and esophageal ulcerations, is the extreme photosensitivity. Reports have come in from users complaining of second and third-degree burns. I, personally, have had second-degree burns caused by sun exposure, which caused blistering, and nausea as well as an increased risk for skin cancer.

Under no circumstances will I take Mefloquine. Furthermore, I am appalled and astounded that than organization that stresses the importance of Volunteer safety and security uses Mefloquine as their primary malaria prophylactic for Peace Corps Volunteers, especially after all the research and reports that have come out regarding its dangerous side effects. Not to mention, the denial of such side effects by the Peace Corps and lack of accountability is beyond me. Entering into Peace Corps service, living and working in a foreign land and adapting to a new culture for an extended period of time are already extraordinarily stressful undertakings. I cannot fathom why the Peace Corps would subject their volunteers to any additional, unnecessary mental strain when there are two other, equally effective malaria vaccinations. In addition, I am not willing to take the risk or gamble my mental health to even try and see if I have any adverse reactions to Mefloquine; I refuse to be a guinea pig. I am fully aware that the two other prophylactics possess side effects, however neither of them indicate any adverse psychiatric reactions. My first choice for malaria prevention is Malarone, with Doxycycline in a distant second. If the Peace Corps cannot offer me an alternative to Mefloquine, then I will be forced to rethink my decision to enter the Peace Corps. I really hope it does not come to that.

Sincerely,

Marie

Attachments:

Ø FDA 2002 Safety Alert – Lariam

Ø Hoffmann-La Roche publication on Lariam

Ø Letter from Sen. Dianne Feinstein

Sources:

Ø The University of Edinburgh College of Medicine – Anti-malarial Agents: www.link.med.ed.ac.uk/RIDU/antimal.htm

Ø Wikipedia: Mefloquine

Ø Medline Plus – Drug Information: www.nlm.nih.gov/medlineplus/print/druginfo/medmaster/a603030.html

Ø Lariam (Mefloquine) Side Effects Lawsuits: www.lariam-lariaum-side-effects.com/pages/lariam_side_effects.html

Ø The Journal of Neuropsychiatry & Clinical Neurosciences – Cognitive and Neuropsychiatric Side Effects of Mefloquine: http://neuro.psychiatryonline.org/cgi/content/full/13/2/302

Ø Healthlink – Medical College of Wisconsin: http://healthlink.mcw.edu/article/979237802.html

Ø Medsafe – New Zealand Medicines and Medical Devices Safety Authority: www.medsafe.govt.nz/consumers/cmi/m/Malarone.htm

Ø EMedTV – Health Information Brought To Life: http://antibotics.emedtv.com/doxycycline/doxycycline-side-effects.html

Bilambiliba

Today marks the one year anniversary of the death of Mr. Djagri, my Togolese counterpart in Kpatchile, Togo. As I was walking home today I was thinking about all the things I wanted say about this day, about what happened and about my regret.

It was a Monday morning when the first person arrived at my house to bring me the news. It was Mr. N'Ghantche, president of the cantonal village development committee. I remember being shocked but not surprised. Mr. Djagri had been sick since March, about six months. Every time I saw him, I asked after his health and learned about what new medicines and healers he had seen, none very effective. Unfortunately, without proper medical facilities, staff, medicine or money available, my counterpart continued to seek help, in my opinion, in all the wrong places. I urged him to go to Kara, the regional capital, and go to a proper hospital, relatively speaking. He eventually did, but not until it was too late.

The last time I saw Mr. Djagri alive, he was sleeping in a dim room on worn out couch cushions. He was so skinny and had lost so much weight that his rib cage was clearly visible and his arms were the size of my wrists. Normally, he was already a small man. He reminded me of a black Robin Williams with a baseball cap, popping peanuts into his mouth and a cute little chuckle. I recall my gasp at seeing him that last time on the floor, and I knew then with certainty that he was going to die soon. This was the first time I had ever been exposed to anything like that. I urged his family to get him help, but they told me by that time they had no more money left. He needed some kind of surgery that he could only get in Lome, Togo's capital, and even then there was no guarantee that he would survive.

