STAYING HEALTHY IN MALAWI Welcome to Malawi! Known as the "Warm Heart of Africa",
Malawi has much to offer in the way of natural beauty and a gracious people.
It is, however, a place with health risks that you may not be familiar
with.
The goal of this information is not to frighten you, but educate you so
that you can stay healthy during your stay here. Please read it through
and ask whatever questions you may have.
MALARIA: Malaria is a common disease in Malawi, especially
in the rainy season (December-May). Malaria is caused by a blood parasite
which is contracted through mosquito bites. There are several species
of Malaria parasites and Malawi has the worst form, P. Falciparum. It
is especially dangerous for people who have never had Malaria. Please
take prevention seriously. While there is no way to completely prevent
Malaria, here are some ways to decrease your chances of contracting it.
PREVENT MOSQUITO BITES BY:
1. Limit time outdoors from dusk-to-dawn when
they feed.
2. Cover exposed skin with long sleeves, long pants,
and socks. Use insect repellent with 15-50% DEET. An excellent repellant
is available in Malawi (Peaceful Sleep). 3. Sleep under mosquito nets whenever
possible. (for increased protection treat the nets with Permethrin-type
insecticide that can be purchased in Malawi).
4. Sleep in screened quarters whenever possible. All
accommodation at ABC is screened. Check your window screens regularly
for large holes. 5. Consider spraying insecticide
in you bedroom prior to bedtime. “Doom” bug spray is
available in Malawi.
MALARIA PROPHYLAXIS: There are medications that, if taken routinely, can
decrease your chance of getting Malaria if bitten by an infective mosquito.
Please check with your personal physician or local health department well
before departure to determine which is right for you. Some medicines should
be started 1-2 weeks prior to arriving so do not wait until you are here.
Below are some of the options along with their advantages and drawbacks.
MEFLOQUINE (Larium 250mg tablets): Dosing: 1 tablet, beginning 1 week prior to arrival,
weekly while here and weekly for 4 weeks after you return. Advantages:
most effective at preventing malaria. Only requires weekly dosing. Usually
quite well tolerated. Drawbacks: Expensive if bought in the US. We stock
this at ABC Clinic for $0.50 per pill. Some question about using for longer
than 3-6 months. Can cause side-effects including drowsiness, disorientation,
sleep disturbance, anxiety, depression, and GI symptoms. NOT TO BE USED
BY ANYONE WITH A HISTORY OF SEIZURE OR DEPRESSION.
DOXYCYCLINE (Vibramycin 100mg): Dosing: One tablet daily beginning 2 days prior to
arrival and continuing daily while here, and daily for 30 days after you
return. Advantages: Quite effective. Inexpensive. Usually well tolerated.
Available at ABC Clinic for $.10 per pill. Drawbacks: Requires daily dosing.
Can cause sun-sensitivity. Can not be used by children under 8 years of
age or pregnant women. May cause yeast infections. Can cause an ulcer
in the esophagus if not taken with enough water.
CHLOROQUINE PHOSPHATE 500mg
PLUS PALUDRINE (proguanil)100mg: Dosing: Chloroquine weekly PLUS Paludrine daily while
here beginning 1 week prior to arrival and continuing for 4 weeks after
you leave. Advantages: less expensive than Larium but similar side-effects.
Available at ABC Clinic Disadvantages: less effective than mefloquine
or doxycycline. Similar side-effects to Mefloquine. Requires daily dosing.
Paludrine not available in the U.S. not recommended by ABC Clinic.
MALERONE (atovaquone 250mg/proguanil
100mg): Dosing: 1 tablet daily while here and for 7 days
after you return. Advantages: Effective. Lower side-effect rates. Drawbacks:
Very costly. Requires daily dosing. Not available at ABC Clinic. Especially
useful for those who will only be here a very short time.
REPORT SYMPTOMS: Symptoms of Malaria include fever, headache,
body pains, nausea, vomiting and diarrhea. Malaria prophylaxis
will help prevent the severe complications of Malaria. Seeking medical
attention and getting appropriate treatment early is critical. Once you
return to the states, many medical people will not know very much about
malaria diagnosis or treatment. If you develop fever or other signs of
infection, it is important that your doctor knows that you were in an
area of Africa which has falciparum malaria and the diagnosis must be
made quickly and treatment started.
