I’LL NEVER TAKE MALARIA PILLS AGAIN

THE TELEGRAPH Nick Maes was left with damaged hearing from medication – he now takes alternative measures in the tropics.  I watch the wispiest of clouds slide hopelessly across an outrageously blue sky and then evaporate when it reaches the sun. Lazing in a hammock, with my laptop balanced on my knees, I occasionally glance at yachts ploughing azure seas towards the horizon and the far-off Whitsundays.

I am, it must be said, a lucky devil. This is another of the various trips I make each year, either holing up to work on a novel or travel writing, and, like all the memorable journeys I make, one that I hope will finish happily with my safe return home.

Sadly, I now have a constant, inhibiting reminder of the exotic trips I took 10 years ago. My hearing has quietly faded over the past few years and I shall soon have to wear a hearing aid. To begin with, the shifts were imperceptible, but, gradually, I found myself making adaptations. I would mishear song lyrics or have to ask a friend to repeat lines while watching a film. I’d lean forward to listen to a conversation and subconsciously avoid noisy restaurants.

Then, a sibilance began to hiss continually at the periphery of my hearing. The problem became more pronounced and friends started to comment about the volume of my radio or television being too loud and, on occasion, about me missing whole parts of a conversation.

Benignly patronising, my GP suggested the condition was imaginary and that, perhaps, I was lazy, not really listening. After I made my case, he reluctantly referred me to a specialist at the Royal Free Hospital in north London. The otologist tested me in a sound-proof booth, inspected each ear with an instrument that looked more suited to affixing icing to a cake, and carried out blood tests,

X-rays and a brain scan. It was official, I was not imagining deafness. The hearing in my right ear had deteriorated to less than half what it should be and, in my left, two thirds that. All we needed to do was establish why.

There is no history of deafness in my family, and my sisters and mother all have perfectly ordinary hearing. The specialist moved on to my past, my health, social and environmental habitats and seemingly pointless avenues of inquiry, all of which proved negative. 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. I answered yes to both questions.

The word malaria is rooted in Italian: mala aria – literally, bad air. It comes from the belief that the disease was caused by noxious gases in marshy places rather than the parasitic protozoans transmitted by the irritating bite of a mosquito. It is foolish to treat malaria lightly – the disease claims many tens of thousands of lives throughout the developing world and infects upwards of 3,000 travellers who return to the UK each year. The symptomatic chills and fever range from a mild flu-like illness to a much more serious and sometimes fatal condition.

I first visited India in 1991 and, like all responsible travellers, sought advice regarding medication before I set out. The local pharmacist recommended I take a malarial prophylactic, a combination of two different pills, one of which was to be taken daily, the other once a week.

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. During this time, I felt queasy and nauseous, but persisted with a view to maintaining my good health. By the time I visited the consultant at the Royal Free, I had made several such journeys, buoying my wellbeing with the same anti-malarial pills.

The doctor was certain he’d identified the cause of my problem; that the medication I’d been taking had been instrumental in destroying my ability to hear. My initial reaction was anger. I had ruined my hearing by trying to protect myself. The prognosis wasn’t much better; my hearing would get worse and the sibilance was tinnitus.

Tinnitus is different for everyone. For me, it sounds like a synthetic orchestra that is continually tuning up: the whistles, piping and drones vary in intensity from a background buzz to high-pitched ringing and this, too, has deteriorated over time. Now, a conversation in a room where there is background noise sounds to me as if the building blocks of words have been knocked out of place, creating a jagged wall of unintelligible sound.

The consultant explained that the medication carried a disclaimer, not only for deafness, but for blindness and, on rare occasions, death. All eventualities are well and truly covered by the pharmaceutical giants – including, ironically, no guarantee of protection from the disease. As I understand it, these extreme reactions are not common. However, my experience put me off taking malarial prophylactics ever again. So how could I protect myself on future trips to malarial areas?

A year after my diagnosis, I spent five months in Zanzibar, working on a novel. Like most tropical climates, Zanzibar has an endemic malaria problem that I obviously wanted to avoid. 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 have serious implications for your vital organs.

I sought the advice of locals and ex-pats living in the capital, Stonetown, and discovered I could look after myself by taking some basic steps. The Zanzibarian malaria-carrying mosquito bites only at night and dislikes light colours. Each evening, I wore a long-sleeved, white T-shirt and cotton trousers. My neck and hands I covered with insect repellent and, at night, I slept under nets and burnt coils.

The precautions were hardly rocket science and were certainly not an absolute safeguard against infection, but, when rigorously adhered to, provided good protection with no side effects. This is a calculated risk that I was prepared to take and will not be to everyone’s taste, but I urge a thorough understanding of these potent medications and their possible side effects.

Ultimately, this isn’t a “poor me” story. I don’t sit around raging against the tinny whistles in my head or 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.

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