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Death By Mosquito

While much has been done in malaria research, it still kills hundreds of thousands of people. In 2017 there was an estimated 219 million cases of the disease, and 435 000 deaths from the mosquito borne illness.
Speak to any surfer or traveller who has survived a bout of the killer disease and you’ll quickly come to understand the dangers of the disease, the importance of knowledge regarding the disease, and the preventative methods and prophylactics utilised in fighting this killer.
Malaria is a parasite; a protozoa that resides in human blood cells after being transmitted by the female Anopheles mosquito. After a mosquito pierces into human skin, it salivates under the skin as a way of preparing for a facile blood feed. It is with that spit that the mosquito transmits the malaria virus into the human system. The malaria parasite (called sporozoites) enters the bloodstream and settles in the liver. At that time no symptoms appear, but the malaria parasite multiplies.

Following its stay in the liver, the parasite enters another phase of its life cycle, the merozotes, which circulate in the bloodstream, penetrating and destroying red blood cells and reproducing again. The majority of symptoms are caused by the massive release of merozoites into the bloodstream, the anaemia caused by the destruction of the red blood cells, and the problems caused by large amounts of free haemoglobin entering circulation after the red blood cells rupture. After you contract malaria it takes a minimum of six days, and up to several weeks, before symptoms appear. Symptoms are a little baffling.
It was 1997 and I was spending the night in Singapore’s Changi Airport – feral ravelling, no money left etc – when I started to feel a bit of a cold coming onboard. I was about a week out of G-Land where I had taken my medication religiously and protected myself from the mosquitoes with coils and cream and long-sleeved clothing. Before I knew it I started feeling really poorly and I was boarding for a long haul to Heathrow. I felt too nauseous to drink myself to sleep, and I had eaten my last sleeping pill a long time ago. But I had my CD Walkman (that long ago). I cranked the new Nine Inch Nails album, and before I knew it I needed to vomit in the plane.
The air hostess, sensing that I was going to seed pretty quickly, organised me a row at the back of the plane to sleep on. I lay there, cradling my stomach and moaning in agony and sweating under a thin little travel blanket.
It was about my sixth time in Indo. When I went the first time, many years ago, I took Lariam as the anti-malarial medication. Rough nights, but I never contracted the disease. Even after camping for sixteen days on an island in the Mentawais in the early 90’s, an area that is rife with the disease. The next time I was in malaria territory was in 1998 in Mozambique. I tried the combination of Daramal and Paludrine. On the second day of administration I experienced chronic side effects, like severe headaches, nausea, diarrhoea and fatigue. I stopped this medication when the toilet paper supply started getting really low.
This time I had gone back onto Lariam. For some reason, the nightmares weren’t nearly as prevalent as the last time.
As mentioned earlier, malaria attacks the blood cells and breaks them down. At the very least, malaria brings on a high temperature as the body tries to kill the invaders. At worst, malaria kills by prohibiting the supply of healthy, oxygen-rich blood to the organs. Malaria can cause collapsed lungs, or liver, kidney or heart failure. Worst of all, malaria can cause a loss of oxygen to the brain, which brings on terrible convulsions and death. The disease thrives in enervated or malnourished people; which makes it specifically lethal in Third World territories.
I had the classic flu-like symptoms. When I presented myself at Charing Cross hospital they immediately put me in bed and stuck a saline drip in one arm and a glucose drip in the other. They analysed my blood, urine and stool.
The malaria belt extends around the world from the equator to 40 degrees north latitude, 45 degrees south latitude, and up to 2500 metres elevation. Take a look at a map … that’s a whole lot of the world’s best surf spots. Surfers are most likely to contract the disease in virtually every tropical place they travel, with the exceptions of Hawaii, Tahiti and Fiji – they are malaria free. Other surf spots such as G-Land, Nias, Mentawais, Mozambique, Madagascar, the Philippines and even Puerto Escondido are heavy risk areas for malaria, and surfers travelling in these areas without knowledge and protection are taking their lives in their own hands.

The medication I was given back then was pyrimethamine-sulfadoxine (Fansidar) single dose, combined with a two-week dose of Quinine. The Quinine was a bit of a bummer. The side effects for me were quite debilitating. Quinine, obtained from the bark of the cinchona tree, is the earliest antimalarial drug, but is no longer used that much because of the frequently occurring side effects. I suffered nausea, headaches, loss of hearing and blurred vision, a group of symptoms known as cinchonism. I heard ringing in my ears, started hearing voices, thought I was finally going mad. Had to keep the radio on for 24 hours a day. Had severe insomnia. Got about four hours sleep a night, if I was lucky, but hey, I made it.
Next time prevention will be paramount. A mosquito net everywhere I go. Loads of mosquito coils to be burning all the time. Long sleeve cotton shirts and pants. Anti- mosquitos spray and something to rub on your body.. But I’m definitely going back to a malaria area in the near future, so I suppose that means I consider the mission worth it. So if you’re about to launch on that dream trip to Centro America just remember not to slack off with the anti- mosquitos protection. If you do slack off, at the least it could mean an early and uncomfortable end to your surf trip, at worst it could mean your life.

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Dr Cohen / Calm As… To Represent at Big Wave Risk Assessment Group Summit in Austinmer.

Kai Lenny © WSL/Morriss_MM



Austinmer, New South Wales – Dr Jon Cohen, representing Calm As… and Surfing Doctors has been invited to the Big Wave Risk Assessment Group (BWRAG) for their Level 1 and 2 Summit at Austinmer on 27-28 April 2019. The summit is hosted by Australian surfers Dan Ross and Zeb Walsh,and will be led by BWRAG instructor former Big Wave World Champion Greg Long.

Greg Long, Dungeons © Red Bull.

Dr Cohen is a long-term member of Surfing Doctors and is the founder of Calm As… first aid kits for surfers, which has started rolling out across Australia, and that came to the attention of the people at BWRAG, along with the Surfing Doctors presence.

Dr Cohen’s talk will consist of:

1) Top to toe – the first 5 minutes of any surf emergency (20 mins). Introduction to a trauma survey with introduction to:
– Minor head injury and concussion basics
– Spinal injury basics
– Chest and abdominal injuries
– Pelvic Fractures
– Long bone fractures and sprains – initial management
– Minor cuts to the face and limbs

2) Worst case scenario – how to save a life in a shark attack situation (15 mins)

3) Snake bite – basic principals of first aid (5 mins)

4) Shoulder relocation – how to identify and fix it in the jungle or bush (10 mins)

5) Q & A (10 mins)

Dr Cohen

“The guys from the Big Wave Risk Assessment group are definitely at the forefront of water safety, and it’s really cool that I got invited down to the Austinmer Summit to share some of my experiences in the surf medicine and emergency medicine fields with their participants,” said Dr Cohen. “Apart from being excited with the chance to share some of my experiences, I’m super excited to be able to learn from those guys about what they do in the water rescue, water safety and big wave fields.”


BWRAG Summit Location

Austinmer Surf Life Saving Club, Austinmer New South Wales


High Surf Risk Management, CPR/AED and medical intervention, floatation vest tutorials, spot analysis.

Level 2 participants will also undergo breath-hold/apnea training and in-water jetski rescue training.