Mefloquine Dreams

So obviously living in a country where malaria is one of the top five causes of morbidity and mortality, I have been doing well to follow my doctor- prescribed course of preventative antimalarial prophylaxis. My doctor prescribed Mefloquine to me, which is one of a number of drugs available for prevention of malaria. As it was explained to me, I was put on Mefloquine rather than any other drug because some are known to cause heightened photosensitivity, which would be a serious problem because I am both very near the equator and at a much higher altitude than I was in Wisconsin, so the sun is a good deal more intense. There is also a good deal of drug resistance, but apparently malaria in Kenya is still sensitive to Mefloquine. I also only have to take it once a week, so I had to carry a lot less pills than the once- a- day doxycycline folks. It seems as there were a number of compelling reasons to go for Mefloquine and to be honest my doctor didn’t really discuss any options with me, just handed me a prescription.
Here’s what they didn’t explain to me and what I probably should have realized before I departed: Mefloquine, according to the FDA, has an impressive list of side effects including “severe depression, anxiety, paranoia, aggression, nightmares, vivid dreams, insomnia, seizures, birth defects, peripheral motor-sensory neuropathy,vestibular (balance) damage and central nervous system problems”. None of those actually seem to desirable to me. I haven’t had any issues with my balance so far and I’m no more anxious than you all know I’ve always been, but let me tell you the vivid dream thing has happened to everybody here that‘s on Mefloquine. When you think of vivid dreams you probably think maybe a particularly intense dream once in a while, the kind where you still remember a lot of the details when you wake up. This is not the case. Sometimes it’s hard to tell dream from reality because there’s a very seamless transition from dream to waking and I’ll often remember word- for- word the conversations I had in dreams, or they’ll be really pertinent to what’s going on in my daily life.

So far I’ve been lucky because none of the dreams have actually been that unsettling, just strange. But there have been a lot of cases in which Peace Corps volunteers get sent home before the end of their contracts because they can no longer distinguish dream from reality or they experience serious mood issues. Oh, and get this: in the 1990’s there was an issue called the Somalia Affair. A Somali citizen was murdered while in the custody of peacekeeping troops from Canada. Mefloquine toxicity was implicated in the incident. Cases of this severity are few and far between and I plan on returning to the US with my sanity mostly intact, however.

It’s frustrating to be in a situation in which we’re constantly reminded about the dangers of living in Nairobi, or where we see cases of extreme poverty every day, and to have some stupid medication creating heightened feelings of “paranoia and depression”. It also really puts things in perspective, because as I dwell on disturbing, or even comical, dreams, there are thousands of people around the country that have no access to antimalarials. Or they get a drug to treat an existing case of malaria, but instead of one person in a household taking a full course of treatment, all five people that are sick in the house each take a day or two worth of medicine, so nobody recovers.

In related news, this may seem like a Debbie Downer post, but I am in fact still having a wonderful time here, I’m glad to be here and looking forward to helping at the clinic I’ll be working at even if my contribution is almost insignificantly minute. There’s a lot to take in every day and always a lot to think about.