This week the ADF issued a statement to Crikey denying that
troops stationed in Iraq were prescribed anti-malarial drugs after we
raised the possibility that Private Kovco’s dream and alleged behaviour
could be explained as side effects of the controversial drug Lariam. We
asked people to share their experiences of the
drug, which is still prescribed by the ADF to some troops deployed to
other parts of the world, and by doctors to some travellers – here are a few of the responses:

Dr Neil Starmer writes:
I was a Navy doctor for ten years and
I remain a practising rural GP and member of the Navy Reserve. I am
sure there are some rules that prevent me from talking to you, but you
asked. My main experience of malaria prophylaxis comes from deployments
to Somalia in 1993 and then to Aceh last year. During these deployments
we mainly used doxycycline as you have stated previously in your
articles. The assessment of local malaria risk is often left to the
medico on the ground as other precautions such as mosquito nets,
clothing and repellent are just as important. I must add that the Navy
is a bit more relaxed about this than the Army. Nevertheless, I
was working with the Army in Aceh and the decisions were basically left
to me.

Defence Force members are never shy about coming to the medics
at the merest suggestion of illness. They are as a whole quite
paranoid about their health, despite having probably the most perfect
and costly health system in the country. The system is also very
forgiving if they are unwell as local commanders are loath to go
against medical advice. I make that point in relation to the Lariam in
particular. If a soldier was taking Lariam because he couldn’t take
doxycyline and experienced side effects from the Lariam I would have
stopped the Lariam. Simple as that. There are alternatives such as
atovaquone and to a lesser extent chloroquine and fansidar. I have
personally taken Lariam on a non defence trip to West Africa and after
the first dose felt awful. The subsequent doses were fine. Because of
the amount of doxycycline taken, my experience with the side effects has
been greater. Most complaints have been due to skin rashes, poor sleep
and constipation. I have removed one sailor from a ship with
oesophageal ulceration after the capsule got stuck but by and large the
drug is well tolerated.

Furthermore, no one supervises the soldier or
sailor taking the medication. There is no pill parade. The tablets are
not accounted for and who knows if they get taken. I used to order the
drugs based on the ship’s complement and have lots left over. Those who
complain about side effects also must remember that people die from
malaria in vast numbers every year. I realise that the whole “must take
medicine because the Army told me” is very emotive but dying from
cerebral falciparum malaria cannot be a nice way to go.

A Crikey reader writes:I was in Baghdad (and northern
Iraq) for most of a year. Anti malarials were not indicated by most advisory
sources, nor by the US military, which did however want to inoculate me against
nasty anthrax and smallpox. (I was working under a US government contract.) I
believe other areas of Iraq, especially where the wetlands are being
reconstituted, are probably indicated as potential malaria areas. Second on Lariam – a friend of mine is a tropical
disease specialist who has, among other things, worked for the Australian
government in places where malaria is endemic. He says prophylactic use of
Lariam is worse than the disease, and does not prescribe it for prophylactic
purposes. He does, however, say it is very effective as a treatment if you get
the disease. As he was the Australian government doctor in at least one post I saw
him, that was probably the “official” position. I know that some of the people
at that post followed his advice on medication and on sensible clothing and
other behaviours (and few, if any, contracted malaria). I know I did not. I
worked in PNG, including several months in the East Sepik district, for a year
or so in early 1970s and took chloroquine periodically. In most other places in
SE Asia in which I have worked/travelled, I have not bothered.

Ray Brown, National President of the Injured Service Persons
Association (Peacetime Injuries), writes:
Common law suing only enables a maximum amount of $110,000 to be
paid which has carried over to the new Military Rehabilitation &
Compensation Act. I have questioned why this amount isn’t indexed or
increased in the MRCA. The answer – to discourage people from common
law claims.

Peter Fray

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Peter Fray
Editor-in-chief of Crikey