The International Schools Review Forum

We're meant to be moving to a high risk area for malaria. Our hope is to stay there for 5 years, possibly longer. Has anyone been in a high risk malarial area long term? If so, did you always take medication?

I'm thinking malarone might be the one I need to take. I'm not sure about taking it for 5 years. If I'm usually in my home or classroom (both closed off and air conditioned) maybe I could risk it? (At least until the pandemic comes to an end?) Any thoughts or personal experiences appreciated.

I knew two colleagues that lived in areas prone to Malaria. One described long lasting negative effects such as hormonal issues and fatigue. The other had serious neurological issues that put him the hospital for months.

I've known others who took the meds short term who had no serious issues.

We took doxycycline daily in Africa, which was inexpensive and available at any pharmacy. It's another daily medication like malarone, which we preferred because we could stop taking it over the summer when we travelled back home and resume taking it about a week before going back to work. My family didn't have any negative side effects from it, so we personally had no issue taking it long-term. We also had a couple of coworkers get malaria, which got rid of any ideas about risking it.

I have lived in malarial areas. The best thing to do is have a 3 day treatment of malarone with you (think 3 pills a day), and if you THINK you have malaria, do the three day treatment.

Disclaimer - I have never had malaria, despite two years in a malaria zone with others getting it, but I was told this by two colleagues who had lived longer in malaria areas, had done this a couple of times when they thought they had it, and ended up not coming down with it because of being proactive.

I wouldnt risk it. What medication to take depends more on you in my experience.
Doxycycline is a daily dose, can be started days instead of weeks before travel, is inexpensive, readily available, few side effects, well tolerated, and offers some protection against other infections mainly ticks and infectious diarrhea. The majort issue is you have to take it daily.
Mefloquine is a weekly dose, must be started weeks before travel, costs more, less available, can have some mild side effects, in rare cases neurological problems, new users should start a 4 week cycle prior to departure to gauge their tolerance and side effects, and can be used as a standby emergency treatment in cases where prophylaxis isnt used (2 doses 8 hours apart). The major issue is its only once a week.
I took Doxycycline but had a small supply of Mefloquine available. There were those like @SJ who went the standby treatment route and didnt use a prevention regiment, who also didnt get malaria.

Generally they are well tolerated and effective over extended periods of time, but as you get closer too 5 years or longer the long term effects are less understood.

Malaria meds are not really feasible long term. Too many side effects. Doxy would mess me up, and one of the other meds can make you hallucinate. I don't know any expats who took malaria meds long term (except maybe daily doses of gin & tonic...)

As shadowjack mentioned, the key is to never ignore symptoms as this is where malaria can get dangerous.

You are far more likely to catch dengue, and it's nasty. In SE Asia, the school of thought among expats was that if you get dengue, you will wish you had malaria instead.

We lived in Tanzania for 3 years. We took malarone for the first 6 months and then stopped. It's really expensive and not feasible to take it long-term. You wear proper clothing and bring bug spray and sleep under mosquito nets. Eventually, people get it. Two of our children did get it and they were not serious cases. We had friends who lived on the coast where it's a constant issue and they lived there 3 years, no medication, no malaria.

I used Malarone for holidays, but as said it's expensive and therefore not a good long-term solution.

But as you probably know: it's good to inquire here, but don't make your decision based solely on the advice of these (or any) ISR forum members.
It would be better to get your information from your future colleagues on the ground (if you haven't already), or join a local expat Facebookgroup and ask around there.
It would be best to ask a proper medical doctor, preferably one in your new country who knows more about the local risks and the local availability of medicine.

The gin and tonic is a thing, tonic water contains quinine which was an still is a malaria treatment, though usually the amount in commercially available tonic water is too small to be therapeutic.

I disagree with @Heliotrope, listening to a FB group is not the way to go. You want to talk to your IS, find out what the situation is locally, whats typical and what options are available at what cost, then take that too your doctor and possibly a doctor who specializes in travel medicine and then under their counsel and care find out what works for you and your family. Malaria kills people, and you dont want to make life and death decisions base on any internet forum.

It seems we actually agree.

As I said:
It's good to ask around here.
It's better to ask people at your IS and other locals on the ground (the FB group is a way to get in touch with expats familiar with the local situation).
It's best to ask a medical doctor (I'd personally go with a doctor in the OP's future country who is used to deal with expats and knows best what the local risks are and what medicine are best suited for that country/city).

@Heliotrope

We disagree.
You wrote it.
FB is not a source to consult with in regard to medical matters that could be life and death.
I would not recommend solely relying on the recommendation of a local physician in the host area until after consulting with MY personal physician. I trust MY doctor, and the associate physicians and medical professionals they refer me too, which differs from what you would personally do.

PsyGuy wrote:
> FB is not a source to consult with in regard to medical matters that could
> be life and death.

That's why I wrote it's best to ask a medical doctor.
And FB is not less reliable than this forum - they're all just personal experiences from individuals without a medical background (except the odd one that does), which can be useful to do some further research yourself and can be the basis for some questions to your doctor, but these experiences and opinions shouldn't be the sole grounds for making a medical decision.
I would however put more faith in experiences of expats in the city I'm moving to then ITs on this forum who don't even know which country I'm heading to.

Personally I don't think my personal doctor will know better what medicine to take when living in Ghana than a local doctor who comes highly recommended by other expats and who is used to dealing with expats and with malaria, but everyone can make that decision for themselves of course. If the OP trusts their own doctor more, go to them. Some medication you need to take before arriving anyway, so it might not be unwise to do so, but I would follow it up with a visit to a local doctor once I arrive and make adjustments if they recommended it.

@Heliotrope

Yes FB is less reliable, in so much as you dont understand what reliability is as this forum has a much smaller user base and variation in opinions. Validity or accuracy would be more relevant, and yes this forum is more valid and accurate than FB, because everything is more valid and accurate than FB.

It would appear I have a grater degree of reliance in MY personal physicians skill, knowledge and ability than you have in yours.
What you would do and what I would do appear to be different things, thus in disagreement.

I agree with Heliotrope and PsyGuy that you should def ask a doctor.
Prior to that asking expats who have been there a few years already and have all gotten advice from various doctors could be helpful, either using FB groups like Heliotrope suggests or using expat forums like InterNations. Your school might also be a good source. Nothing beats the advice of a doctor though.