Sunday, August 28, 2005

Last minute

Yesterday we took our first malaria prophylaxsis which actually went very well, considering getting the stuff was such a trial.

Since we returned from the beach last Saturday there were a few odds and ends to finish up. These weren't exactly inconsequential, for without getting our passports or tickets we couldn't even depart our homeland. But having the car picked up and starting our meds were important as well.
Everything was completed on schedule, but when Ian spoke with a specific FSI nurse... well, she's never been our favorite person. We'd decided long ago to choose Malarone as our prophylaxsis of choice. After looking it up in my drug book, reading the literature from the clinic and talking to those who have taken the various options, Malarone seemed the best choice for our family. While it's a daily pill, it has the least number of side effects. Our other options were Larium/Mefloquine and Doxycycline. The former is weekly and can have neuropsyhiatric side effects (depression, sleep disturbances, nightmares, hallucinations, and occasionally, convulsions). The latter is daily, causes sun sensitivity and is contraindicated for humans under the age of 12.
For obvious reasons, we didn't choose Mefloquine. For obvious reasons, we couldn't choose Doxy.
On Wednesday, Ian learned the clinic doesn't actually dispense Malarone, even though the clinic gives out information about it and lets the Officer decide. The nurse pushed Mefloquine but that was the last drug we wanted. Ian came home with adult dosage Doxy in unsplittable capsules... for the whole family.
We argued about whether taking it once would hurt anyone with the intent of switching to Malarone at post, we argued about pulling the capsules apart and guessing at children's dosages (though they're on the paper, we don't have a way to measure mg at home), we even considered relying on Off insect repellent until landing in Lome' and getting meds direct from the Peace Corps clinic.
On Thursday, after some sleep, we considered other options.
With a call, we knew SA-1 didn't carry Malarone either. My dad encouraged me to call his physician for a prescription, but they wanted to make appointments and register the entire family as new patients. No time for that, the office gave the number for Smart Travel (703-379-8645) on King Street, a spot for travelers to obtain travel meds. They're closed on Thursdays. Time was running out, so we bit the bullet and went back to FSI to exchange the Doxy for Mefloquine, with the understanding that if we all did OK with it (side effects usually appear within the first 3 dosages; there's a 5%-50% chance of having some form of negative reaction, so with a family of 6... you do the math) in three weeks we'll know whether to switch completely or stick with it. The clinic was closed when we arrived.
Friday, after the car drove off to Baltimore to get on a slow boat to Togo, Ian returned once again to FSI, spoke with the nice nurse on shift and aquired our meds. Finally.
You're supposed to begin taking Mefloquine 1-2 weeks before departure, but since we were so late already, another day wouldn't matter. The drug is effective within 20 minutes of entering the bloodstream. Dehydration exacerbates potential side effects and the nurse had anecdotal evidence that taking it in the morning lessens the chance of reacting badly, so our game plan:
Saturday morning
Big breakfast
Lots to drink
Think it'll work? I'm not certain. Last night Nicholas had a nightmare, tonight he's already woken screaming. It could be nerves, he's been anxious about this move for a while. I really hope it's nerves.
Oh, Rebecca and Nicholas get kudos for taking their pills yesterday. Down the hatch, no problem. Katherine had flashbacks to her INH days and gagged on them. Jonathon spit his out into his drink and just let it dissolve... then unwillingly drank the slurry.
P.S. My thoughts are with those in Katrina's path. Maybe building a city below sea level wasn't a good idea? I hope all stay safe.

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