malarial malarkey

When Mood Music
2006-01-20 02:13:00 annoyed Right Turn Clide-The Bloodhound Gang-HORRAYforBOOBIES

Last week I was told that I need the following vaccinations and to take a good supply of anti-malarial drugs with me:
• Japanese B encephalitis
• rabies
• booster for hepatitis A
• meningitis ACWY

I booked the earliest possible appointment (4 pm yesterday) at my local practice to get the hep A and meningitis vaccinations and was told that I could get a private prescription for the prophylactic anti-malarial drug of my choice* at that time. However, I’d need to go elsewhere for Jap B and rabies vaccinations (both prescription** and actual injection), so made an appointment at Ninewells travel clinic for 2pm today to get these injections.

Yesterday, I was seen by a nurse. She discussed the issues of anti-malarials with me and gave me the injections completely painlessly. (However, I was still reeling from the £31·10 cost of the drugs.) Being a nurse, she could not write a prescription for the anti-malarial drugs but said that a doctor at Ninewells would do so without any problems. (It would be a private prescription and hence cost £11 plus the actual cost of the drugs.)

So today, once I’d finally found the travel clinic, I was seen by a real live doctor: name-badge, stethoscope, illegible handwriting, the whole works. She prescribed the Jap B and rabies vaccinations but, as with just about bloody everything, there’s a catch. I can either have a one-off rabies injection which gives 80% coverage or have three injections: one today, one a week later and one 3 weeks after that. For Jap B, there’s no choice: 3 injections at the same intervals. Because of my timetable, I’ll either have to have the third injections for Jap B and rabies in a random travel clinic down south, come back to Ninewells specifically for these injections or not bother. (I’ve already heard that the regular Worcester general practitioners won’t touch me with a barge-pole until my medical records have been transferred to their practice.) OK, at least I have options here (one of which is to forget all about further injections because each will cost me £30).

I then ask the doctor to advise on anti-malarials. She says it’s really up to me to decide depending on my plans:

  • Malarone is to be taken daily. Its side-effects can include rashes, abdominal pain, headache, anorexia, nausea, diarrhoea, coughing and mouth ulcers.
  • Mefloquine is to be taken weekly. Its side-effects can include nausea, diarrhoea, dizziness, abdominal pain, rashes, pruritis and rarely headache, convulsions, sleep disturbances and psychotic reactions.
  • Doxycycline is to be taken daily. Its side-effects can include photosensitivity. That’s a fat lot of use: where do mosquitoes live? Mostly in sunny countries!!!

Overall, I think I might prefer malaria itself!

In the end, I decide on Mefloquin because even I can remember to take a pill once a week and because the thought of travelling with 200 pills rattling in my rucsac doesn’t appeal at all. So I ask for a prescription for it. The doctor says she can’t give one but that I can get it over the counter at a pharmacy. I ask about the others: same response. I think ‘this is weird but she’s a qualified doctor working in a travel clinic – she must be right’ and go off to the treatment area to get injected.

My treatment is interrupted by another nurse coming into the room twice to ask about some medicine for someone else. The interrupter said the name of the patient out loud while standing three feet from me – that’s a breach of this patient’s confidentiality. I was pleased when a doctor who is a vague friend (he’s married to the counselling nurse who saved my sanity a few years back) came into the treatment room – I’d wanted to see them before I go and it’s brilliant to see a familiar face when someone else is about to prong me with a sharp piece of metal.

When it’s all over and I’ve paid the £60 for these two injections, I get on the bus back to Dundee city centre, feeling that if I get the anti-malarials, today will have been worthwhile. So I stomp into Boots and am told flatly that I cannot obtain any anti-malarial drug without a prescription. Now I’m really annoyed and almost lose my temper with the Boots pharmacist. She tries to tell me that this situation is very common and is able to tell me the costs two of the drugs:

  • Malarone: £40 for 12 pills ( I should start taking it 2 days before I travel and keep taking it for a week after I return so will need 198 pills, total cost £680)
  • Mefloquine: £24 for 14 pills (I should start taking them 3 weeks before travelling and keep taking them 4 weeks after I return so will need 33 pills, hence total cost £72)
  • Doxycycline: unknown

So tomorrow I have to try for an appointment with my own doctor to get them to write a prescription for an anti-malarial drug. Why am I being pissed about like this? All I want to do is prevent myself getting ill and costing the NHS a hell of a lot in treating the illness.

*and I’m the world expert on anti-malarial drugs, of course!

**for the non-UK readers, a doctor diagnoses your complaint and decides the correct course of treatment. If this involves drugs which are not freely available at pharmacies, he or she writes a prescription: a form stating that you and you alone are to get these specific drugs, (usually) courtesy of the NHS. You then take the form to the pharmacy and they give out the medicine you’ve been prescribed. (I think it’s fairly sensible system because it cuts down on the number of loonies taking irrelevant or harmful drugs because ‘they know better’*** and means that the NHS doesn’t have to dish out cash on idiots’ random whims. Of course it has its faults. For example, a doctor can only prescribe NHS-approved drugs – unless you’re able to pay the non-NHS-subsidised prices. This caught my mother a few years back when she needed a specific antibiotic but it needed to be in a sugar-free pill because of her diabetes. The one brand of pill containing this antibiotic which didn’t have a sugar coating wasn’t on the NHS-approved list because it was more expensive than brands with sugar coating.)

*** because they don’t – they haven’t conducted the clinical trials and almost certainly haven’t read the results from trials other people have conducted

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