As with many developing countries, the threat of malaria in Bangladesh is a very real danger to the people who live here, though the malarial zones in this country are smaller than in other countries afflicted with the disease. Carried by mosquitoes, the effects of malaria can range from flu-like symptoms to much more severe consequences, including the onset of coma and death. Volunteers posted to these countries have no inherent immunity to the disease and are just as likely to develop malaria as anyone else who lives here without the proper prevention being in place. For most of us, this means taking one of the antimalarial drugs prescribed as prophylaxes for the prevention of the onset of the disease. Each of these drugs has side effects that differ in severity and kind from person to person. The widely-prescribed doxycycline can burn one’s throat, damage the liver or cause an over-sensitivity to the sun, a rather regrettable side effect in sub-Saharan Africa. Malarone has been touted as an effective alternative with few side effects, but the cost of the drug, combined with a required daily dosage, makes it unattractive for agencies responsible for providing the drugs to a large number of long-term volunteers. This leaves Lariam, or mefloquine, as the remaining alternative for people at risk of contracting malaria. But as many people have discovered, the effects of the drug can be almost as dangerous as the disease it’s meant to prevent.
The warning posted in the VSO Health Handbook provides a clue as to the particular risks invited by taking Lariam:
People with a history of epilepsy, cardiac arrhythmias, anxiety, depression or other psychiatric problems, or those who have not reacted well to it in the past, should NOT take mefloquine.
Common side effects listed include stomach upset, insomnia, dizziness, vivid dreams and anxiety or depression.
An assurance is included at the bottom of the section that any side effects that do occur are usually “transient and tolerable”.
Well, I guess that all depends on your love of giant insects. Having spoken with a few volunteers in Nigeria about the side effects they experienced from Lariam, some listed hallucinations so severe that they decided the risks posed by malaria were preferable to the mind warp that Lariam induced. One described the sensation of having something crawling on her leg and looking down to find a monstrous maggot the size of a terrier coming up to greet her. Another volunteer had regular visits at night from a ghostly figure sitting at the foot of her bed, an annoyance for sure, especially if the damn thing can’t carry on a decent conversation.
And me? I have Ronald Reagan.
I’ve been taking Lariam for the last eighteen months, and I can happily report that I’ve been one of the lucky ones who haven’t suffered severe psychotic episodes as a result of taking the drug. But this doesn’t mean that I haven’t been affected by my weekly dosage. The most significant side effect has been its impact on my dreams, which have been elevated from pleasant distractions to something approaching performance art.
On most occasions, the dreams are innocuous, though they do bear the worrisome hint of underlying insanity. My afternoon with Ronald Reagan is a good example. Now, I must admit, growing up in the 1980s, I was a fan of the President, being at that young and impressionable age where his charm and personality meant more than a careful consideration of his policies. But since he left office twenty years ago, I can’t say that he has occupied my mind. So, I’m at a loss when it comes to explaining why I chose to dream about spending a few hours with Ron and his family. The selection of appetizers we enjoyed was impressive, as Nancy had ordered in quite a spread, but the mood in the Reagan home was anything but buoyant, as Ron had just lost his bid for re-election. In real life, of course, Reagan had rolled over Mondale to gain another four years in the Oval Office. My dreams may be vivid, but they do take artistic liberties. Despite my best efforts to console him, Reagan remained downcast throughout the afternoon. Things didn’t improve when George Bush (Senior, not Dubya) called the house to offer his condolences and complained to Reagan that I answered the phone by saying “Hello, this is the Kennedy household”. (For the record, I said no such thing.) Somewhat soured by the Bush accusation, Reagan banished me to the kitchen, where I took solace in drinking all of their filtered water. Maybe it was all of that water, but I woke up then with an overwhelming need to pee, so I didn’t find out whether Reagan and I were able to patch things up. And I guess I never will.
The dreams sometimes drift into nightmares, and even these have proven to be entertaining. One night, I became convinced that our bedroom had been invaded by rats that were now targeting our bed. Feeling one of the nasty beasties brush my arm, I snapped awake and jumped up in the bed. Making a break for it, I found my escape blocked by the mosquito net, so I began madly pawing at it to find an opening. Meanwhile, the rustling behind increased, so I knew the rats were right behind me. With a flashlight, no less. “What are you doing?” Kristel asked, and I spun around to look at her with a wild wide-eyed look that was likely equal parts frightening and hilarious. I collapsed on the bed in relief and tried to explain, in the nicest way possible, how I had mistaken her for a pack of vermin. Luckily, she was still laughing too hard at my deer-in-the-headlights impression to be offended or banish me to the sofa.
Providing the side effects of the Lariam never go beyond these Presidential dreams and rodential nightmares, I’ll consider myself lucky and keep taking the drug. But the night that I wake up to find Reagan and Bush in bed with me is the night that I flush those damn pills down the toilet and take my chances with the mosquitoes.