“I’ve Had Malaria Twice”: Musings on Lariam, Neurosis and A Wee Bit of “Genetic Engineering”

As an undergraduate, I studied abroad at the University of Ghana at Legon. Several weeks into this adventure, I got malaria. I recovered. Then I got it again.

My bouts with malaria were hardly the important part of my study abroad experience. They simply provide me with an excuse to take a science break today. Since I have not yet returned to school, I do not yet have the luxury of reading or writing texts that I don’t assign to myself—unlike many of my readers. My atrophied brain and my jealous heart seek solace. You will all have to deal with my decision to shelve “Your Notebook Is Too Old for You and Doesn’t Care About You or Your Academic Career to Boot” for now. That may have made for zestier reading, but the quality of this writer’s mercy is nevertheless presently strained.

(Besides. As woefully annoying self-help author Julia Cameron likes to say, “Jealousy is a compass”. Now, jealousy may feel like serrated fangs in your heart, but, really, it is merely one of the truest guides you have. Its reliability as a guide probably explains why I can live in Hollywood’s town envying the veritable flocks of beautiful starlets naught but their silk designer dresses and perfect teeth. (Fine. That and my impenetrable vanity. Okay?) It also explains why I can’t amble along, say, Charles E. Young Drive East without glowering at everyone in a white lab coat. But I digress.)
Read more. . .

Before I left the country, I saw a physician at an Air Force Base. I wanted her to prescribe mefloquine hydrochloride, or Lariam, to me. At the time, Lariam had a reputation as the rock star of malaria prophylaxes. Unlike its nearest rival, Malarone, it allegedly reduced a user’s chances of contracting malaria to “25%”. Wherever the fuck that statistic came from, it still impressed me. Lariam also tended to induce “lucid dreams”, which everyone knows are fun. All the UC Students Abroad in Ghana were doing it, you know. I wanted to do it, too.

“I can’t give you Lariam,” said my physician, firmly. “And it’s not just you. I no longer prescribe Lariam to any of my patients. I refuse to take the risk.”

“The risk of what?” I asked, like a petulant twenty-one-year-old.

“Psychological problems,” she answered. “A very rare side effect of Lariam, supposedly. A year ago, I had a healthy patient going to a malarious country . . . I checked this patient out. Everything was fine. I gave them Lariam, and they wound up committing suicide. You can’t imagine . . . I’m not, not, not giving you Lariam. I flat-out refuse to give you Lariam. I’m not giving you Malarone, either. I’m giving you doxycycline instead.”

“Doxycycline?!” I protested. I already took tetracyclines, in a futile attempt to control the miserable acne problem I had at the time. There was nothing sexy about tetracyclines! “What good will that do?”

“Oh,” she said, cheerful again, “it’ll help keep you from getting malaria—as much as Malarone or maybe even Lariam ever would, anyway. At any rate, you’re going to get it anyway—none of these are wonder drugs, and you’re going to be in West Africa for a long time.”

I sulked.

“You can’t expect me to give you something I have to worry about, anyway. I know the doxycycline has an incredibly low chance of hurting you.”

I played my last card: unmitigated whining. “There are fifty of us going, and I’m the only one who will be on doxycycline.”

My physician paused. “You have a history of depression, right?”

I gave up.

My physician tried to console me with the news that the search for my yellow fever shot was over. Most civilian hospitals in the US do not readily offer yellow fever vaccinations. However, the government of Ghana denies visas to any foreign traveler who hasn’t received one. I was an ex-Air Force Brat about to age out of the privilege of access to military services as her father’s dependent, and I didn’t frequent military clinics anymore. I’d had a hell of a time finding the yellow fever stuff. In addition to the yellow fever shot, she gave me Demulen, which I took to treat my acne problem and skip periods instead of getting frisky like a normal, sane adult. (Though, I suppose, I may have harbored some ludicrously vague intention to remedy this last. I wanted to be edgy, you see.) She was very nice. I wasn’t totally ungrateful. Then.

In retrospect, I am thoroughly grateful. I left for Ghana in 2001, before 9-11. The military already prescribed Lariam to soldiers and officers on tours of duty in the Middle East, though. These tours were not uncommon before the present wars; my dad went on one while I was in high school. Meanwhile, most Americans don’t visit “malarious countries”, and civilian doctors don’t prescribe Lariam as frequently as their military colleagues. So, I wouldn’t be surprised if concerned military doctors were some of the first scientists to notice odd correlations between use of Lariam and serious psychological problems. Only after roughly two years in Afghanistan and one in Iraq did enough military personnel attribute violent and suicidal ideation to Lariam for the public to pay attention.

