The Great Mosquito War did not begin with my journey to Asia. But until now, every prior encounter in our ongoing hostilities has been, at worst, a small skirmish. Oh, there was one particularly brutal sortie during spring when I was fourteen or fifteen hiking in the Sierra Nevada mountains with my father and younger brother. Climbing out of a particularly steep pass with many switchbacks late one afternoon, out of sheer exhaustion we made the serious tactical error of pitching camp in a meadow, close by the bank of a sweet little stream, which we saw then only as a convenient water source. As dusk approached, we realized the enormity of our error.
They came from the marshes lining the bank as a raging hoard, and true to my experience, they had eyes - and stingers - for no one but me. I spent the entire evening with every inch of my body covered by clothing, a towel over my head to protect my neck, ears and the part in my hair, swatting ineffectually at the raiders while they harried me mercilessly. I can still picture the utter misery.
But now, in Asia, the war has begun in earnest....
Prior to leaving, of course I visited a travel physician for consultation on which vaccinations, medications, etc., I would need to carry with me, and other medical advice. In between turning me into a human pin cushion, one of the subjects I investigated in depth was malaria. It is so strange that in the US we pay almost no attention and have so little familiarity with this disease that kills millions of people worldwide annually. Not until we travel do we really concern ourselves with this scourge and, as I research, I find there are no really good solutions. This is definitely not bedtime literature: reading on the subject can be seriously scary....
I read that there are five different species of plasmodium parasites known to infect humans with malaria. In defense against this nasty little creature, several anti-malarial prophylactic drugs are in common usage throughout the world today; Mefluoquine (Lariam), Malarol and doxycycline, chloroquine, primaquine. But taking these drugs is problematic at best. To begin with, the type of medication which will be effective depends on where one is going and which type of plasmodium one will be exposed to in that area. What kills malarial parasites in southeast Asia, the parasites in India, Africa or Oceana may be resistant or immune to and vice versa.
And there are side effects. All of these medications make some people sick, nauseated, cause headaches, etc., etc. Mefluoquine has some really freaky neurological effects and the stories of people having psychological/emotional problems while using it range from general malaise, depression, nightmares, to full blown psychotic episodes. Doxycycline causes diarrhea and digestive problems -- not really what you want to be dealing with when traveling in the tropics -- as well as a dramatic increase in sun sensitivity just as one encounters that ferocious tropical sun. Malarol seems to be the easiest to tolerate in the short term, but in addition to being very expensive, it is a fairly recent drug and there are NO studies of people taking it for more than a few weeks consecutively and what the long term effects might be. And these are only approximate solutions. Match the proper drug, with the proper region, and you may still end up with malaria: sometimes months or even years later, in which case it is frequently misdiagnosed because no one expects to encounter malaria in the US.
So. Conundrum. "What are the chances I will be exposed to malaria vs. the absolute knowledge that I am taking medications that will damage my body?" I ask the experts to weigh in: My travel doctor, a young woman born in Cambodia, has told me that she does not take them when she returns home. But she also believes that people born in countries where there is common incidence of the disease may also have a higher level of natural resistance. Three of my closest friends, all physicians who also travel extensively, tell me that they do not take anti-malarials. They feel that for themselves the risks of contracting the disease are acceptable. But my most travelled advisor thinks these people are crazy.
Even if one resolves the malaria dilemma, there is Dengue fever, another disease, mosquito borne, which is on the rise in Asia and other parts of the world. While malaria is a parasitic infection spread by the Anopheles mosquito who only bites dusk through dawn, Dengue fever is a viral infection spread by the Aegypti mosquito: a super trooper who attacks all day long. Although Dengue fever is fatal in only about 5% of cases, there are now about 110 million cases worldwide each year and the numbers keep rising. Dengue fever can morph into hemorrhagic fever or cause serious neurological complications such as Guillame-Barre syndrome or transverse myelitis. And there are no vaccines or prophylactics for this one.
Am I scaring you yet? I have certainly scared myself....
The upshot of all of this is that, when I board Ever Charming, bound for Asia, I still don't really know what I am going to do. In my first aid kit there are about 300 doxycycline tablets. I will either take them prophylacticly, or I will keep them to use in case I begin to have symptoms of malaria and I am unable to reach a hospital immediately -- in which case 300 tablets might be overkill... As I have mentioned before, it has been made very clear to me, by friends, doctors and travel guides to avoid hospitals in Cambodia, Laos, Myanmar if at all possible. Unless the situation is immediately life-threatening, run for Thailand as quickly as possible. But if one has malaria, this could be problematic...
In the end, because I am scared of those parasites, I decide to take the doxycycline beginning with my arrival in Bangkok. By the time I return from Myanmar, three weeks later, I have had almost continuous diarrhea, no appetite and have lost almost 15 lbs. Not to mention the truly amazing sunburn I got one day walking the beach in beautiful Ngapali. At this point I decide that the moderate risk of contracting malaria in southeast Asia is preferable to the certainty that I will become seriously ill if I continue along this path. I stop taking the doxycycline.
