I first knew something was seriously wrong when I couldn’t eat the spaghetti. Granted, it wasn’t the best spaghetti ever, cooked over a fire on the rocks near the top of the tallest mountain in Sierra Leone, West Africa. But it was better than the large rodent our guide had shot and cooked the night before, and I should have been famished after a day and a half of sweaty jungle hiking.
But the nausea was too intense. I gave up on the spaghetti, packed my gear, and started shuffling. It felt like the longest day of my life, getting down that mountain. I trudged, staggered and slipped my way down, alternately boiling and shivering in the sticky jungle heat. Just one foot in front of the other. Left, right, left, right…
An eternity later I dragged my dazed self into Sinekoro village. Surrounded by dozens of staring children I pitched my tent in the chief’s front yard, grabbed the luggage I’d left at base camp, and zipped the tent closed against the rows of curious little eyes. Finally I was able to dig out the prize I’d been thinking about all day long: my malaria test kit and a packet of treatment pills.
Ten minutes and a lot of bloody finger pricking later, I was staring at a positive malaria test. Well, shit.
Falciparum malaria, the kind prevalent in West Africa, is usually very treatable but occasionally has been known to kill in less than 24 hours if untreated. And here I was in pretty much the most remote part of Sierra Leone, at least a day’s drive from medical care. The next step was obvious: I swallowed the first malaria treatment pill from my emergency stash, choked down a few crackers, and passed out into a feverish sleep.
Rewind a couple months to Uganda, where I’d started my five month journey in Africa. I watched a fellow visitor succumb to malaria only 5 days after his plane landed, technically faster than the shortest possible incubation period but verified at the health center by blood test. He had been taking prophylactic pills, as was I. But as many travelers to Sub-Saharan Africa eventually realize, no prophylactic medication for malaria is 100% effective.
I felt horrible for him, but his misery ended up being an unintended gift to me. Watching him puke for days, unable to choke down even the mildest cassava that our lovely host family could concoct, the reality of malaria hit home for me. And I was about to head to remote parts of West Africa, the most malarial region in the world, alone and with very limited knowledge of the local languages.
Before leaving Uganda I dropped by a pharmacy and picked up a malaria test kit and course of treatment pills, no prescription needed, not even a second look from the pharmacist. It cost a couple of dollars. Cheap insurance, I reasoned, and buried it in the bottom of my pack.
Now, back in my tent in the Loma Mountains in Sierra Leone, that kit and medication felt like my lifeline.
Recovery and New Friends
The next day I accepted a ride back to Makeni with a group of NGO workers who happened to show up for the hike on the same day I did. Their air-conditioned Land Cruiser treated me much more kindly than the motorbike taxi I would have taken otherwise, but still it was a rough day. My stomach churned and my teeth ached strangely.
We blew our last spare tire on the rough dirt road. I lay down in the dirt beside the car as others ran to the nearest village for help, staring up at the tangle of jungle and wondering if I had finally pushed things too far.
The happy ending is that I recovered well, resting up in my new friends’ house during the three day course of treatment for my relatively mild case. For a scared solo traveler very far from home, their hospitality and friendship were therapeutic far beyond the physical. On the fourth day I reluctantly said bye and hit the road again, rattling eastward in a battered shared taxi toward Liberia.
In the end it makes a good story, one of those travel rites of passage that gets good reactions when people ask about the craziest parts of my trip. But malaria is no joke, for travelers or for locals who unfortunately suffer far more of the consequences.
Must-Know Tips About Malaria and Travel
Obviously I’m not a doctor and you should consult one – ideally a doctor who specializes in travel medicine – before your trip. But I do want to share the following tips to give you a sense of the risk and the precautions you should be considering before any trip to a high-risk malarial area.
First of all, check out this great resource about malaria for travelers.
To highlight a few key points:
- Malaria is spread by the bite of infected mosquitoes which are most active from dusk to dawn.
- Malaria is treatable and most people recover without serious complications, but it can occasionally be deadly, especially for young children, old people, and pregnant women.
- There are several kinds of malaria in different regions around the world, and some are resistant to certain treatments. Therefore, it’s important to use the right medicines in the right areas.
- There is no surefire vaccination against malaria, but many travelers to risky areas take a preventative medicine (also called prophylaxis) to lower their odds of getting the disease.
The risk is real.
Some parts of Sub-Saharan Africa have the highest risk of malaria in the world by a factor of about 100. If you’ve been to Southeast Asia, for example, and didn’t take the pills (been there done that) don’t compare the two. Do your research and consult a travel doctor to find out if your destination is a high risk area, as it does vary from country to country and even town to town.
