Together Against Malaria

Archive for the ‘What is Malaria’ Category

 

by Philip Yaffe

 

 

We live in a cynical age where the values of truth, honesty and integrity seem to be in short supply. We are therefore always looking for examples of such values in action, especially with regard to politicians.

 

 

I would like to offer you such an example from Africa. You have probably never heard of this man, but for me he stands as a true model of integrity. It’s not Nelson Mandela, but Mr. Mandela would certainly be proud to have his name mentioned in the same breath with him. His name is Julius Nyerere.

 

 

Julius Nyerere was the man who led then Tanganyika, today called Tanzania, to independence from Britain in 1961. Unlike many other independence movements, this one succeeded without a single drop of blood being shed.

 

 

I had the privilege of living two years in Tanzania shortly after independence. Being a city boy (I grew up in Los Angeles), for me Tanzania was quite a revelation. I virtually lived in a mud hut, suffered through a drought, saw leprosy, and contracted both malaria and dysentery. All of these things affected me. But getting to know Julius Nyerere as a political leader was truly a life-changing experience.

 

 

When Nyerere became head of state in 1961, he was so popular that he could easily have taken on the trappings of a king or potentate. But he did exactly the opposite. He chose to live very modestly, because that was his nature.

 

 

More importantly, he inspired confidence in everyone, and never betrayed that confidence, because that also was his nature. He of course had political enemies. They were often critical of his ideas and policies – but never the man. The worst I ever heard anyone say about him was, “President Nyerere is doing all the wrong things for all the right reasons.”

 

 

Julius Nyerere was a realist riding a wave of idealism.

 

 

For example, shortly after taking office, he cut the salaries of all government ministers by 20-50 percent, including his own. Although by world standards these ministers very poorly paid, by Tanzanian standards they were very rich. Nyerere argued that such a poor country simply could not afford to maintain its government in such a lavish style. Any minister who refused the cut was invited to leave the government, and a number of them did.

 

 

In the 1960s, the first thing a newly independent country wanted to do was set up a national airline and rush to industrialise. Nyerere was different. He concluded that Tanzania could not become truly industrialised for at least a century. So instead of devoting all its energies and limited resources to trying to build an industrial base, it made more sense to strengthen its agricultural base.

 

 

This meant reforming the schools. Instead of turning out potential clerks, shop assistants and middle managers for the cities, the goal should be to turn out scientific farmers. These would then go back to their villages to teach their compatriots, who were mainly subsistence farmers.

 

 

Advocating this was close to heresy. Most people felt that the purpose of going to school was precisely to escape from the backward rural villages. There was considerably opposition to Nyerere’s idea, but ultimately it was implemented.

 

 

As a Peace Corps teacher in a boarding school, I could immediately see the difference. Suddenly, we were required to start a school farm and to grow much of the food the students would be eating. The students didn’t take kindly to having to do manual labour, but eventually the protests subsided and farming became part of the daily routine.

 

 

At roughly the same time, Nyerere looked at Tanzania’s university students, who were the elite of the elite. It is important to understand that there were only about a thousand university students in the country out of a population of nearly 10 million because Tanzania had virtually no educational base. At the age of 6, less than half the children were in school. There was a severe examination to go from primary to secondary school, which nearly 85 percent failed because there just wasn’t any place for them. So those who reached university were by definition the elite of the elite.

 

 

Nyerere noted that it took the total annual income of 78 Tanzanians to keep one university student in school for one year. To help cover the costs, he proposed that on graduation each student give two years to public service.

 

 

Once again, rebellion; the students went on strike. Once again, Nyerere stood his ground, declaring that as much as the country needed university graduates, it needed true Tanzanians more. He therefore closed the university for a year and sent the students back to their rural villages to rediscover their roots. Those who received good reports from their village headman were allowed to return the following year.

