Although I know many that go without, anyone travelling to a malaria rich area like Sub-Saharan Africa, should take anti-malarial meds. It’s almost stereotypical, and is seen by many as a symbol of the colossal failure of African economies to create hygienic environments, or an indication of the terrifying blackness of Conrad’s “Dark Continent” spoken to scare privileged white children at night. The truth is, that it’s only been in the past 60 years that the United States successfully eliminated malaria, and even more recently that Europe experienced it’s last indigenous cases. For the rest of the world, malaria is still a fact of life, such as that which has been the norm for all of human history. To this day, the number one killer of children worldwide is malaria.
Meds now have come a long way since the discovery of quinine, a miracle drug which allowed the white man penetrate his parasitic, resource extracting tentacles ever deeper into the African continent. Now, for those of us who were not born in a malarious area, we can safely travel to places which would likely kill us, or leave us incapacitated to the point where we wished we would die. Some medications are more expensive than others, but they all have a similar bizarre side-effect which varies in intensity according to how much you are willing to pay. Anti-malaria meds induce nightmares.
I don’t dream, or, should I say, I don’t remember my dreams, perhaps mostly because I don’t sleep well. However, on malaria meds, I do. These dreams are graphic to the point of being past NC-17, vivid and detailed visions of bloody dissections and exposed bone, of horrid beasts and killings performed with the precision of a scientist. It’s frightening to wake up from one of them, as the thread between dream state and awake state is often thin under the fog of being rustled from mid-sleep. The world is often still tainted with the color of blood red and pristine white bone matter against a back drop of gray tinged blackness that seemingly extends without bound. Fortunately, the details are quickly forgotten.
While the nightmares are reportedly milder on the meds I take (Malarone, $3.00 a pill, taken every day), persons who take cheaper meds such as Doxycycline and Mefloquine report graphic visions, sometimes leading to the point of insanity. Doxycycline prescriptions often recommend a psych evaluation. The suicide rate on Doxy is extremely high, one of the highest of all prescription meds, and the context in which they are taken likely doesn’t help. Women report commonly of graphic sexual assaults, almost as if the drug plays on the individuals greatest fears. During waking hours, hallucinations on Doxy are common.
For many that come to countries in Sub-Saharan Africa, the reality of actual human suffering, insanity and depravity comes as a shock. Against a back drop of contented smiles and a level of happiness absolutely unknown in the depressed and debilitatingly lonely developed world, one sees evidence of the spoils of disease. Walking TB and HIV cases publicly teeter on the cusp of death. Common are the scars of burns, some perhaps intentional, and mysterious lesions that could be the results of accidents or attacks. Worse yet is the linear gash of a panga knife across a head or face, remaining as a testament to the incredible violence that Africa is famous for.
Conversations with Africans will reveal that incredible 1 in 10 people, who tell tales of seeking refuge after entire witnessing entire families murdered in the midst of conflicts like the 30 year Mozambiquan civil war, of abductions by rebels in Somalia or of witnessing the decomposing results of mass killings by rebel groups. It’s a fucked up thing, and although the US is no stranger to violence, we do a much better job of keeping its victims sequestered silently away. Here, people will smile and casually relate horrific stories of senseless and disgusting violence as if relating any other past memory. In the US, we’re not allowed to talk in real terms about violence, and if we do, we’re considered weak and somehow deserving of our fate. Here, it’s a fact of life.
My feeling is that suicides on Doxy and Mefloquine are fed by this grim and terrible reality and the inability to parse out the apparent contradictions between a continent full of some of the most mild mannered people on the planet, and the incredible capacity for mass insanity and bloodshed. We rationalize things in the west, occupying our own separate compartments at the bottom of a greater hierarchy of powers. The heart is contained within the mind, which is contained in the body which is contained in the family, in the social group on up to the greater order of things. Here, the only order is as much that can be given on a day to day basis, security is only in the preservation of precious friendships and family relations, evidenced in Malawians incredible ability to remember those who even only casually pass through their beautiful country.