Ike Anya: Tackling imported malaria in the UK

It is a typical busy, Thursday afternoon in the office in central London, as I recall the mental note I made to myself earlier that day: ring GP practice to arrange anti-malarial prescription. I am going to Nigeria on Monday and have resolved to make sure that I take my malaria prophylaxis rigorously this time.

I have not always been so scrupulous about taking these drugs on my regular visits home to Nigeria. Ten years ago, I came to the UK to study at the London School of Hygiene & Tropical
Medicine learning in great detail the science behind the need for prophylaxis and seeing first hand at the Hospital for Tropical Diseases the tragic consequences of not taking it. And yet, for those first few years, whenever I went back to Nigeria, I did not take any preventive medication.

It wasn’t a rational decision- although some poorly articulated reasons floated in my subconscious to underpin my reluctance:

“The drugs will make me feel queasy or worse and they will ruin my holiday.”

“Surely I retain some degree of immunity from the several bouts of malaria I had suffered while living in Nigeria.”

“Taking anti-malarials will in some way confirm that I had become a ‘foreigner’ in my own country.”

Five years ago, at a conference, I met a woman from the Health Protection Agency who was
conducting research on why UK residents with family ties to malaria endemic countries did not take prophylaxis on their visits home. Her research had been prompted by the increasing numbers of such people needing treatment and sometimes, hospitalisation, having developed malaria after visits “home.”

She confirmed that my reaction was not dissimilar to the answers from other immigrants in her
research, and told me that nearly 65 per cent of all malaria reported in the UK occurred in travellers visiting friends and relatives, usually in a country in Africa or Asia from which members of their family migrated.

That conversation somehow triggered a reaction that ensured that on my next few trips to Nigeria, I made arrangements for, and took anti-malarials. It wasn’t straightforward- there was the long duration I needed to take the cheaper doxycycline for compared to the expense of the shorter-duration proguanil-atovaquone; the additional hassle of booking an appointment, and making time to go and pick up the prescription in an often very frenetic pre-travel period; the first time when I forgot to take the medication after food as directed and ended up with the most excruciating stomach pain…. but I persisted.

Last week I rang my GP practice and asked for a prescription for anti-malarials. The receptionist
explained that I would need to speak to the practice nurse who was not available until later in the day. In between meetings, I rang the practice again, and asked to speak to the nurse. I was asked to ring back between 11 and 12 the next day, Friday. I set an alarm reminder on my phone and rang back at 11 15 on Friday. This time, thankfully I was put through to the nurse who asked how long I was going away for and whether I had any preference for which medication I preferred. Having answered her questions, she promised to have a prescription ready for me that afternoon and reminded me that there would be a £15 charge for the prescription.

Given the number of things I still had to do that day, I ventured to ask if by any chance, the surgery was open on Saturday. The nurse seemed taken aback at my question and confirmed that they were not.

What time did they close on Friday? 6 pm

I managed to dash back straight from work, with just minutes to spare and picked up the
prescription and paid for it. The next day I headed to the pharmacy where I had to wait for 20 minutes and pay nearly £60 for the prescription to be given to me.

As I walked out of the pharmacy, clutching the paper bag with the golden pills, I ruefully recalled the mantra I learnt early in my public health training: “making healthy choices, easy choices”

Ike Anya is a public health consultant in London.