You should take preventative medication when visiting a high risk area.
Here’s a good overview of several different drugs for malaria prevention. I’ve always taken Malarone, which is considered a good choice because it has few side effects, but it’s often the most expensive. In the US many health insurance plans won’t cover malaria prophylaxis, only the treatment, so the cost for a long trip can add up. I found major discounts by using GoodRx and choosing my pharmacy carefully.
Even if you take preventative medication, you can still get malaria, so it’s important to take other precautions.
All it takes to become sick is one bite from an infected mosquito and some bad luck. Therefore, don’t skimp on the bug repellent, and cover up starting at dusk. I thought I did all these things, yet still the bites popped up from time to time. Here are the basic must-do’s:
- Use bug repellent, especially starting at dusk. I like this kind from Ultrathon because it goes on like lotion. Apparently it’s popular with Peace Corps volunteers in Africa so presumably it’s good.
- Cover exposed skin starting at dusk.
- Sleep under a mosquito net that has been properly tucked under the mattress and does not have holes.
- Bonus: consider soaking your clothes in permethrin before traveling.
If you’ll be traveling to remote areas, get yourself a test kit and treatment pills once you arrive in a larger town or city.
The locals keep this stuff on hand (usually not the test kits – they know the symptoms so well) and self-treat without hesitation. You can get it very cheaply and easily from a local pharmacy once you’re there.
Obviously I’m not a doctor and the choice to self-test and self-treat is yours. There are certainly risks, like using the wrong medication or incorrectly treating a different and serious disease. But I believe it’s nice to have the option when the symptoms hit and you’re far from any health center.
Note: if you’re from the US like I am, you can ask a travel doctor to prescribe emergency malaria treatment but they might refuse. I asked and was told that if I became ill while traveling I should seek treatment right away instead of risking self-treatment for the wrong thing. In hindsight I realize that doctor didn’t understand the realities of travel in this part of the world, a place where getting to treatment within a day or two may not even be possible. I’m glad I ended up taking matters into my own hands.
Start treatment as early as possible.
My case ended up being relatively mild and many people told me it was likely because of two factors: I was taking prophylactics, and I began treating right away. I’ve talked to people who delayed treatment for a day or two and ended up half-conscious in a dodgy rural clinic with an IV in their arm for days. That’s another whole set of risks you’d rather not deal with. If started early the typical treatment is pretty routine, takes only three days, and is usually extremely effective.
Travel Lessons Learned
In addition to learning more about malaria than I ever wanted to know, this little adventure taught me some general lessons that apply to both travel and life.
Seriously dangerous situations often happen when multiple things go wrong at once.
I’ve read this about search and rescue missions in the outdoors as well. Often we can recover from one problem, for example getting malaria, if everything else goes ok. But if we’re unlucky enough to have multiple things go wrong – for example getting malaria in a remote place, not having treatment available, and then getting delayed with a flat tire on the way back to civilization – that’s when we can really run into trouble.
The takeaway from this is that it’s smart to think through your backup plans for the potentially serious things that actually could go wrong. Don’t make yourself anxious thinking through every scary thing that could possibly happen, but think carefully about the few things that are truly your biggest risks from a statistical perspective. Then imagine what you would do if it all hit the fan, so to speak, at once. If cheap and easy backups exist – like buying travel insurance or carrying emergency malaria treatment to remote places – then put them in place.
We need to take responsibility for our own safety.
No one cares about your own safety as much as you do or knows the details of your situation as well. When my doctor told me I didn’t need to bring emergency treatment, I believed her. It was only when I arrived on the ground in Africa and understood the situation for myself that I decided to go against her advice and get some anyway. Always think critically about what people tell you and don’t be afraid to go against it if you have good reason.
Certain types of travel demand more risk assessment and preparation.
Do you travel solo, in remote places, and/or in places where you can’t communicate easily because of language barriers? Are you crazy enough to do all three at once? I adore this kind of travel and I believe it’s safer than all the naysayers like to think, especially if you’re a woman. (In which case everyone seems to think we’re going to instantly die a gruesome death. Don’t even get me started.)
However, I’ve learned from experience that this type of travel does carry more risk for any traveler, simply because you have fewer options if something does go wrong. This doesn’t mean we shouldn’t do it. It just means we need to do our homework, think through the most realistic risks we face, and figure out if there’s anything we can easily do to reduce them.
Have you ever had malaria? Or have you saved your own butt by making a smart decision on the road? Tell us about it in the comments!
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