A necessary evil for all travellers? Well, I've been to malaria infested areas of Costa Rica, and to mosquito-disease-risk areas of Thailand without one problem, or one worry. How come I'm so paranoid now? It's health nurses, and books on India, that's why. Immunizations, malaria pills, iodine tablets, boiling water, don't eat the ice cubes (so much for those wonderful fruit shakes in Thailand and Costa Rica), don't eat from street vendors (how can we miss a night market in Thailand or a soda in CR? - that's part of the whole experience!). Do we ignore the warnings, or obey them and live in a constant state of paranoia? Have we been swayed to believe something beyond what our natural instincts will tell us? It makes tons of sense not to eat from a street vendor whos (who's...whoes?) food has been sitting out for hours, or from one that serves from unclean dishes.

Enough ranting now....The big question is: what are we doing about health-related issues? A few months ago, I spoke with a travel nurse in Fort St John. She gasped when I told her our itinerary, and subsequently sent us a three-pound package of health-related info. Contained within was 100s of health-propoganda that we were to sift through so that we do a cost-benefit analyses on immunizations. Rabies ($55), Japanese Encephalitis (a whopping $150), Typhoid ($35), Hep A ($40/shot - 3 shots), Hep B ($60/shot - 2 shots), Measles/Mumps/Rubella ($55)..... After much deliberation, we settled only a few shots, and skip those recommended for the "risk averse". Here is our rationale in more detail:

• Rabies - recommended for those working around animals, or the risk averse: NO
  
• Japanese Encephalitis - recommended for rural areas, stays greater than 4 months, and risk averse: NO
  
• Typhoid - I still don't know what this disease is about, or how one contracts it, but it sounds bad, and is recommended everywhere and for everyone: YES ps: three weeks later, I still had a hideous bruise on the back of my arm from this vaccine.
• Hepatitis A - Can be contracted through anything anywhere, and I don't think I can resist the fresh blended juices of Thailand: YES
• Hepatitis B - Neither of us will be sexually active with locals, sharing needles, or getting tattoos. The only risk we face is if we crash in a bus, train or plane, or if we decided to rescue a bleeding person somewhere who just happens to have the disease: NO.
• Measles/Mumps/Rubella - I have yet to meet a healthcare professional in Alberta who doesn't lecture me on the fact that I have never had this shot. Contracting risk is likely low, and I don't plan on having kids, so: NO
• Tetanus/Diptheria/Pertussis - Recommended for anyone and everyone. Anyone and everyone should have had these thorugh childhood. I haven't. Hence, I was scared into getting them done. Big mistake. To catch up after 27 years of non-vaccines, one needs a series of three shots to be up-to-date. The second one is 4-8 weeks after the first, the last one a year later. Well, for a full four weeks after my first shot, I couldn't lift my left arm, let alone sleep on it. I've had my first, and am NOT going for my next two: YES / NO.
• Polio - Same as DipTet, I'm not going for my second in the series. Tony got his booster: YES / NO
• Yellow Fever

The decision making behind the malaria prophylaxis (sp?) was an even bigger one than that for the immunizations. If we had based our decision on the health unit documentation or the CDC website, we would be taking these pills for a good 8 months straight, considering that we are heading to Peru, Egypt, India, Malaysia, Thailand and Costa Rica. This was unsettling and I was unconvinced. I decided to sleep on it for a few weeks. One day while perusing the internet, I found a site a little more informative, and better yet, realistic: The The UK's NHS Fit for Travel. Here is were I discovered that ONLY India presents a malaria risk (and in Nepal just inside the border from India). Phew! This site saved us 8 months of pill-popping

Now we needed to find a suitable malaria med for the 8 weeks in the Nepal/India area. The options are as follows: Mefloquine (Lariam), Chloroquine+Proguanil, Malarone or Doxycycline. The side effects for mefloquine seem worse than the disease itself, so Mefloquine is out. Plus, I (Krista) cannot take this for health reasons. The second, Chlorquine+Proguanil is out because there are strains of malaria resistant to this concoction in India and Thailand. So that leaves us with Malarone ($50+CDN for 12 pills..another yikes) or Doxycycline. A little research revealed that Doxycycline has horribly unpleasant side effects: yeast infections (getting these in India would be a nightmare), and sun-sensitivity. Considering we are whiter than white, this isn't so desirable. Thus, it looked like Malarone until I met with my doctor: NO for the reason that it possesses certain side effects risky for me. Well, I'm thinking...that leaves me with Doxy and perpetual sunburns. That though lasted me about 5 seconds until my doctor suggested something that I NEVER thought was possible. No documentation I had read ever said this, and doubtfully would it be recommended by any health care professional besides him (who practiced in Mozambique for a year): "why don't you just not take anything, and get treated only if you get malaria?". Whoa. This is incredible. Another medical opt-out? I'm in. So that's what's going to be: no malaria prophylaxis, only treatment/cure if we get it. Cool.

So, bottom line what are we doing about malaria? We are going to have wash, shower and marinate in DEET while in India, dress in long sleeve everything, and be inside when then Indian red sun sets or rises. But, it involves no pill-popping, no unpleasant side effects, no yeast and no sunburns. I'll let you know if it's effective in about a year and a half.