 

 

A neutralist during the Cold War, Nyerere was basically a man of peace. However, he could take military action when the situation called for it. For example, in 1978 he sent Tanzania troops into neighboring Uganda to oust the notorious dictator Idi Amin, who fled into exile.

 

 

When he retired as head of state in 1985, Nyerere took on the role of roving diplomat and peacemaker. Because he was so trusted, he was invited to mediate disputes all across the African continent. For instance, he was instrumental in bringing an end to the slaughter in Burundi in 1996. He also worked tirelessly to put an end to apartheid (racial segregation) in South Africa.

 

 

Nyerere didn’t look like the consummate leader he was. He was rather small and had a bushy little moustache that made him look like a chocolate Charlie Chaplain. But when he spoke and when he wrote, you knew that you were in the presence of someone special. He was affectionately known as “Mwalimu”, Swahili for teacher, which is what he was before going into politics. This was a sign of respect, not reverence.

 

 

I am not a very emotional person. But when Julius Nyerere died on October 14, 1999, I felt a sudden emptiness in me. It was as if something good had left the world. And it had.

 

 

Nyerere was a devout Catholic and in 2005 he was proposed for beatification. He is currently under consideration for canonization, which is one step away from sainthood. I don’t think I would put him on such a high pedestal. I didn’t necessarily agree with everything he did. But I never doubted that it was always for the best of reasons.

 

 

Every time I hear his name, I still feel the same emptiness I felt on the day he died. So if you are ever tempted to say that politics and integrity don’t mix, please remember Julius Nyerere. You will never find a better model of integrity, either in politics or in daily life.

 

 

Philip Yaffe is a former reporter/feature writer with The Wall Street Journal and a marketing communication consultant. He currently teaches a course in good writing and good speaking in Brussels, Belgium. His recently published book In the “I” of the Storm: the Simple Secrets of Writing & Speaking (Almost) like a Professional is available from Story Publishers in Ghent, Belgium (storypublishers.be) and Amazon (amazon.com).

For further information, contact:

Philip Yaffe

Brussels, Belgium

Tel: +32 (0)2 660 0405

phil.yaffe@yahoo.com, phil.yaffe@gmail.com

Malaria and travel

Malaria is a major international public health problem. There are enough statistics to prove the same and in order to protect ourselves against it , all it requires is common sense and an understanding of how the disease is spread.

To summarize, malaria is caused by a parasitic micro-organism called Plasmodium. Since there are four different types of Plasmodium that infect humans it stands to reason that there are four different types of malaria. There are a few other less common species but of limited health significance to us.

These parasites are transmitted by the female Anopheles mosquito. It is important to understand that only Anopheles can transmit malaria. If visiting an area endemic for or rampant with dengue , it would be useless and not to mention toxic , to binge on anti malarials since dengue is transmitted by a totally different mosquito – the Aedes species. Of course , standard mosquito repelling measures must be taken as usual since other mosquitoes transmit a fair number of other diseases as well.

The standard approach to dealing with this is traditionally described as ABCD

A – awareness

B – bite protection

C – chemoprophylaxis

D – diagnosis and treatment in case of infection

Awareness

This means to familiarize ourself with the area about to be visited … whether mosquitoes are present, what type of mosquitoes, what diseases are endemic , drug resistance patterns. Such information is constantly updated and hence it needs to be reviewed often.

Unnecessary panic is also unwarranted – in many cases mosquitoes are present but there might not be active malaria. Its good to follow local news and health reports to ascertain this.

Though many might be of the opinion that its safer to take the medicines before hand , sometimes it could be overkill.

Medicines – and in many cases high end ones, have to be started a week before and have to be continued for 2 weeks after returning from the area. It is an individual decision and there will always be arguments for and against it.

Bite protection

Anopheles mosquitoes generally have nocturnal feeding habits. Hence it is prudent to take maximum precautions during the evening and night. However , it must be kept in mind that other mosquitoes which are involved in spread of diseases like Dengue are daytime biters as well

Wearing clothes that cover arms and legs adequately as well as applying repellent on exposed areas usually works well – and in many cases obviates the need for taking medication. While sleeping its wise to use mosquito nets – those impregnated with repellents work even better.