I understand that I’m no doctor or physiologist and that my opinion doesn’t mean jackshit. I also have had it beaten into my aspiring scientist’s head that correlation doesn’t equal causation. However, on the strength of my merely anecdotal evidence, I still discourage the use of Lariam. Sure, the hype about Teh Awesomez Lucid Dreams proved true for several students:

“Juniper. You gotta switch to Lariam. ”

“It’d be too expensive for me to switch now. And troublesome.”

“No, but you gotta. You want to hear the amazing dream I had last night?”

“YES.”

“See, there was, like, this plateau. Against a blue sky. The sky was so, so blue. The grass around it was so, so green. I could feel the wind, Juniper. And, in front of me, there was this child. Like, a dark-skinned ten-year-old boy. And I think he was like my guide or something. To the plateau. And he motioned to me with his thin hand, but when I got near him, the bright, like, really bright sun just spilled over his face . . . which began to melt off. Like, his skin, you know? It just dripped away. And I could see every bone in his skull. I could see every vein. It was amazing. All those bones . His brain was so graphic and throbbing. I felt the blood on my fingertips. I reached out—“

My floormate from the end of the corridor, who took Lariam, and who still contracted malaria so grave she was hospitalized for it and placed on an IV drip not one month into our trip, arrived to announce that anyone who fancied fried bread and Milo for breakfast had better make haste for the café. My Lariam advocate actually told his story several more times; this is what I remember of it. I more clearly remember my greedy longing to have lucid dreams more than once in awhile. It really was a long time ago. I was a mystic then. Please stop laughing at me now.

Ahem. As weeks passed, however, some users enjoyed Lariam less and less. Some students grew depressed, attributed the depression to Lariam and illicitly ditched malaria prophylaxis altogether. Some students grew anxious, and they also attributed this development to Lariam. Lesser but not insignificant complains included continual nausea and sleeplessness.

The psychological toll possibly exacted by Lariam interests me as a particularly dangerous side-effect. I’ve battled clinical depression since age sixteen. Since I refused to treat my mental disorder until age twenty-six, my escape from my unhappy Berkeley relationships to Ghana changed very little. In fact, soon after I arrived, Demulen exacerbated my depression. I threw it out.

Still depressed, barely functional, I developed a moody and subtle recklessness. I drank water from questionable sources, smoked lots of equally dubious tobacco, roamed isolated streets and fields alone, and wept at night. Ghana offered no shortage of generous people and beautiful experiences. But I dwelled on negative circumstances and interactions: the white students, including my roommate, who squealed, “We’re just like celebrities!” and “Everyone wants us!” on every day trip; the superannuated white men seducing nubile black damsels on the beach near the highlife concerts I dined and danced at until four in the morning; the black tour guides at the “slave castles” in Cape Coast who insisted that Europeans had carefully taken the best and the brightest of the West Africans and left behind those who were not half as strong and persevering as the mosquitoes around them ; the attention young Ghanaian boarding school girls gave me for being “half-cast” (“You’re really pretty! And you have really pretty hair! There’s only one other girl in the whole school with hair like yours, because she’s half-cast like you, and she’s allowed to grow her hair long, while the rest of us have to keep it clipped very short.” It never matters that I have lifelong practice at receiving sinister compliments like these); the men who frowned disapprovingly whenever I drank Guinness or played pool; the taxicab in downtown Accra that exploded into a fireball with me and my friend in the backseat. . .

(Okay. Fine. The exploding taxicab was the funniest “Oh, shit!” moment of my life, and remains so to this day. The driver, who was already outside, had accidentally ignited everything under the hood of his ancient cab in a valiant attempt to get us moving again. Unharmed, he angrily contemplated what to do next, as my friend and I dove in unison through the unlocked passenger doors, like the heroes of an action flick. It was not funny. But it was. I was getting too solemn for a moment.)

Back to solemnity. I’d fought with my mom and stolen her credit card—thus estranging myself from her—clumsily stained the most presentable of my shabby clothes with Clearsil, borrowed my roommate’s CD Walkman without her permission, distressed said roommate by singing aloud, and channeled my various political frustrations into a bristling racism against white people. I either embarrassed or snubbed students to discourage their inexplicable and repeated attempts to accompany me anywhere. I spent my own money imprudently. I was very lonely. Sometimes, I wanted to kill myself, and I wondered why I hadn’t yet done it. I had three manic breakdowns before I returned to the States. No one in the state I was in as a twenty-one-year-old should fuck with Lariam. No one in a remotely similar state of mind should fuck with Lariam. I shudder to imagine what I would have been like on Lariam!

Malaria itself has a tendency to induce a peculiar neurosis. Alongside the fever, chills and leaden fatigue, it can make you paranoid. I found a malaria pamphlet that described “mild to serious psychological troubles” as a malaria symptom. I disbelieved this until it happened to me.