FOOD AND WATER-BORNE DISEASES Travelers diarrhea is common. It can be serious,
or at the very least, unpleasant. Here are several ways that you can reduce
your risk of these infections.
Drinking Water: While the water at ABC comes from the city and is
supposed to be treated, it should not be depended upon. Drinking water
from the tap is not recommended. There are several way to treat your drinking
water to make it safe.
Boiling Water: Will kill most contaminants and is easy and cheap.
20 minutes of a rolling boil are required. There are certain pathogens
that will not be killed by heat.
Water Filters: A high quality ceramic water filter is one of the
most popular ways to treat drinking water. This should be brought with
you if you are staying more than for 4 weeks. ABC Staff houses are all
equipped with filters. A good one should filter down to 2 microns or less.
Popular brands are British Berkfeld (Big Berkie) and Cetadyne. They are
not cheap though. Backpacking stores such as REI carry small, portable
filters, which are nice if you are planning on doing a lot of traveling.
You can purchase a filter online for less than retail stores.
Iodine Tablets (like Potable
Aqua): Are small tablets that can also be purchased at sporting
goods stores and are useful in emergencies. They give the water a strange
taste so they would not be good for routine use.
Dining Out: Be cautious when dining out in Malawi. When dining
at off campus homes, you will have to judge what risks you will take to
avoid being rude.
Avoid any cooked food that is not served hot
Avoid undercooked meats-Those who like their meat rare,
don’t do it!
Avoid any food that looks undercooked or not clean.
Be cautions about salads and fruits. Unless you can
wash it or peel it yourself, exercise caution.
Be cautious about ice cubes in beverages.
Try to stick to more reputable restaurants rather then
roadside stands. Ask ABC staff members for recommendations.
Although field mice on a stick look appetizing, just
take a picture, don’t eat them!
IF YOU ARE EATING AT AN ABC STAFF MEMBERS HOUSE, YOUR
FOOD IS QUITE SAFE. THEY TAKE GREAT CARE TO PROVIDE YOU GOOD FOOD.
DON’T PLAN ON SURVIVING ON POWER BARS AND PEANUT BUTTER.
YOU WILL DEFINITELY GET SICK!
FOOD PREPARATION:
Meats: As in the U.S., all meats should be considered contaminated.
Always wash your hands, utensils, plates, cutting boards or other surfaces
before having them come into contact with other foods especially food
that will not be cooked. Be sure to cook meat well.
Fruits and Vegetables: It is advisable that all fruits and vegetables be
treated before eating. Soak them in a solution of water and household
bleach (available in Malawi) for 10-15 minutes.
House help: If you choose to have house help, be sure that they
are shown exactly how you want these foods handled.
Treatment of Diarrhea: If you have severe diarrhea, especially with fevers,
or have diarrhea that lasts for more than three days, you may have an
infection that requires antibiotics. Whenever possible, seek medical advise
regarding the selection of antibiotics. If you are somewhere where there
is no doctor, bring medicine with you to take just in case. IF YOU ARE
IN LILONGWE AND HAVE ACCESS TO ABC CLINIC, PLEASE SEE THE DOCTOR THERE
BEFORE TREATING YOURSELF. DIARRHEA CAN BE A SYMPTOM OF MALARIA!
For acute diarrhea (1-7 days): Take Cipro (Ciprofloxacin)500mg twice a day (not for
children) or Bactrim (960mg) twice a day.
For more persistent diarrhea: Flagyl (metronidazole) 500mg three times a day may
be advised by the doctor.
If the diarrhea is severe: It is critical to replace the fluids that you are
losing. Oral Rehydration Salts are small packets that are mixed with clean
water that should be sipped regularly. These packets are available at
any pharmacy, including ABC Clinic. Once you are able to take solid foods,
begin with very bland foods (BRAT diet) such as bananas, rice, bread,
crackers or broth. Gradually advance your diet.
ACCIDENTS AND INJURIES An important thing to remember in Malawi is that if
you are involved in a serious accident, high quality rescue and medical
facilities are a long way away. Being careful and smart is the best way
to prevent injuries.
Motor Vehicle Accidents: Unfortunately, Malawi has one of the highest traffic
fatality rates in the world. The most important rule is to always wear
your seat belt. As you will soon see, the roads are full of pedestrians,
bicyclists, goats, ox carts, stalled vehicles and everything you can imagine.
