One of the first things we did when I found out I got the job was to go to a travel doc in Halifax. We had to get quite a few vaccines to prepare for this move. Since we’d traveled to Libya and Egypt in 2007, we already had Twinrix (HepA/B) so that saved us a little bit of cash. It was recommended that we update many of our vaccines, plus get some new ones. We got our yearly Influenza vaccine, and updated our DTaP (Diptheria, Tetanus, & Pertussis), and our MMR (Measles, Mumps, Rubella). These were all free. We also got Menactra (protects agains 4 strains of meningococcal meningitis) which set us back $40 each – not too bad, and a Typhoid vaccine at $150 each. The most expensive was Ixiaro for Japanese Encephalitis. Though incidence is low in PNG, you never know if you are going to be one of the unlucky 1/250 to develop encephalitis. This was the most expensive vaccine at $250 per dose X 2 doses each. Since we’ll be encountering all sorts of diseases there that we don’t have in Canada, like Dengue and Malaria, we decided that we might as well protect ourselves from those we can.
The people I will be working with have assured us that there are a few good pharmacies where we can order in medication, and not worry too much about counterfeit medication. We decided to leave with 3 months worth of our medications, just to give us time to settle in, get new prescriptions, and find such a pharmacy. The travel doc also recommended we take a few doses of Azithromycin, an antibiotic used to treat gastroenteritis, strep throat, pneumonia, etc.
One of the diseases that we may encounter in PNG is Malaria. Malaria is caused by a parasite, Plasmodium falciparum or Plasmodium vivax. Immature forms of the organism are carried by female mosquitos, and introduced to humans when bitten. The parasite travels via blood to the liver where they mature and replicate for a week to a month. Finally, the mature forms burst from the liver cells, and are released into the bloodstream where they infect red blood cells. Here, they again go through a multiplication cycle – after which they burst from the red blood cells and infect new ones. This can result in repeated waves of sickness characterized by fever, headache, fatigue, chills, cough, and nausea. Because the parasite ‘hides’ within host red blood cells, it is very difficult for your immune system to get a handle on things and clear the infection. And some strains of P. vivax can remain dormant in the liver for extended periods of time – months to years! The travel doc in Halifax recommended that we take Doxycycline, an antibiotic similar to Tetracycline, prophylactically to prevent Malaria – for 3 years. The people I’ve been in contact with in PNG have assured me that the incidence of Malaria in Goroka is very low, since they are at 1600m in the mountains – basically above the mosquito line. They only take prophylaxis when they go to the coast. To be safe we will take it when we first get there, and reevaluate once we’ve gotten the lay of the land. So, we are taking 3 months worth of Dox with us. We are also taking some Malarone with us to take the minute we suspect we are infected. These antimalarials were the most expensive, but well worth the investment in case of infection.
When Matt’s dad was working in Kenya, the company actually gave him some little malaria kits that we will be taking with us. They have a thermometer that you stick to your forehead and it acts like a mood ring. It also has a few doses of Coartem, an artemisinin-based combination therapy used for P. falciparum, that the travel doc actually recommended, but couldn’t prescribe. It even has few little blood tests – similar idea to a pregnancy test / diabetic sugar measuring test.
If you’d like to learn more about Malaria, the CDC website is full of information: CDC Malaria