When the Queen bites in Khartoum

Indian Expatriates in Sudan may have an impression that since we have had malaria back home once or more than once, we are immune to malaria in Sudan. This may be a misconception. Here is a case of a couple who has been struck by malaria even after a decade’s healthy living in Khartoum. You may think that you have had flu or influenza or viral fever but it may not be so. Don’t forget the rains have caused water logging in your neighbourhood which is ideal for the breeding of mosquitoes. You may have been bitten by femme fatale- the female anopheles mosquito. It is this bite that transmits the malarial parasites. Your Blood Film Test for Malaria Parasite may be negative but the symptoms of intermittent fever with shivering and vomiting may persist. This is when you should insist on the confirmatory Immuno Chromatographic Test (ICT) for Malaria and to your surprise it may give a positive result. Once you are confirmed to have malaria, the treatment in Khartoum, Sudan is not like what is back home. It is the treatment of uncomplicated falciparum malaria (the more dangerous type). Physicians don’t take a chance here even if your Blood Film Test shows that you have trophozoites (feeding stage) of Plasmodium Vivax (the common less harmful bug that causes malaria). Well this is of empirical value which comes through experience that there is every possibility of mixed infestation of both Plasmodium Vivax (less dangerous parasite) Plasmodium Falciparum ( near fatal parasite). If you are an adult you need to take eight injections of Artemether 80mg. First day 2 injections (12 hourly) followed by once daily total of eight. The injections are to be taken on your buttocks and make sure you are in safe hands with gloves and disposable syringes. On the day of the last injection you need to take three tablets of Sulphadoxine + Pyrimethamine, popularly known as Fansidar tablets, after dinner. It may not be available in the pharmacies but it will be available with 6 tablets of Artesunate. The Artesunate has already been administered through intramuscular injections. Now one needs to consume only the three white tablets in the pack.

If you think that eight injections and 3 tablets have taken care of all the malarial parasites, again you may be mistaken. There may be some hypnozoites- sleeping bugs comfortably sheltered in your cozy liver. Most of the relapse of malaria occurs when these dormant parasites wake up and start feeding on our red blood cells. Primaquine 15mg tablets are to be taken once a day for 14 days. Now Primaquine tablets are not available in Sudan. It will be a good idea to get them next time when you are in India.

During these days eat light which you can digest easily. Drink a lot of fruit juice but avoid extra sugar.

One has already lost at least a week’s working days. But you are still drained out of energy because these malarial parasites have literally destroyed your red blood cells. You need to administer haematinics- medicines that help you build blood.

Don’t keep your doors or windows open and use mosquito repellents at home. You will never realize when the queen mosquito comes and kisses you. Keep them away and stay safe.

The above piece is no prescription for malaria. It is only a guideline from practical experience and the dosages given above are only for adults not children. Please consult your Doctor whenever you feel that the female anopheles mosquito has touched you. Keep safe.