Strategically speaking, all of the authorities, all of the doctors, all travelers agree that the best defense against mosquito-borne diseases is: "don't get bitten." But, it is a fact -- yes, fact! -- that I am a mosquito magnet. If I am sitting outdoors in a group of fifteen -- or fifty! -- other people, it is has been a frequent and consistent phenomenon that no one will be bitten by mosquitoes except me. Repeatedly. Through some combination of skin type, scent, capillary construction, I am the mosquito equivalent of a sumptuous buffet. They attack me without restraint or mercy, buzzing their defiance of any attempts to thwart them. Again, thinking strategically, in this war offense is not possible. I cannot eradicate all of the mosquitoes in Asia. No, there is no possibility that I will not be bitten. I am going to have to fight a tactical war. That means defense.
Although I have been using them all along, I now become obsessed with armor, i.e., mosquito repellants. I have scouted the "natural" options; "Skin-So-Soft", lemongrass, eucalyptus oils, combinations of the above, but most health authorities assert that DEET is the only truly effective repellant. DEET, however is toxic at certain concentrations and has its own inherent health risks. I will be traveling for the next few months and I am not fond of the idea of covering my body with a toxic substance (several times!) each and every day. I have already spent considerable time prior to leaving researching the available varieties and concentrations looking for an acceptable answer. At one point, I have even spent $25 for shipping of $25 worth of RID, a low-concentration DEET product only available in Australia, into the US.
Upon entry into Asia - even while using the doxycycline - I use the RID spray after my showers, on every inch of my body because those tireless warriors can even penetrate clothing. It has a not unpleasant odor and works pretty well until I begin sweating in the 40C, 90% humidity.....perhaps about 15 seconds later. Once my skin becomes wet, anything brushing against me; my shoulder bag, passersby in the crowded streets and markets, overhanging branches, chairs, whatever... clears a path for the marauders and they renew their assault. One evening, returning from Haad Rin to Sanctuary in Ko Phagnan, I step out of the boat taxi into shin-deep water and wade ashore. I am bitten 15-20 times on my feet and ankles in the three minutes before I can make it to my bungalow to respray....
The bottles of repellent I have in my luggage, such as they are, last for about a week each. So, in each new town or city along the way, I must spend some part of my time scouting; the chemists, the 7-Eleven, the herbalists. Each new acquaintance, I beg for information, dig for their secrets. Most of them are only marginally sympathetic. They think I am a wimp. They just apply a little of 'whatever' and occasionally get bitten. Only rarely do I encounter an ally who understands and shares the intensity of this quest. It becomes my practice, whenever I wander past a shop selling naturally derived oils and lotions to ask if they have anything that might offer a solution to my dilemma. At best I achieve moments of stalemate. I am besieged by an enemy probing, searching, waiting for the smallest chink in my armor.
And then, finally.....!
On the day after I arrive in Phuket, I go to shop for tennis shoes which I will need for sailing. Walking through a Western-style shopping mall, there it is before me: Thann Spa skin care boutique. I enter the store and approach the gorgeous young Thai girls at the counter. All three of them have perfect, creamy, Asian complexions. I don't know whether to hate them or sit at their feet trying to learn their secrets. I chat with them for a few minutes: my greeting in bad Thai: "Saw-o-di-kah", prompting them to gather around and giggle at me, and then I inquire as to whether or not they have any new recommendations for driving the evil insects away. Instead of the usual spray-on repellents, they lead me directly to a large, wonderfully designed bottle labeled 'Oriental Essence Oil' and begin repeating: "lemongrass, lemongrass, lemongrass". And they are insistent, incredibly smug and certain about this. "Yes, yes,yes! You buy! This work!"
I think to myself: "I have been down this road. So many times". Each time, I have an almost teary-eyed hopefulness: "Can this be it? Oh please, please....". I have tried sprays with lemongrass before. My hopes have been dashed again and again, as I look down to find yet another mosquito in mid-meal on my arms, hands, legs, feet. In fury, I strike at them, watching my own blood well from their smashed bodies, knowing this act of violence to be futile... There are countless billions more eagerly waiting to join the fray.
Now I am skeptical. But I am also just about out of the last semi-effective bottle of spray I purchased from the last beautiful Thai girl who assured me it would work... I need to buy something today. And the hopeful voice whispers, again, inside me: "Maybe? Please...." So, I stall only a few moments, put off by the price: 1100 THB - over $30 US - is a lot of money in Thailand. But this oil in beautiful bottles, for which I am always a sucker, is thick, rich, smells delicious -- unlike the usual repellent which smells like it will kill me slowly -- and my skin could definitely use some attention. And there are those smug, young Thai girls with their beautiful skin, looking so certain of victory. So I fork over the money.
I take my oil back to the villa where I am staying, go for a long, cool, swim and then shower and apply the oil all over my body and face. It smells divine! My dry, over-exposed skin drinks it in like water. And this is the the beginning of heaven...
No,I will not tell you that I am never bitten again. But the mosquito nation's score drops from several bites each day, continuous repellent application notwithstanding, to one small incursion every two or three days. Even after hours of sweating. Even after short immersions in water. Now, sometimes they approach and I do nothing. I sit watching their feeble attempts to harass me, taunting victoriously: "Ha!", as they try to approach, only to retreat in impotent frustration.
If one must be besieged -- there can never be complete victory or unconditional surrender, knowing the enemy is out there, watching, waiting -- it is so much better to be besieged, armored in luxurious oil, smelling nice with soft skin.... <br /