Watch Out For Bad Air Mozzies

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May 282008
 

“too many seafarers are unaware that malaria is serious and potentially fatal; the real risk for seafarers is often miscalculated; seafarers are not familiar with the signs and symptoms of malaria; and seafarers do not protect against malaria sufficiently and do not take appropriate protective medication”

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Just as I recieved reports of a malaria outbreak at the Hanjin Shipyard on the other side of Subic Bay, visible through the foliage of dipterocarps outside my office, the American P&I Club’s Currents carried an article by Dr. Rob Verbist, Director of Mediport Maritime Medical Service Antwerp, Belgium warning of the dangers of that disease so associated in the west with the European adventures of the 19th and early 20th century, when it was almost fashionable, but which today sickens more than half a billion people a year and kills up to 3 million, mostly children, annually.

Malaria gets its name from mal aria, or ‘bad air’, and was also known as ‘marsh fever’. American doctors during the US occupation of the Philippines in 1899-1902 believed it was the product of some sort of fumes coming out of the ground and sometimes recommended flooding the afflicted area, which only made things worse because the disease is carried by mosquitoes, ‘mozzies’, that thrive when there’s water around.

There are several types of malaria, falciparum being the most deadly.

For those with a historical bent, malaria in the Philippines is a bit of an oddity because, while elsewhere associated with low lying marshy areas, until a couple of hundred years ago it was mostly confined to the highland forests where the malaria-carrying mosquito preferred the local water-buffalo to people but did infect people who ventured into the areas once in a while, which is why forests were regarded as dangerous places filled with deadly spirits that made one sick.

Commerce changed all that. Clearance of lowland areas deprived people of their homes and forced them in the malarial forests where they became infected. These people went to the lowland marketplaces to buy food and to work on the new, vaste, rice farms, transmitting the disease to the lowland mosquito which bit them and then injected some other poor victim and epidemics of malaria followed.

With the rise of the timber industry, workers ventured into the forest to cut down trees, thus exposing themselves to the malaria mosquito and also carried it to the lowlands.

You don’t get malaria from other people but from the mosquito which has bitten an infected person. The mosquito actually has a good reason to bite, the ones that cause the problem are pregnant females whose sole aim in life is to secure a meal of blood for their offspring-to-be.

Where the Hanjin shipyard sits is at the base of a mountain which, until the 1960s, was richly covered with forest. The forest has been erased from the face of the earth, giving the malarial mosquito nowhere to go but down to the marshy lowlands.

In the first six months of 2007 some 321 cases of malaria were reported among workers at Hanjin and the surrounding areas.

By and large, malaria mosquitoes inhabit the sort of areas where you’re likely to find ports and shipyards and, therefore, seafarers. In some areas, malaria has built up a resistance to treatment so it’s worth checking out the World Health Organisation website for information to areas you might be calling at.

Malaria is an obvious threat to seafarers. Dr Verbist says: “too many seafarers are unaware that malaria is serious and potentially fatal; the real risk for seafarers is often miscalculated; seafarers are not familiar with the signs and symptoms of malaria; and seafarers do not protect against malaria sufficiently and do not take appropriate protective medication.”

So, I’ll wait here while you go and check out that you’ve taken the appropriate medication to prevent you getting malaria. For what it’s worth, quinine extracted from the bark of the cinchona tree was the first anti-malarial medicine but tasted so bitter that it was mixed into tonic water. The British, being what they are, found that grain alcohol helped it go down even better and thus was born the gin and tonic. However, entering a potentially malarial area is not an excuse for consuming gin and tonic on board.

Several medicines are now available and the choice may depend upon whether the malaria in a particular area is resistant to chloroquine.

Dr. Verbist says that those most at risk are seafarers staying onboard, at anchor, or taking shore leave; seafarers signing off , travelling inland, or joining the ship in that port; and the duration of stay, daytime or also at dusk ordawn (with higher risk).

Prevention is better than cure, which may be dubious anyway, so he gives the following advice: “Within 2 miles of a malaria shore it is important that:

  • doors and windows are kept closed after dusk;
  • any mosquitoes entering compartments are killed;
  • insect spray is used, also under tables and chairs and in dark corners;
  • long sleeved shirts and trousers are worn;
  • pools of stagnant water, dew or rain are removed;
  • refuse bags and bins are sealed properly;
  • portholes, ventilation and other openings are covered with fine wire mesh; and
  • lights are screened to avoid attracting mosquitoes.

Mosquitoes are most active in low light hours after dusk and prior to dawn. Air conditioning helps
to keep the mosquitoes away, it is important that it is left on all day. While sleeping, use undamaged
impregnated mosquito nets, put under the mattress, fixed on the four corners of the bed.”

If worst comes to worst, how do you recognise malaria? Beware of a fever or flu-like symptoms that develop between one and three months after entering a malaria zone. If there’s any doubt it’s best to start treatment immediately and call for radio medical advice.

Says Dr. Verbist: “Symptoms are flu-like and include fever (often exceeding 40°C), chills, malaise, nausea and vomiting, fatigue, myalgia (muscle pain), headaches, and sweating. A typical
attack lasts 8-12 hours.

“Three successive stages may be observed: (1) cold stage; (2) hot stage; and (3) sweat stage. These stages are often NOT observed in the lifethreatening “falciparum” malaria. A patient with severe falciparum malaria may present with confusion, drowsiness, extreme weakness and may develop cerebral malaria with convulsions, an unrousable coma and rapid death.”

Some shipping routes involve several short stays in malarial areas over a period of time so it’s wise to be prepared for standby emergency treatment. You’ll find some guidelines at seafarershealth.org, the International Committee On Seafarer’s Welfare, together with the brochure Malaria, You Are Part Of It, and three posters which you can download and print out for display at the top of this page.