DAILY MAIL As a travel writer and broadcaster, going to malarial countries is part of my business. Over the years, I’ve been to many – Uganda’s rainforests, the islands around Zanzibar, India and South Africa are just a few.
Like all responsible travellers, I was careful to take precautions against contracting malaria and other diseases. But my efforts to avoid illness have also been my downfall. Despite malaria-free travelling, the side-effects from the medication have left me deaf.
Malaria is not a disease to be dismissed lightly. It claims tens of thousands of lives throughout the developing world and, according to the latest Health Protection Agency figures, infected nearly 2,000 British travellers returning from the tropics in 2005 – 11 fatally.
The early symptoms – chills and fever – can be effectively treated with Artemisinin, a drug based on a Chinese herbal remedy. But left untreated, the condition can quickly lead to paralysis, coma and death.
Shortly before my first trip to India, I sought medical advice. My local pharmacist recommended a malarial prophylactic, a combination of two pills, one of which was to be taken daily, the other once a week. I wasn’t given any information about the possible side-effects.
As advised, I started the course a week before leaving, stuck with it throughout my month-long stay and for another couple of weeks on my return home. The whole time I was taking the pills I felt queasy and nauseous; I guessed it was the medication, but I persisted because I didn’t want to catch malaria.
Over the next five years I made 11 journeys to India and Africa and continued to take the medication whenever I went to a malarial country. But my diligence about anti-malarial treatment on these trips was to my cost.
Five years after the first journey to India in 1991, I noticed that my hearing had begun to fade. To start with, the shifts in sound were almost imperceptible, but gradually, I found myself leaning forward
to listen to a conversation and subconsciously avoid noisy restaurants.
Then a constant hissing sound was noticeable at the periphery of my hearing. As this became more dominant, I started to mishear song lyrics or had to ask a friend to repeat lines while watching a movie.
Looking back, the tell-tale signs were obvious. People became irritable after I kept asking them to repeat themselves. I had the telly volume on full; I was always saying “pardon?” and sometimes missed out on conversations completely. Even so, at just 32, I didn’t think I was deaf – I just didn’t hear so well.
After a year in a muffled world, I eventually went to see my GP when a close friend commented on the sorry state of my hearing.
Benignly patronising and after only a cursory glance in my ears, my doctor suggested the condition was imaginary and that, perhaps, I was lazy, not really listening. But I wasn’t prepared to be fobbed off and he reluctantly referred me to a specialist at the Royal Free Hospital in North London.
Eight weeks later, I found myself being tested in a sound-proof booth and having each ear inspected with an instrument that looked better suited to icing a cake. I also had blood tests and a brain scan to rule out a fractured skull or meningitis – both known causes of deafness.
The specialist’s verdict was swift; the hearing in my right ear had deteriorated to less than half what it should be and, in my left, two thirds. Over both my ears, I’d lost more than 60 per cent of my hearing.
The news was crushing. It was official – I wasn’t imagining deafness. Now we needed to establish why. There’s no history of deafness in my family. The specialist moved on to my social and environmental habitats to check that I’d not been in
excessively noisy places – a known cause of sudden and unexplained deafness.
It was only as I got up to leave that he asked me, in passing, if I’d been abroad lately and if any of the places I’d visited had been malarial. The answer was, of course, yes.
The doctor was certain he’d identified the cause of my problem; the medication I’d been taking had been instrumental in destroying my ability to hear. The news was absolutely shocking.
Hundreds of thousands of people are given this medication on a yearly basis but rarely are people warned of the side-effects. Yes, they may know about the possible hallucinations, nausea and gastric problems – but who ever heard of deafness?
My initial reaction was anger. I had ruined my hearing by trying to protect myself. The doctor told me that I had suffered an extremely rare reaction to the drugs.
In my case, although he didn’t know why, it had led to the damage of the sensory hairs on my cochlea – a coil-shaped bone in the inner ear – which, when working perfectly, send electrical impulses to the brain, enabling us to hear.
The prognosis: my hearing would get worse and I’d be left with hugely debilitating tinnitus.
Tinnitus is different for everyone, the symptoms range from a mild and intermittent ringing to continual noise that can trigger depression. For me, it sounds like a synthetic orchestra continually tuning up, and varies in intensity from a background buzz to high-pitched ringing.
This, too, has worsened over time – nowadays, my hearing is never free from it. A conversation in a room where there is background noise sounds to me as if the words have been knocked out of place, creating a jagged wall of unintelligible sound.
Now, with my hearing loss permanent, I’ve had no choice but to have hearing aids fitted.
The consultant explained that anti-malarial drugs carried a disclaimer, not only for deafness, but for blindness and, on rare occasions, death. But who, apart from lawyers, reads the small print? Certainly not me.
All eventualities are seemingly covered by the pharmaceutical giants – including, ironically, no guarantee of protection from the disease. But this is a health conundrum: if you don’t take medication to ensure wellbeing, then what do you do?
Dr Brian Greenwood, a leading malaria specialist at the London School of Hygiene, recommends taking a balanced view: “I travel to Africa a lot and don’t take prophylactics every time. In a city such as Nairobi, I wouldn’t take the drugs, but in rural places, I would.”
So it’s a case of knowing exactly where you are going and doing your homework. For those of you now planning trips, it’s well worth getting the latest information about malarial areas on specialist travel websites to assess whether medication is necessary.
It’s also worth bearing in mind that millions of people have safely taken these drugs. As I understand it, extreme reactions, such as deafness, are rare.
However, my experience has put me off taking malarial prophylactics ever again. This is a dangerous decision, but one that I’m prepared to risk. My worries of contracting malaria are outweighed by the risks of damaging my hearing even more. So how do I protect myself on trips to malarial areas?
A year after my diagnosis, I spent five months in Zanzibar working on a novel. Like most tropical climates, it has an endemic malaria problem. Anti-malarial pills were never going to be an option, not only because of my bad experience but because taking the drugs for extended periods can lead to kidney damage.
I was advised that I could look after myself by taking some basic steps. The malaria-carrying mosquito generally bites at night and dislikes light colours. So each evening, I wore a long-sleeved, white T-shirt and cotton trousers.
My neck and hands were covered with insect repellent and, at night, I burnt insecticide coils and slept under nets. I still take these steps when in malarial areas.
The precautions are not an absolute safeguard against infection, but, when rigorously adhered to, they provide good protection and no side-effects.
But few will be prepared to take such a calculated risk with their health. Even so, I would urge anyone planning travel in the tropics to get a thorough understanding of these potent medicines and their possible side-effects before making any decision.
Dr Greenwood agrees: “Nothing beats sound advice, because every journey is a specific thing.”
This isn’t a “poor me” story – deafness is no fun, but neither is malaria, and the pills protected me against the latter. So I don’t sit around feeling hard done by. Inconvenienced? Yes, I am. Irritated? On occasion.
However, there is an upside: if I sleep on my side with my deafest ear up, wherever I am in the world, I invariably get an uninterrupted night’s sleep.