By Linda Hsieh, Managing Editor
Although Ebola is the disease that’s dominating the bulk of media attention these days, it’s malaria that companies should be thinking more about in terms of protecting employees. Malaria “is nothing new, but honestly our companies are more at risk to get a fatality with malaria versus Ebola today. And, unfortunately, malaria is likely to last,” Dr Francois Pelat, Director of Medical Services for Transocean, said at the 2014 IADC Drilling Africa Conference in Paris on 2 October.
Particularly for Western companies with expat personnel in malaria-endemic countries, those employees can be at particularly high health risks. Unlike individuals who were born and raised in malaria-endemic areas and have developed a partial immunity to the disease, expats don’t have this partial immunity and are considered to be “non-immunes.” “Non-immunes are most likely to develop very serious consequences and to get sick very rapidly,” Dr Pelat said.
Even if you’ve done numerous trips through endemic areas, it doesn’t mean you’ve developed that partial immunity, he warned. Further, individuals who were born and raised in endemic areas but who have moved to non-endemic areas may have lost their immunity. Every year, thousands of imported malaria cases are reported, including in the US and Europe. Dr Pelat referenced the case of a 19-year-old British student who got sick after a trip to Uganda. Upon returning to the UK, she visited a doctor and mentioned her trip to Africa. Unfortunately, it was not enough to raise a red flag with the doctor. The student was diagnosed with the flu and was given paracetamol, also known as acetaminophen. She was found dead three days later of cerebral malaria.
This case illustrates several challenges that expats may also face. First, malaria symptoms aren’t specific and can easily be mistaken for a flu-like illness. “Doctors in Houston or Louisiana or the UK are not used to (malaria). It’s not the first diagnosis that they’re going to make,” Dr Pelat said. For expat workers who have come home after traveling to an endemic area, it can be challenging for them to get access to malaria testing tools or treatment medications. “And, of course, we’re talking non-immune cases. They are the ones who progress very quickly to the worst (conditions).”
To protect its employees, Transocean is taking a proactive approach to malaria prevention. “First, if you’re committed to do something for your people, if you expect people to walk into an endemic area, you need to have policies and procedures,” he said. Transocean’s Malaria Prevention & Control Plan begins with a mandatory online awareness briefing; compliance is tracked, and completion certificates are issued. A malaria induction video follows, required for all newcomers onboard offshore installations in endemic regions. The video reiterates the components of the company’s malaria control plan.
Company-paid preventive medication is another key part of the control plan. The most user-friendly medication does come with a high cost, Dr Pelat acknowledged, but companies must see that cost as part of their responsibility for sending employees into endemic areas.
“Unfortunately, even if we pay for the drugs and we tell the guys to take it, we still have people who don’t want to take it.” As a backup option, Transocean put together a diagnostic and treatment kit that includes three rapid tests and a course of curative anti-malaria drugs. An alert card highlighting the employee’s recent trip to sub-Saharan Africa and displaying Transocean’s malaria hotline is also included. “So whether they’re in the south of France or Louisiana, they can go to their doctor, bring the kit… the doctor will have the test and the treatment, and he has a hotline to call. Everything is in the box,” Dr Pelat said.
Overall, he continued, Transocean takes an active case management approach to malaria prevention and control. This means that treatment is always available offshore to initiate management of suspected cases. That’s always followed by referring the employee onshore for re-evaluation. “We get him onshore, even if he’s looking good… You should take every potential case very seriously. Otherwise it will lead to trouble. Today, tomorrow, after tomorrow – you don’t know when, but it will happen.”