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An Expat’s Guide to Surviving Malaria

The following is an excerpt from Expat Etiquette: How to Look Good in Bad Places, by Michael Bear and Liz Good.

The first time I got malaria was, as is often the case, the worst. No, actually, that’s not true: the fourth (and most recent) time I got malaria was the worst, but only because it was an unexpected relapse that struck while Christmas’ing in Athens. Talk about unfair.

expat etiquette

But anyway, the first time was definitely the scariest. I’d started getting sick on a Friday, and being new to West Africa, and thus not knowing how to get help or who to call, I decided to ride out the weekend in the hopes that my body aches and fever were “just” the flu and/or might miraculously go away on their own.

Besides, I told myself: people here live and work with malaria all the time. Right? Right. Surely if they can do it, so can I. Right?


By Monday my fingernails had turned blue and my bedroom walls had begun to undulate. By the time my coworkers showed up to rescue me, in response to my hysterical phone call, I could barely move, let alone walk. They all but dragged me down to the car, before starting a frantic round of phone calls to determine which hospital was our best bet. In a country that boasted only 50-60 local, legitimately-licensed doctors to serve a population of 3.5million, this was not as simple a question as you might think.

My hospital stay was tedious and lonely. For three days, every four hours, a Jordanian male nurse would come inject my IV with some medicine that, no joke, made my vagina burn for the first five seconds. Trying to tell him this, given the linguistic and cultural barriers, proved an exercise in futility. He only got embarrassed, and I can only imagine what he thought I was trying to say. Once, while taking myself down the hall to the bathroom, my 1950s-esque IV fell-out of my arm, and I begun gushing thick red blood all over the hallway. Gross. It was still there the next day, albeit brown and dried. Even grosser.

We ultimately aimed our nose for the UN-base hospital, just on the outskirts of town. Though technically not supposed to be admitted entrance, the guards took one look at our white car, with my white convulsing self in the back, and waved us through. The doctors were similarly sympathetic. Turns out, on top of the malaria, I had also contracted walking pneumonia, and the lack of oxygen accounted for my blue nails and hallucinations.

I’d come without my glasses, without a book, without my laptop, and without my phone charger. On the first night, once the phone died, I had nothing to do but stare at the out-of-focus ceiling. Fortunately, friends came the next day bearing clean underwear, portable electronics, and bootleg DVDs. These things only made the stay bearable; they did not make it pleasant.

I checked myself out a few days earlier than recommended, in order to catch a flight home that I’d had scheduled for months. As I left I promised that I would start taking my malaria prophylaxis. I meant it at the time. I really did. It just wasn’t a promise I was ever able to keep, something my immune system will forever hate me for.

How to Deal with Malaria

First of all, don’t get it. Seriously. It’s really easy not to. There are a number of inexpensive prophylaxes available. If you happen to be like us, however, and wind up taking your pills sporadically, or not at all – usually out of some misguided bravado or perhaps poorly-researched concern about “long-term use” – then this advice might be too little too late.

The basic symptoms of malaria include some combination of fever, chills, headache, sweats, fatigue, and nausea and vomiting. Symptoms will often appear in cycles, and can appear anywhere from seven to forty days after the initial infection.

If you fear you do have malaria, then:

1. Get tested immediately.

2. Check and double-check the results – second opinions are a good thing, especially if the first exam cost you 50 cents at the nearest one-room clinic. Malaria is one of the most “over-diagnosed” diseases out there, or so says one of our doctors.

3. Start taking meds immediately – better the wrong meds than a cerebral meltdown.

4. Whine; you’re allowed.

5. Call home, it’s worth the expense

6. Rest – it’s going to take you less time to feel mostly better than you’d imagine, but longer to feel fully better than you think.

About the Book

Going overseas is hard. Leaving friends and family behind. Traveling to a country where you probably don’t speak the language, and definitely don’t understand the culture. Foreign foods, foreign diseases. Loneliness.

Of course, it does have its compensations. Smoking. Casual sex. Functional alcoholism.

Add a little danger and excitement, and it’s a difficult offer to refuse.

Expat Etiquette is a guide for all of those who want to travel to far-away and sometimes dangerous lands – for the best or worst of reasons – while still retaining a modicum of style.

Style defined as “appearing to know what you’re doing, even when you have no idea what’s happening around you.”

Traditional travel guides don’t tell you how to drink bootleg liquor and not go blind. How to handle an overseas affairs. What to do if you hear gunfire.

Expat Etiquette does.

The two authors spent years living in places like Afghanistan, Iraq and Liberia. This book captures what it’s like to leave the normal world far behind. In humorous and ironic tones, it provides advice for everyone who wants to wander off the beaten path.

Advice that isn’t available anywhere else.

All profits from the book go to benefit the Center for Civilians in Conflict: 


About Author


Humanosphere will sometimes post articles from authors from around the globe. Although these folks are not regular contributors, we hope you enjoy this change of pace.