Two more people visited me that day to tell me Mr. Djagri had passed away and each time it got harder and harder to hear. The family buried him that morning in a grave directly in front of his house, covered in cement. I missed the burial, which at the time, I was upset, but in the end, it was probably better that way. The Togolese do not really express sadness openly, so when I arrived at the memorial and openly wept, a woman approached me, tried to pull my hands away from my face and tell me to stop crying. I got angry and pushed her away. That day I did not care about cultural norms. I was going to have my grief and express my sadness whether it made other people uncomfortable or not. I mostly just sat there with my head in my hands and cried while the villagers talked and drank and ate. It didn't seem that different from my own culture. Just before I left, I noticed that the family had a picture hanging next to the entrance of the house, and as I walked by I saw that it was the picture my friend, Jamie, had taken of me and Mr. Djagri in the marketplace, drinking calabashes of Tchouk. I walked away as a new set of tears emerged.

I spent the rest of the day on the floor of my house crying and sleeping, sleeping and crying. Mr. Djagri was someone I had known for two years. He had welcomed me into his village and his home. He helped me set up countless meetings, some productive some not. He was my translator, and when I was upset about work, he was my sounding board. He was always giving me food even though he probably could have used it more than me. He did the best he could. He did too much; I think he was on multiple committees and a full time farmer and Tchouk drinker. I wept that day partly because I could not believe he died and partly because I felt like I failed him. I should have taken him to Kara. I had the means. But, I didn't. I have no excuses. My host family that day told people that I was "sick" that day to keep them from bothering me.

I must have purged myself that day since the next day I felt remarkably better. Life moves on. Mr. Djagri passed away on September 28th, 2009. He widowed three women and orphaned twenty-two children. This is why I do not support polygamy. In the aftermath of his death, one of his oldest sons, Emmanuel, came to me repeatedly to discuss his struggle to find the means to finish his last year of university. In the end, I gave him the rest of the money he needed to finish school, and I am very happy to have at least done that. I think I owe it to his father.

I sometimes think that even those closest to me do not fully understand all that I experienced when I was in Africa, so this is my way of sharing my story and allowing myself to heal and move forward. I hope to one day go back to Kpatchile and see Mr. Djagri's family again and maybe lay some flowers on his grave. May he rest peacefully.

Untying the Knots

Now is a good time to reflect on my impressions and experiences in Togo as a Peace Corps volunteer.

I must admit that the last four months I was in Africa were some of the most stressful moments of my life, so my return to America was a welcome respite. September brought with it distinct highs and lows, beginning with the excitement and luxury of the Close of Service Conference. However, it was quickly followed by a car accident and the death of my counterpart ("homologue" is the french word). October was riddled with the anxiety of saying goodbye to the village and people I now called "home," in addition to the frantic scramble to compile two years worth of work into legible reports. Perhaps a glutton for punishment, I spent a tumultuous two weeks with my significant other and obsessing about how to spend the six-week, post-service vacation I allotted for myself.

Overland travel throughout Western Africa is not a small, comfortable feat. Six weeks of sitting in hot, dusty, overcrowded buses, dodging the vomit on the floors for ten hours at a time is not for the weak or faint of heart. Then imagine, sleeping on dirt floors, or if we were lucky, in grungy hotels, on sheets that looked like they had never been washed. Our destinations weren't resorts on the beach, but meeting your boyfriend's family which is hard enough when they are from your own culture, let alone a completely different one. African families love to force feed strangers, which instead of becoming a pleasurable experience became one filled with dread. Traveling is inherently stressful, so if we didn't like each other so much, we may have parted ways, especially since I was the sole funding source for the expedition. That is an aspect I do not recommending copying. So, it is not entirely unimaginable that I eagerly welcomed the familiarity of my family's faces and a hot shower upon my return.

To be continued...

Goodbye

The twenty-eighth of September two thousand nine

Today my homologue died.

Gripping Surreality

9/29/09

I am uncertain I can stop crying long enough to recount the tale. First, you should try to pronounce his name. Bilambiliba. Try to imagine what a black Robin Williams might look like. That’s him.

Some things that are flashing around my mind are the way he laughs – his shoulders shake a little, his chin is tucked towards his chest, he’s smiling and making a scratching noise in the back of his throat.

