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Thursday, 11 October 1984
Page: 1639

Senator PETER BAUME(12.58) —I wish to say a few words about malaria, one of the great imposters in medical practice and one of the great preventable diseases. My contribution has been provoked by a letter I received from an old colleague in the practice of medicine, practising as a consulting physician, who drew my attention to his dissatisfaction with the level of knowledge available at present to practitioners of medicine, and certainly the lack of knowledge available to those who travel. It seems that very little publicity has been given to the possibility that malaria can be contracted and, indeed, is being contracted by Australians in countries in this region to which they go as tourists and from which they come without proper treatment. The high risk areas include the Solomon Islands, Papua New Guinea and Vanuatu and they are places particularly where Australians tend to concentrate a lot of their travel. The numbers are very considerable.

Other countries about which Australians should be aware in which malaria is endemic at present include China, India, Bangladesh, Kampuchea, Thailand, Vietnam, Malaysia, the Philippines and Indonesia. In other words, the region in which we live is one in which malaria is endemic and, indeed, in certain parts of northern Australia one has to think of this illness whenever someone presents with an unexplained fever. It would not be my intention to raise unnecessary fears about travelling from Australia to these areas but there is a legitimate concern that not enough is being done to publicise the possibility that malaria might occur and to publicise the very legitimate actions which might be taken at an individual level or a national level by way of prevention; not enough is being done to advise people on the treatment they might receive on returning from these endemic areas. We simply cannot be sanguine about a situation where malaria could exist and, in fact, be increasing in Australia.

I remember, before I came into the Senate, being called upon to give advice about a person who had a fever in a surgical ward. This gentleman had decided to hitch-hike from the country. He had been picked up by a truck driver; he later woke up in hospital after a period of unconsciousness, the truck having crashed. The interesting thing was that this man was unfortunate enough to have contracted malaria from the transfusion of blood he was given to treat the effects of the road accident. That is just one of the bizarre effects that can occur. Someone had come from a malaria endemic area with an infection unrecognised and had then carried on with his normal practice of being a blood donor. I well remember that particular case with an interesting twist on worker' s compensation, third party compensation or whatever it was.

My colleague, the one who wrote to me and provoked this speech, has drawn my attention to several examples which have come through his practice of Australians who contracted malaria in Papua New Guinea. One of them actually died of cerebral malaria and the other man-the patient of my friend-indicated that he was totally ignorant about malaria. He was ignorant about the fact that he was entering a high risk area. He was ignorant about the fact that malaria presents with certain symptoms which we can recognise. He was ignorant about the ready availability of treatment and the simplicity of treatment but really that patient would be the rule rather than the exception in our society. In fact, an eminent Australian practitioner, Dr Robert Black, suggested some seven years ago that the problem, in fact, is becoming more serious and the problem is increasing rather than diminishing. At that time, seven years ago, Dr Black estimated that there were about 200,000 people coming into Australia each year from areas where malaria is endemic. He pointed out that only special people- certain designated classes of people-were being given treatment as a matter of course. The classes of people would include soldiers returning from active duty who are treated with a drug called primaquin which has the effect of eliminating any residual malaria of a kind called vivax malaria which people can sometimes carry and which may not manifest itself for some time. Dr Black observed at that time that it may be too difficult to treat all the 200,000 people but that our level of consciousness is not high enough.

It seems that more must be done by the Department of Health to help the doctors who carry the burden of diagnosis, treatment and advice and also to help inform the public of what are the high risk areas, what are the available means of prevention and what are available treatments. It has been suggested by my colleague-the one who wrote to me-that the Australian Medical Association, in conjunction with the Department of Health, produce a booklet about these matters for wide distribution within the profession. Many doctors feel uncertain and unhappy about the occasional treatment of malaria. Drugs continue to be developed but for many doctors it is years since they studied malaria in medical school. This booklet could be available to doctors. It can also be available from medical practitioners to the public; it could also be made available through large employers who regularly send members of their work force into malaria endemic areas.

The booklet could be made available from travel agents to those members of the public who are travelling and perhaps it could even be handed out to individuals or family groups who are leaving Australia, particularly for holidays where they might be going into high risk areas and where they imagine that there is no need for them to cover themselves against the risk of malaria. It is suggested that any such book should emphasise prevention, that it should encourage travellers to malaria endemic areas to use either chloroquine or a combination of pyrimethamine and dapsone. They could use one of the modern drugs, such as fansidar, which is likely to be effective in the prevention of malaria. Combinations of drugs are needed in areas where malaria tends to be chloroquine resistant, and that is something that is occurring more and more throughout the world. But advice about these drugs, advice about their use and their effects, should be carefully set out in layman's terms and made available because as part of the region of South East Asia we will become increasingly part of the problem of malaria. As travel increases and travel times diminish we will get more and more people presenting in this country with the effects of the infection which they have picked up as tourists or travellers en route to Australia.

We should also look at treating as a matter of course a wider variety of people who are returning from high risk areas. People who have suffered an attack of malaria while they have been away would be one group of people; another group would be those who have lived overseas for longer than a brief moment of time; longer than perhaps a short vacation. Particularly worrying might be those tourists who are going on boat trips to remote areas of Papua New Guinea or who are going off to new holiday resorts in the Solomons and who may be aware that they are likely, almost inevitably, to be exposed to the plasmodium. We should consider giving primaquin treatment to these people. Finally, more information should be available generally about the effects of malaria on those who may be particularly sensitive, and it would be very good if any booklet that could be produced through the Department of Health and readily available included advice for those who wish to take infants into endemic areas or those who may be pregnant and who will be travelling into the areas. They should be given advice about drug prophylaxis, about the correct way of using the drugs. The advice would also need to be given to those who are nursing mothers who are taking children into the same areas.

My medical colleague has raised with me a very important matter. He has raised it as a matter of public interest and done so in an extremely positive way. I hope that the Attorney-General (Senator Evans) will be able to pass my comments on to the Minister for Health (Dr Blewett). They are offered in a spirit of goodwill on a bipartisan basis and I hope that Senator Evans will pass them on on my behalf to see whether the Minister for Health will respond to what is essentially a very positive suggestion.

Sitting suspended from 1.08 to 2 p.m.