Not to mention that you are driving on the left side of the road from
the right side of the car. It is important that you use all of your defensive
driving skills and don’t take any long trips until you’ve tested your
wings a bit with short local trips. Always, always, always use your seat
belts. Assume that every other driver is a bad one and every pedestrian,
bicyclist, and goat is trying to get run over by you. Did I mention, always,
always, always wear seat belts.
Sports and Recreation: The mild weather of Malawi is conducive for outdoor
sports and recreation. Please think ahead and play smart. Use appropriate
safety gear (ie helmets and pads) and always make sure that you have someone
with you. Being closer to the equator, and being on malaria prophylaxis,
please use sunscreen (spf 30 or greater) whenever you are out in the sun.
It is advisable to take a first aid kit with you when doing outdoor activities.
CRIME While random violence is unusual, thieves may use
physical violence to rob you. Avoid crowded markets alone and always be
aware of what is happening around you. Preferably do not travel alone
(especially women) and at night. Do not wear a lot of jewelry, expensive
watches, cameras, purses etc. Carry only as much money as you will need
for your shopping. Do not be flashy with money or talk aloud about money.
Be careful about where you park your car and make sure that you lock your
doors. Do not pickup any hitch hikers. Lilongwe is a city just like any
other, act sensibly.
Rape of foreigners is not common, but with the HIV
epidemic, it is even more dangerous than in your home country. Again,
women should avoid going off campus alone and travel at night should be
minimized. In case of rape, be sure to seek medical attention as soon
as possible as there are medications that can decrease the likelihood
of contracting HIV and other sexually transmitted diseases.
HIV/AIDS Malawi has among the highest rates of HIV/AIDS in
the world. It has had a devastating effect on the health and economy of
the country. As you likely know, HIV is transmitted through sexual contact
and direct contact with blood from someone infected with HIV. Sexual contact
is extremely risky. If you have struggles with sexual purity, Malawi is
not the place for you to visit. Blood transfusions in Malawi should only
be done if they are life saving and should be from a low risk donor like
a fellow missionary. It would be wise if the clinic was informed of your
blood type so that we could easily identify potential donors should the
need arise. ABC Clinic has safe blood testing equipment and provides secure
transfusions. If circumstances are such that you are assisting in caring
for someone who is having active bleeding, please use latex gloves. It
would be wise to carry a pair or two with you when you travel.
TUBERCULOSISis a common infection here. It can infect
even those without HIV. If you develop a cough that lasts for more than
a week or so or is accompanied by fever, shortness of breath or chest
pain, seek medical attention. It would be wise to discuss with you physician
here or when you get home about having a test done to see if you have
been exposed to TB (a PPD test).
ROUTINE MEDICAL CARE
The ABC doctors and the clinical officers
are available to assist with your ongoing medical needs. If you have any
medical problems, please contact the ABC doctor or see the doctor soon
after arrival so that you and he can formulate a plan for monitoring during
your stay here at ABC. If you are on routine medications, please bring
enough with you for your entire stay or contact the ABC doctor to confirm
that refills can be done here. Inform the doctor of any medications that
you take or allergies that you may have when you arrive at ABC. Routine
dental and eye visits are available in Lilongwe at off campus clinics.
See the ABC doctor for recommendations Routine gynecological checkups
are best done before coming and, if you are here for any length of time,
when you return. The ABC doctor is almost always around and available
24 hours a day for ABC students, visitors, staff, faculty and their families.
If you are in need of medical assistance, please do not hesitate to call
the doctor. Of course routine questions should be addressed during
the usual working hours. Potluck and chapel are not appropriate times
for medical treatment or advice.
HEALTH & EVACUATION INSURANCE Be sure that your health insurance is up to date and
that you understand how to handle claims for care that is given abroad.
It is recommended that you investigate evacuation insurance either through
your health insurance provider or a provider who specializes in this.
If you are seriously ill or injured and have to be evacuated to another
country for health care, the bills can be astronomical and is often not
covered by your standard health insurance policy. Suggested companies
are AIG, IMG and International SOS and BUPA. Most American health insurance
carriers do not cover illness abroad. Check with your insurance company
about this before leaving for Malawi.
Our goal is to keep you healthy and
productive in whatever work the Lord has for you to do while you are here
in Malawi.