It always kind of annoyed me the way he ate peanuts; he wouldn’t place them in his mouth. It was more like a projectile launch from around the region of his chest to his mouth. But, why be annoyed by this? Death has a way of turning a person’s idiosyncrasies into something dripping with nostalgia.

He was one of the only people here that consistently gifted me yams, as if I am lacking the resources to eat let alone march out into my courtyard and pound yams in a giant pedestal and mortar. But, we know this is not the thinking. What about his family? I am the one who should be giving him food.

It’s what breaks my heart now. What are his three wives and twenty-two children supposed to do now? He now makes my case against polygamy here. There are so many things wrong here. What a mess. The least of my concerns now is polygamy.

I feel just a little more defeated when one of the good ones is lost. This world needs all the gems it can get its dirty, grimy hands on.

I went to the burial yesterday. I lost it, just f**king lost it. I didn’t care. Some woman tried to make me stop crying by clawing at my face. People don’t show this kind of emotion here, not really, not as an adult, not even when someone dies, at least, not publicly. Since this death was personal, all bets were off and I went there with all my American sentimentality hanging on my sleeve.

It’s amazing how much his brothers, and definitely one in particular, look like him. Every time I saw that brother and the sympathy I felt for him it was enough to bring forth fresh wells of tears to my eyes.

What really got me shaking with grief was seeing the photograph famed and hanging next to the entrance to his home. It was us – my homologue and I having a calabash of Tchouk in Kossia’s stand at the market. How classic.

A votre santé!

Vous reposez en paix.

Like sands through the hourglass, so are the days of our lives

My last day as a Peace Corps Volunteer: 11/11/2009!

But, I won't be back in America until just before Jesus Christo BDay.

Material Dreams

8/24/09

My host sister Freesia is about 13 years old; age can be an abstract thing here where the day of the week is often more important than the year in which you were born. For the most part, aside from a migration from Ghana to Togo when she was just a wee tot, Freesia hasn’t ever really left the Dankpen prefecture. A prefecture is similar to a county. In fact, she’s never really left my village. So copying her older brother’s trip to the regional capital two years ago, courtesy of my predecessor, I wanted to offer his hard working, slightly timid, younger sister the same opportunity to see the bustling city of Kara, the regional capital. We spent two days in Kara meandering the streets and avoiding kamikaze moto drivers and one day in Guerin-Kouka, the prefectural capital of Dankpen, serving a nice transition back to village life. My purpose for doing this was to have her see for herself and possibly imagine a life and future filled with more than water pumps and mud huts. The tall buildings, the paved roads, the electricity, the running water, relative ease of transportation and access to resources all help to keep her focused on her goals, to know that there is more out there. It’s strange to say it, but they give hope for a brighter future and to avoid catastrophes like HIV/AIDS, early pregnancy and abandoning school. If girls like Freesia can see that their dreams are real, tangible, it makes them more inclined to pursue and realize those dreams.

During our plunge into the urban jungle, I was most excited to witness Freesia’s reactions to various scenarios. It was her first time eating in a restaurant, it was her first time staying in a hotel, it was her first time using a flushing toilet and running water, it was her first time eating Fanmilk (think ice cream) and it was her first time seeing and using a computer. She giggled throughout the Microsoft Word and Paint demonstrations. I don’t think she’s ever eaten so well in her life, meat or protein with every meal. We slept in. We gazed at people, taking in all the sights, sounds and smells of big city life. She remarked at how large everything was: the city, the hospital, the market. She noticed all the women riding around on motorcycles, some even driving cars. Where she comes from, girls are lucky to even own a bike. I gave her some money and made her go into the market to buy presents to bring back to her family, teaching to navigate a market five times the size of her village’s as well as managing the funds to buy gifts for five people. Despite all this, what made me happiest was when we finally returned home. Amidst the signature belly laughs of her mother, Kossia, and squeals from her cousin, Hannah, I heard her recounting all of her experiences to her family. Freesia is not the most expressive person at times, but the perma-grin told me a lot. I was and am just happy I could do something like this for her and I am guessing she is too.