The Foreign Service Journal, June 2004

JUNE 2004 • AFSA NEWS 7 Antimalarial Medications BY SPECIAL CORRESPONDENT EURONA TILLEY M any embassies and con- sulates are in locationswhere malaria is a real everyday threat. The disease still causes over one million deaths a year worldwide. Malaria prevention must be taken seriously. While dangerous, malaria is preventable through proper medication and the avoid- ance of mosquito bites. Protect your family from mosquitoes by wearing long pants and long-sleeved shirts during the dawn and dusk hours, using insecticide on exposed areas and eliminating standing water near household dwellings. Taking antimalarial drugs is often at the topof the “ToDo” list formany families prepar- ing to leave for post. There are five differentmedications commonly prescribed, depend- ing on the patient’s age and health status as well as the location of the post. To be effec- tive, antimalarial medications must be taken according to the exact prescribed schedule, according to a doctor’s orders. Mefloquine, Doxycycline or Malarone are taken if travel includes malaria risk areas in South America, Africa, the Indian subcontinent, Asia and the South Pacific. If travel includes malaria risk areas in Mexico, Haiti, the Dominican Republic, certain locations in Central America, the Middle East or Eastern Europe, either chloroquine or hydroxy- chloroquine sulfate is usually prescribed. Mefloquine—brand name Lariam— is given to adults in 250mg tablets and should be taken once a week with food. Side effects associated with mefloquine include nausea, dizziness, insomnia and lucid dreams. Occasionally, in extreme cases, this drug can cause serious problems such as seizures, hallucinations and severe anxiety. Mefloquine should not be taken in the case of a previous allergic reaction to the drug or in the case of amed- ical history of seizures, a psychiatric disorder or an irregular heartbeat. Doxycycline is given once per day in 100 mg doses for adults. It is not recommend- ed for pregnant women or children under the age of 8, because it causes permanent teeth discoloration. Doxycycline use is also associated with an increased susceptibility to sun- burn, yeast infections, and nausea which can be avoided by taking the medication on a full stomach. The latest antimalarial drug, Malarone, is actually a combination of two drugs, atovaquone and proguanil. It should be taken once per daywith food ormilk. Side effects are uncommonbut can involve nausea, stomachpain, vomiting andheadaches. Malarone should never be prescribed to patients with kidney problems, pregnant women, infants weighing less than24pounds orwomenbreastfeeding infantswhoweigh less than24pounds. Chloroquine, brand name Aralen, and hydroxychloroquine sulfate, brand name Plaquenil, are both taken once per week in dosages of 500 mg and 400 mg, respectively. Pregnant or nursing women should consult their doctor before taking these drugs. In a limitednumber of incidences, these drugs have causedheadaches, dizziness, blurred vision, itching, vomiting and nausea. The usage of chloroquine and hydroxychloroquine may worsen the symptoms of psoriasis. Infants and children are particularly susceptible to the malaria parasite; consequent- ly, extreme caution should be maintained. Small amounts of antimalarial drugs can be passed through breast milk, though these amounts will not protect the baby frommalar- ia. Medication for infants should be considered only in consultation with a doctor. Antimalarial drugs must be stored out of the reach of children: an overdose can be fatal. that he is looking at possibly changing the assignment process, AFSA asked if there was any information to pass to ourmem- bership about potential changes to the way assignments are made. He said no, but noted that it makes him “uneasy” every spring when the work force goes around begging, traveling, etc., to get a job. He made a comparison to the mil- itary, where you can indicate preferences for onward assignments, and that’s it. “There is a problem with ‘hard to fill.’ I should be able to send people where I need them,” he said. He added that he needs to better understand the current system before deciding on any changes. AFSA reiteratedwhat it has done with regard to “fair share.” Crane noted that AFSA had advocated adding a hardship service requirement for crossing the threshold into the Senior Foreign Service and this has now beenmandated. AFSA also supports the fair share rules, and this year agreed to tighten them. AFSA told the Secretary the fair share process should not just be a way to fill hardship posts, but a way to help promote shared sacrifice, which is why “fair share” is the appropriate term. Crane alsomentioned the AFSAGoverning Board’s initiative to study the background to the Foreign Service Act of 1980 to look at what the record says about the “exceptionalism” of the Foreign Service, with a view toward preserving andmaintaining its unique sta- tus. Sharing the burden of dangerous and difficult service is one demonstration of the exceptional nature of the Foreign Service. In closing, the Secretary saidAFSAhas been “a great supporter of what we have wanted to do.” ▫ Powell • Continued from page 3 Sharing the burden of dangerous and difficult service is one demonstration of the exceptional nature of the Foreign Service. Continued on page 9 FOREIGN SERVICE HEALTH WATCH