A variety of insect repellents work , but the most effective one is DEET. Various formulations of varying concentrations are available and how often reapplication is required depends on the manufacturer.

Using electronic repellents which vaporize liquid formulations of insecticide is reliable .

They might be fancy pieces of equipment but most ultrasonic frequency emitters have been shown to be ineffective in repelling mosquitoes.

Often, the local practices for keeping the marauding insects at bay are most effective.

 

 

Chemoprophylaxis

This refers to the widespread practice of taking antimalarial drugs before , during and after the expected period of exposure to the mosquitoes. The idea being that it takes care of any parasites that might be in the blood as a result of a bite.

For the most part , all the routinely prescribed drugs are well tolerated , but side effects can occur. Mostly they are more inconvenient rather than outright debilitating , however in case of serious reactions , it goes without saying that medical attention is needed.

Drug regimes broadly fall into 2 types :-

Chloroquine resistant areas – where the parasite is no longer susceptible to chloroquine. This is the case with most areas. If not full blown – there is at least a moderate level of resistance. In such cases drugs such as Mefloquine, Doxycycline and Malarone ( Atovaquone + Proguanil) are the standard choices.

Chloroquine responsive areas – these are fairly rare in number . Chloroquine is rarely prescribed alone , its mostly given along with Proguanil.

A detailed review of dosages and side effects of anti malarial drugs, as well as special circumstances like pregnancy, is beyond the scope of this article.

Diagnosis and Treatment

In spite of all precautions , sometimes mosquitoes could find a chink in the repellent armor. If nothing else, they have sheer numbers on their side.

The good news is , malaria is very much treatable. In case there are no healthcare facilities nearby, it is wise to keep emergency medication ready. Consulting a doctor beforehand to understand symptoms of malaria and what to do in case you end up having it is a good idea.

 

GENERAL TRAVEL INFORMATION



Visa and Health Regulation:

Visa requirements vary from time to time and should be checked with nearest tourist office of diplomatic mission. Health certificates are required but these vary with country of origin and should be checked with relevant authorities. Yellow fever and cholera vaccinations are recommended. Anti malaria medication should be started prior to arrival.

Photography:

Films and batteries are available at most lodges but in restricted stocks and sizes so it is suggested you bring your own supply. A 200 mm to 300 mm telephoto lens is recommended for game and bird photography.

Much of East Africa is generally warm, minimal humidity and cool evenings. Temperatures vary with altitude.

Clothing:

Cotton, linen dresses, light slacks and short sleeved shirts are recommended. Bring a warm sweater, as nights can be chilly at high altitudes. Comfortable walking shoes, swim suit, sun glasses, suntan lotion, flashlight and an alarm clock will complement your safari gear.

Hotel Check in/check out:

Check out time is usually 1000 hours. Hence check in cannot be guaranteed before 1100 hours unless room is reserved from night before. Day rooms up to 1800 hours are usually available.

Accommodation and Meals on Safari Lodges:

Rooms are singles, doubles, triples and suites. Lodge facilities include lounges/bars with log fires, dinning rooms and viewing platforms. Most lodges have outdoor swimming pools.

Tented camps:

These range from simple luxurious and provide spacious twin beds with mosquito netting, private bathrooms and verandas.

Meals:

On safari, meals are provided on full board basis. There is full English breakfast. Lunch is often buffet style set out with salads, cold and hot starters and hot main dishes. Dinner is 3-5 courses with a combination of dishes.

