Marine conservation in Honduras

You may have heard that the political situation here in Honduras is a bit rocky... It is very difficult to get a clear view of what is going on, as the media depict two completely different and contradicting stories.

President Zelaya was taken out of the country (to Costa Rica) by the military early on Sunday morning. He also signed a resignation before exiting, and a new provisional government is now in place, led by the new President, Micheletti. Zelaya, supported by other politicians, has sworn to return to Honduras. The most likely scenario is for him to get arrested as soon as he get through the border.

I am now at last on the island of Utila since Monday evening, after a very tiring trip. I had to take a plane from London to Madrid, then Madrid to San Jose (Costa Rica), and from then to San Pedro Sula, Honduras, before taking another small plane (or as it turned out three of them) to Utila. Needless to say I arrived exhausted, after several problems (first the suitcase, then canceled flight, and finally related to the whole political unrest as I was stuck in San Pedro Sula for two nights).

Since my arrival on Utila, however, everything's been running smoothly and apart from the curfew imposed (10pm), there are no signs of any problems whatsoever. Most the other volunteers are about 21-22 years old and we all get along great, it's been a lot of fun. The plan for tomorrow (day off) is renting some carts and exploring the island, which sounds pretty fun. We've also had all our marine ecology lessons this week, together with training dives, in fish, benthic, lobster and conch ID, as well as survey techniques. My Spanish lessons are very good too, I've already learned a lot.

We have a fish ID test on Monday,we have to be able to recognize all the stages (juvenile, initial and terminal) of the parrotfish, surgeonfish, groupers and snappers, which is actually not an easy job a they can change colors... I'd better get some revision done before dinnertime.

Bis bald
Virginia.

I'm now getting ready for my trip to Honduras, where I'll be spending a month doing marine conservation on the island of Utila. Getting ready for such a trip is quite daunting, but I'm up-to-date with all my vaccinations and currently choosing the last items I will add to my first-aid/medical kit.

There's a risk of malaria throughout the country and it is more acute for people volunteering in rural areas, or staying for more than three weeks, and around San Pedro de Sula and in the Bay Islands. Let me think... check, check and check. Lucky me, I fit the profile to perfection and am about to become a living statistic. Malaria is a life-threatening disease, contracted through infected mosquito bites and caused by a parasite called Plasmodium: http://en.wikipedia.org/wiki/Malaria. Being a "living" statistic doesn't look so bad any more now, does it?

So now on top of the challenge that is fitting dive-equipment in an already stretched baggage allowance, I have to worry about anti-malaria tablets... which brings me to the subject of this post: which antimalarial tablets should I agree to take?

My doctor gave me a prescription for Lariam today whose active component is mefloquine. He also explained that it has psychological side effects, especially in people with a history of depression. I've never had any such problem so this didn't really concern me, until my father mentioned he remembers having side effects when taking the drug decades ago. He couldn't remember exactly what those were, so nothing too serious, but that got me curious. Looking at the official Roche notice on Lariam, http://www.rocheusa.com/products/lariam/pi.pdf, I learnt that the potential side effects of mefloquine go far beyond what I thought would be, at worst, a depressive mood.

A rather disturbing article written by CBS news a couple of years ago can be found here: http://www.cbsnews.com/stories/2003/01/27/60II/main538144.shtml. As that was the first source I read, I immediately assumed the author was excessively alarmist, maybe adopting a sensational point of view instead of a balanced one. However, most of his facts were corroborated in all the other documents I came across, including the official Roche notice quoted earlier. Side effect include, but are not limited to, nausea, vomiting, diarrhea, dizziness, loss of balance, difficulty sleeping, bad dreams, as well as neuropsychiatric disorders such as convulsions, agitation or restlessness, anxiety, depression, mood swings, forgetfullness, panic attacks, confusion, hallucinations, aggression, psychotic or paranoid reactions, suicidal ideation and suicide. Note that this truncated list has been copied from the official Roche notice once again, which admits that cases of serious mental problems have been reported occuring in patients with no prior mental health problems, and side effects including mental health problems can persist after the treatment with the drug has been stopped.

Now let's be honest: all medicines may cause side-effects and Lariam is good at preventing malaria, although no anti-malarial tablet has a 100% efficacy. It is also convenient, in that it's administration is only once per week (instead of the daily dosis of most other anti-malaria drugs). Furthermore, the notice states that, amongst others, people with a history of mental health problems or epilepsy should not take it and it is not to be mixed with a number of other medications (including antihistamins and other anti-malaria drugs). Patients on mefloquine should be extra carefully when driving or doing other activities, including scuba diving.

After my hour-long research on mefloquine, I'd rather not use Lariam. There are other drugs available, and chloroquine is particularly indicated when travelling to Honduras, as the specie of Plasmodium parasite present in Honduras is chloroquine responsive (and in most Central American countries). All sources I looked up recommend chloroquine as the first choice antimalarial drug to use when travelling to Honduras. Basically the problem with chloroquine is that the parasites in some regions are resistant to it, but this is not the case of Honduras. A good interactive map can be found here: http://www.cdc.gov/malaria/risk_map/.

Using Lariam does not look like a chance I want to take, especially not while diving and when an alternative sounds promising: I'll call my doctor first thing in the morning to discuss the possibility of using chloroquine instead of Lariam. Chloroquine has side effects too, but compared to those of Lariam it is very safe. The only real concern is the dosage, as taking only twice the recommended dosage may prove fatal: http://en.wikipedia.org/wiki/Chloroquine#Adverse_effects.
But I am already developing sides effects of mefloquine before even starting Lariam, namely anxiety and difficulty sleeping: surely that qualifies as a contraindication?