Project MARC

Volunteer Information Manuals

This manual -- prepared by Emily Allen RN (2002 volunteer) --  contains a treasure trove of Project information. Therefore, all volunteers are strongly encouraged to download the .DOC file (which can be opened with recent versions of MS Word or even with Wordpad) and print it out for their own use.

Volunteer Information Manual (Word DOC format - 334 KB)

WARNING: Both the packing instructions (pages 61 and 62) and the chapter on malaria prevention (pages 16 thru 20 ) have been substantially modified since 2002 !! 

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
For updated packing instructions use the "what to bring" lists on the next web page.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

For up-to-date malaria prevention instructions, study the following paragraphs very carefully (print out, if needed):

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Malaria Update for Project MARC Volunteers 

 (written in 2006 by Poject MARC veteran Deirdre Duffy, MD)

 A useful introduction to Malaria can be found in Emily's manual and much of that information is not reproduced here. There are a number of very important points to bear in mind about Malaria risk for volunteers, however, which I would like to mention.

I
~ Malaria can kill you ~

Plasmodium Vivax is the less harmful and non lethal form and causes an illness that is very similar in symptoms to the flu-like viral illnesses that volunteers would be used to in their home countries.

Plasmodium Falciparum, on the other hand, causes a much more serious illness that is potentially deadly but can begin just like a flu yet can lead to coma and death in a matter of hours.

Adults who live in Vanuatu develop a degree of immunity following exposure over many years and so most of them have quite a mild illness. The three groups of people that Falciparum Malaria kills are children under 5 years, pregnant women and tourists. You are much more likely to develop the deadly form of disease that the Ni-Van who gets bitten.

II
~ Malaria is preventable ~ 

Falciparum malaria is transmitted by the Anopheles mosquito. This mosquito bites from dusk to about midnight both outdoors and indoors and is attracted to the lower limbs by substances produced by the body and secreted by the skin.

Malaria can be prevented by avoidance of mosquito bites and by taking medication to kill the parasite if it is picked up by a person. Because of the life cycle of the parasite within the body and the fact that the medications only work at certain stages of the cycle it is necessary to take the medications just before entering a malarial area and for some time after leaving the area for them to work properly.

III
~ Mosquito avoidance ~

You can reduce the likelihood of being bitten by wearing clothing that covers your arms and legs during the peak hours of dusk to bedtime. Washing with soap in late afternoon will reduce the amount of attractant chemicals on your skin so this is a good time to shower. Anopheles does not fly far from land so being on the boat in the evening is safe unless you are berthed at shore.

You can soak your clothing and shoes in Permethrin at home before you travel. This is an effective and non toxic insecticide and lasts for about a half dozen washes. You can use an insecticide treated mosquito net in bed to protect you while sleeping. This is the way WHO recommends protecting young children who live in Malaria zones.

Repellants containing DEET are effective and can be applied to the skin. You do not need a repellant that contains greater than 50% DEET as peak effectiveness is achieved at that concentration. During the dry season, which is the time you will be spending in Vanuatu, there is much less risk as there are much fewer of the pools of water that the mosquito uses for breeding.

Falciparum malariain Vanuatu is resistant to some of the malaria prophylaxis medications that work quite nicely on the other forms of the parasite so when you get your medication it is important that you get one that is going to be effective against Falciparum malaria. The government of Vanuatu supplies Fansidar to Aidposts for treatment of Falciparum malaria. This decision is based on effectiveness, and cost but because of serious though rare side effects it is not suitable as a preventive drug for traveller's to the country.

IV
~ Malaria Prevention Medications ~

There are three effective medications for Vanuatu:
-- Mefloquine or Lariam
-- Atovaquone-Proguanil or Malarone
-- Doxycycline

They each have advantages and disadvantages that make them suitable for a particular person. Emily's manual gives more detail on each. Make sure your doctor is following current CDC guidelines for Vanuatu (available easily online) The website for more information is www.cdc.gov/travel/malariadrugs.htm

Mefloquine: In spite of recent bad press this is usually very well tolerated. The side effects that usually cause discontinuation are stomach upset, sleep disturbance or mood disturbance. Much cheaper than Malarone if using prophylaxis for longer than a week or two of exposure. Needs to be started a week before entering Vanuatu but if you are concerned about side effects try beginning three weeks before and if problems arise you have time to get an alternative drug. Needs to be taken once a week for four weeks after leaving the malaria area. Sunday is the best day to take it as this is a day of rest throughout Vanuatu and makes it a really easy day to remember to take your malaria pills.

Malarone: The best tolerated of all the medications but expensive for longer stays and has to be taken daily. It only has to be taken for a week after leaving the area though. The limiting factor for most people is the price.

Doxycycline: A broad spectrum antibiotic that is effective and cheap. It can cause sun sensitivity and promote yeast infection in women so if you use it make sure you also pack a sunhat and SPF 30 sunscreen and a treatment for yeast. Another disadvantage is daily pills for a prolonged time after leaving the area, 4 weeks.

Some countries in Europe subscribe to the practice of giving travelers a treatment dose of medication to be used if symptoms occur. This is not recommended by the CDC. It is not intended to be an alternative to seeking medical care but rather to use to get you to medical care.

V
~ Malaria Treatment ~