Getting around

BORDER POSTS:

The major crossing point between Kenya and Tanzania is at Namanga, which is open 24 hours a day. Other crossings include Lunga Lunga and Taveta. The Ethiopian border post of Moyale is becoming increasingly dangerous because of civil fighting. The border was closed for a while but has now reopened. For those with four-wheel drive vehicles, a more adventurous route to the west near Lake Turkana is quite popular. Ask the locals for advice before trying this route. There is no border post on either side of the border crossing so you’ll have to get your visa stamped in Nairobi. Malaba and Busimia are the main Ugandan border posts. At present there are no overland crossings with Somalia and Sudan as it is not safe to cross unless part of a refugee convoy.

RAIL & BUS:

Wildlife Safaris Rail is a safe, reliable form of public transport. Passenger services run from Mombasa to Malaba via Voi, Nairobi, Nakuru and Eldoret. It is essential to book tickets two to three days in advance. Kenya has a good network of buses, as well as matatus (minibuses) and share-taxis, but none are very safe as drivers tend to overload and speed, and horrific accidents are reported regularly. Where possible, rail travel should be the chosen means of transport. Private 18-seater buses offer shuttle services connecting Nairobi and Mombasa with Arusha and Moshi in Tanzania, which are more expensive, but more comfortable and safer.

AIRPORTS:

Domestic air services operate between the major airports:

Jomo Kenyatta International, Nairobi (NBO)

Moi International, Mombasa (MBA)

A number of airlines operate between Nairobi, Mombasa, Kisumu, Nanyuki, Malindi, Lamu and the national parks/reserves of Amboseli, Masai Mara and Samburu.

ROADS:

There are 63,800 km of highways in Kenya, 8,863 km of which are paved. Roads are generally in good condition, but have deteriorated and some stretches are very unsafe. The A104 running from Mombasa to Malaba via Nairobi is a heavy truck route. High speed and unpredictable local driving habits are daily hazards on Kenyan roads. Roads in the north and north-east are predominantly dirt roads and in the rainy season are only navigable by four-wheel drive vehicles. Your national driving license is accepted, with an English translation if necessary. Driving is on the left side of the road. As fuel shortages can occur, it is best to fill your tanks before leaving a major town.

Passports and Visas:

ENTRY REQUIREMENTS

All visitors are required to carry a passport that is valid for six months beyond the intended length of stay. There should be sufficient blank pages for entry stamps upon arrival.

Nationals of some countries may obtain visas upon arrival. Check with the Kenyan Consulate beforehand. Those wishing to enter Kenya on business or for longer than 30 days, should obtain a visa from their nearest Kenyan Consulate.

Requirements for this are:

» visa application form,

» business letter (for business visa),

» one passport photograph,

» proof of sufficient funds and onward travel / return ticket.

Visas cost  US$50 and are valid for three months.

General Accommodation Info:

Most safari lodges vary in size and style, and are built to blend in with the local environment. Accommodation tends to be of rondavel or banda type, with a lounge, central dining and bar in single unit hotels. Do not be misled by the term “tented accommodation” – this tends to be luxurious insect-proof tents and are usually permanently pitched on concrete bases, often including en suite bathrooms with flush toilets. These are very popular and give the visitor the true experience of being close to nature without the inconvenience and discomfort that can be associated with camping in the open. In the towns, cheaper hotels are definitely avoidable. Prices for higher range hotels vary according to season. Note that although prices may be quoted in US$, payment in local currency is the accepted norm. Campsites in national parks and game reserves tend to be very basic, with running water, but only pit toilets. It is strongly recommended that you reserve all your accommodation as far in advance as possible as availability is often at a premium, especially in peak season.

BUDGET CAMPING:

Budget camping is the ideal way for those who like to “rough it”. The tents are spacious enough for two people and they have a mesh on each window to keep off insects.

All preparations at the camp are made on arrival at the campsite. Guests are often expected to help pitch the tents, but the cooking and cleaning is all left to the camping crew. We recommend visitors to bring their own sleeping bags. Public campsites provide basic washroom facilities of reasonable hygienic standard for budget camping safaris.At some Parks we use semi permanent campsites which offers an upgrade camping style with facilities like showers(hot showers on request) and Flash Toilets.

