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#2101: Health safeguards in Haiti : Judson comments


    Here is another thought on the Lariam issue addressed by Anne Russell.  
While at Hospital Albert Schweitzer in Central Haiti for the past two years, 
we did participate in a WHO study.  Hospitals all over Haiti including ours 
checked blood smears of patients known to have Malaria after treatment with 
Chloroquin. there were no failures of treatment.  CHLOROQUIN IS COMPLETELY 
ADEQUATE FOR VISITS TO HAITI. Its other name is Aralen. Dose is 50mgs taken 
once a week beginning one week before departure and finishing three weeks 
after return to the States.  Prophylaxsis is extremely important.  One of our 
visitors who was only there for four days did not do so and, upon return 
home, spent a week in the Intensive Care Unit with Cerebral Malaria!  If 
Chloroquin is problem for anyone, the other proven effective routine is to 
take Doxycycline 100mgs per day beginning three days before departure and 
finishing two weeks after return.  This routine can be  problem for some 
because it might make them more sensitive to the sun.  Finally, Mefloquine 
(Lariam) should NOT be used in Haiti for all of the reasons outlined by Anne 
Russell but also because it has one terrible side effect which is not common 
but terrifying.  This is toxic psychosis which required on weeks psychiatric 
hospitalization for at least one person who took that drug before coming to 
our hospital.  His family was badly frightened by this event but there was no 
problem afterwards.  Lariam is necessary in some parts of the world but not 
in Haiti!    Hope this is helpful - let me know if questions.
                        John P. Judson, MD