Here’s a mild example. On a day when I had our grim concrete balcony to myself, I dragged out an extension cord and cooked pasta with small and unsafe appliances without 220-volt adapters. Everyone cooked and washed clothes on their balconies—particularly the girls, who lived in nicer dorms, and who were largely expected to do it anyway. American students made lots of pasta, and a few held “dinner parties”, replete with Star beer and Guinness. (Plus weed. Sometimes, with more weed than pasta . . . though, as a lone wolf who never partook, I cannot say for sure . . .) I made sauce out of tomatoes, tomato paste and more powerful chili peppers than most of my (totally non-Korean) fellow students could stand, because I didn’t expect company.

Of course, my popular roommate and her entourage bustled in just as I strained the pasta over a bucket. She greeted me. The other girls eyed me and my undergraduate accoutrement before they gave me a halfhearted hello. Pleasantries exchanged, they returned to their ardent chat about what cloth they wanted to purchase at market, and which dressmakers they wanted to visit. No one paid me any mind. Normal Juniper would have been satisfied.

“Oh, my God,” I suddenly thought. “I don’t have enough pasta for seven people. I don’t have enough pasta for seven people! That scary Marigold is going to think I’m so rude . . .”

I flipped. Inside. I wanted desperately to crawl under our balcony table, but three girls were crowded around it, having a smoke. I bit my tongue and started to shake a little. Maybe, if I said nothing, they wouldn’t notice the pasta at all.

But there were so many chili peppers in it!

Goosebumps popped from my arms. It made alarming sense to me. I almost cried. No! Mustn’t be conspicuous! I hovered around the wall by my mattress, where I remained until my roommate and her companions swept away.

I continued to feel very unwell afterwards. I had a hard time walking from one end of the room to the other, and I did not feel like sightseeing or attending class. Shortly after this incident, my kind roommate took me to the unofficial expatriates’ hospital that most Ghanaians couldn’t afford to use. Us American students invariably did. Here, needles were guaranteed to be clean, and medicines came directly from France and Britain. A blood test confirmed my second contraction of “scanty” malaria. (The first began to manifest itself on September 11th, the day my horrified roommate ran onto the balcony at three pm to fetch me and the fever I forgot as we ran with the others to the only television set on campus.) At least I’m truly not that crazy.

Can you imagine what havoc Lariam might have wreaked on my malarial mind, though? In the end, how did Lariam stack up, anyway?

My next-door neighbor tallied the casualties. The vast majority of the fifty American students in the UC group took Lariam, while a handful took Malarone and I alone took doxycycline. All but four or five of our motley crew contracted malaria. About half got it twice. “Getting it twice” meant that you tested positive the first time, you submitted to the fourteen-day regimen that cured you, you tested unequivocally negative afterwards, and, a few weeks later, you felt awful and tested positive again. Most of the students who got it twice were Lariam users. Most of us, including myself, had not contracted serious strains of malaria in either case; this is probably due to our antimalarials, which, incidentally, are never completely worthless. Two students had, and they required hospitalization when their fevers surpassed 102 degrees Fahrenheit. One of these had quit Lariam because of an unprecedented onset of depression. I think one person got it three times, but this I can’t remember. In sum, Lariam users fared no better than I did, and, in terms of psychological struggles, some of them may have fared worse.

Malaria parasites have a notorious resistance to many drugs, regardless of whether those drugs are preventive or remedial. So, when Mrs. Method and Theory emailed to me a job advertisement for a laboratory assistant, I jumped from my seat when I discovered what the lab’s research entailed. Dr. Anthony James and his team at UC Irvine are working on a “novel and genetics-based” solution to the malaria problem. They want to genetically engineer mosquitoes that can’t host malaria parasites and introduce them into the wild, where, hypothetically, they will breed out the whole population’s ability to host.

Is this what you younger scientists mean by creativity? It takes my breath away. The idea alone is beautiful. For the sake of this kind of beauty, I have never objected to tinkering with genes. (NB: Ultimately, I have a hard time thinking in terms of “natural” vs. “artificial”, first because humans, despite their anthrocentrism, are a part of nature, and, second, because one can always describe things in terms of physics and chemistry, which aren’t constrained by this distinction.) Geneticists shouldn’t feel guilty about wanting carte blanche to do what they like. No one who honestly cares will tend to reckless experiments that result in bad data and unethical practices. Many geneticists dream of and work on replacing chemotherapy with a superhero version of the cancer patient’s own immune system, repairing brain cells and customizing medicine. They want to understand the instructions by which our biology constructs ourselves. They want practical solutions to real problems, and, yet, they can never divest their work of its potential to contribute to the evolution of our species in ways astronomically difficult to comprehend or predict . . . it’s like art. There’s nothing inherently perilous about this uncertainty. It is all beautiful to me.

Damn it. Now I crave my copy of Genetics in Medicine. Alas. I can’t. I must conserve energy and reduce our electricity bill by going to bed soon.