GAME DRIVES/GAME VIEWING:

The game drive/ game viewing is the standard mode of wildlife viewing in the African national parks, concession, where both regulations and safety considerations restrict exploration on foot. Conditions are ideal for vehicular safaris; rising savanna fame country from the security and comfort of a car, you will encounter a large number and variety of animals imply by chance. Game drives in most of the parks are always invigorating: you may go from one species to the next –observing zebra here, giraffe ther
e, a knot of impala on the right, a trio of elephant bulls ahead. However, there is really no guarantee on what you will see; the animals are free to move around as they please and may even pass beyond park boundaries.

DRIVER GUIDES:

Each safari group will be accompanied by the best driver-guides with expert knowledge in wildlife and other areas of tourist interest. The driver-guides are continually under training on subjects as varied as the maintenance of safari vehicles, client’s safety, the mating habits of various species, preservation and conservation, general knowledge and foreign languages: English, French, German, Spanish and Japanese

Kenya – Health:

Requirements:

Everyone entering Kenya must be in possession of a valid International Certificate of Vaccination against yellow fever. It is imperative that you obtain malaria prophylactics before entering Kenya. When purchasing these, please tell your doctor or pharmacist that you intend visiting Kenya. It is important to note that the Kenyan authorities have banned the use of chloroquine combinations as prophylaxis, and instead recommend the use of either mefloquine (Lariam/Mefliam) or doxycycline. Start your course at least one week before entering Kenya and continue taking the pills for six weeks after leaving the country. If you suffer from side effects, try taking your malaria prophylactics at night, after dinner. Precautionary measures that you can take to prevent contact with mosquitoes are: sleeping under a bed net or in room/tent with mosquito proofing (remember to keep the flaps zipped at all times), spraying your accommodation with insecticide, making use of a mosquito repelling lotion or stick and wearing long sleeve clothes, trousers and socks when outside at night. Immunization against typhoid, tetanus, tuberculosis, polio, & meningococcal meningitis are recommended.

Medical Services:

Medical services in Kenya are good in urban areas and in the vicinity of game parks and beaches, but are limited elsewhere. Doctors and hospitals often require immediate cash payment, but usually accept major credit cards. It is advisable to secure medical cover on your medical insurance before arriving in the country. Note that major hotels have contracts with physicians and dentists. Visitors are however advised to bring along supplies of specialized medication they may require. Otherwise, medicine may be purchased at pharmacies and emergency pharmacies are open all night.

Safety :

Adventure Safaris Travel in Kenya is generally entirely safe, however, there are the occasional regional ethnic skirmishes. You are advised to remain informed as to the situation in areas to which you plan to travel, particularly remote parts and borders. Ugandan, Somalian and Sudanese shifta (bandits) rove their borders with Kenya. Violent cross-border attacks and cattle raids occur, so it is best to avoid the border regions. Border crossings into Somalia and Sudan are strongly discouraged. Petty crime and theft occurs in some of the urban areas, so be vigilant and keep valuables concealed. Security within the parks is quite good, but never leave possessions unattended. It is always better to travel in a large group.

Water:

While water in major towns is chlorinated and relatively safe to drink, there are frequent breakdowns and this can lead to mild to serious abdominal upsets for first time African travelers. Rather stick to sealed bottled water, which is available from most hotels and lodges, and which is highly advised for the first few weeks of your stay. Do not use ice cubes or eat rare meat, raw seafood or dairy products. Avoid roadside stands and street vendors and only eat well-cooked foods while they are still hot and fruits that can be peeled without contamination.

Seasons and Climate:

SUMMER: December – March

WINTER: July – OCTOBER

Kenya is divided by the equator and enjoys a tropical climate. It is hot and humid at the coast, temperate inland and very dry in the north and north-eastern parts of the country. The hottest time is in February and March and the coldest in July and August.

The average annual temperatures in the main areas are:

Mombasa (coastal):

Max 30ºC, Min 22ºC

Nairobi: Max 25ºC, Min 13ºC

North Plain lands: Max 34ºC, Min 23ºC

The long rains occur from April to June and short rains from October to December. Rainfall is sometimes heavy and tends to fall in the afternoon and evenings.

WHAT TO PACK:

Generally, casual comfortable clothing is suitable throughout the year. The most practical items to pack for safari are:

» Khaki, green, beige and neutral colors

» Blouses and shirts with long sleeves (even in summer, they will protect you from the sun and from mosquitoes)

» T shirts

» Shorts or a light skirt

» Jeans or safari trousers for evenings and cooler days

» Some hotels and country clubs require gentlemen to wear a jacket and tie and women to be suitably attired for dinner

» A jacket and sweater are recommended for early morning and evening game drives

» Swimwear and beach apparel

» Comfortable walking shoes

» Sun block, sunglasses, hat, insect repellent, moisturizer and lip salve are all essentials

Good quality, locally made clothing and shoes for safaris are available in Nairobi and Mombasa shops at reasonable prices. If you are traveling with an organized safari, it is important to check what your weight limit is. Generally you will need to restrict your luggage to 10-12 kg (packed in a soft bag) plus a reasonable amount of camera equipment.

When to go:

Kenya is a year round destination with excellent game viewing. One of Kenya’s greatest attractions is the annual wildebeest migration between Serengeti National Park in Tanzania and Masai Mara National Reserve in Kenya. This takes place between June and September. Traditional peak season is January to March as this is when the weather is hot and dry and most comfortable for traveling. This is a good time for bird viewing on the Rift Valley lakes. Game viewing at perennial water holes is also good at this time. April – June are less popular times for visiting Kenya as these are the rainy seasons and flooding often occurs. However, it is usually possible to get around easily during these times and the rains do not hinder visibility.

Currency:

The unit of currency is the Kenya Shilling (KSh), which is divided into 100 cents. Notes are in KSh1000, 500, 200, 100, 50, 20 and 10. Coins are KSH40, 20, 10, 5 and 1 KSH

Basic Costs

EXCHANGE RATE:

The exchange rate is in your favor. Generally, you will find that fine cuisine, wine and entertainment cost a fraction of the tariff charged by equivalent establishments elsewhere in the world. The price of a beer starts at KSh85. A traditional meal will cost about KSh150, while you can expect to pay about KSh500-1000 for a more classy meal. Petrol costs about KSh 105 per liter..

Banking hours: Mon – Fri 09:00 – 16:00

First Sat of each month 09:00 – 11:00

National and international banks have branches in Mombasa, Nairobi, Kisumu, Thika, Eldoret, Kericho and Nyeri and in most other major towns. Banks in Mombasa and the coastal areas open and close half an hour earlier. Banks and bureau de change at international airports are open 24 hours a day



CREDIT CARDS:

All major credit cards (MasterCard, Visa, Diners Club and American Express) are widely accepted.

TIPPING:

Bear in mind that salaries in East Africa
tend to be very low, and that people working in service industries rely on tips to supplement their wages. On safari you should tip your driver, cook and guide. These people do not earn very much so you should tip as much as you feel you can, but of course this depends on you and how happy you were with your service.

As in most African countries, there is a huge range of cheap souvenirs to be purchased along the roadside. These are handmade, but mass produced so always check the quality before buying. Materials include ebony, soapstone and ivory. Note that it is illegal to export products that contain any elements of elephant, rhino or sea turtle. Tribal souvenirs are available, including Maasai beaded jewellery, kiondos (woven sisal baskets) and natural or decorated calabashes (dried gourds). Bright sarongs (kangas or kikois) make good wearable souvenirs. If you are after quality artwork, it is probably wisest to look in galleries and shops that deal in it, rather than buying on the black market.





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