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The romance of the rainforest resonates – the whirring chirp of cicadas, glowing rivers of fireflies, the dance of the dragonfly. But it can all be marred by one tiny detail – things that sting! The mosquito is the main culprit. Urban, rural, they rise as a mighty army bringing a mass of minor miseries in the form of weals and itching and scratching and eventually, for the most committed itchers, open wounds. Local people will often claim that mosquitos prefer Western food because apparently the blood is sweeter! Then there’s the sandfly – common on many Borneo beaches – which has a sting that just keeps on giving. Just when you think the itch has passed, it returns with a vengeance, leaving you with the appearance of a pox patient ready to scratch your own skin off just to get some relief. Then there are fire ants (semada api), descriptively named with a sting like a scorpion which burns like, well, fire. Of course, Borneo also boasts scorpions, but these are slow, lumbering beasts and you can easily outrun one!
The mosquito is the most feared as the bringer of malaria. Most Western doctors have Malaysia listed as a malaria zone and will recommend a whole panel of prophylactics before, during and after your stay.
Professor Balbir Singh, Director of the Malaria Research Centre at UNIMAS (the University of Malaysia Sarawak), however, is a voice of calm. He says that the chances of anyone getting the disease in Sarawak are ‘very, very small.’ The Anopheles mosquito, the only species capable of carrying the parasite, is a jungle dweller and even then, for every Anopheles that might get a taste, the chance of it having the parasite is ‘infinitesimal.’ For one, only females bite to feed egg production. Then, for malaria parasites to form, that mosquito would need to bite an infected human (or monkey, but more of that later), allow it to gestate for at least a week, and then bite you, all within its four-week life span. With less than 1,200 reported cases of malaria in Sarawak each year (that’s under 0.05% of the population), and the vast majority of those in the Kapit region, any visitor is pretty safe. Locals, of course, don’t take any anti-malarials and Professor Singh, personally, would not recommend them since the side effects of the drugs are often worse than your chances of contracting it.
In fact, the number of malaria cases in Sarawak and Sabah is falling. From around 8,500 cases per annum in 2000, they are now less than a quarter of that number and, as Professor Singh says, malaria is a treatable disease. If you have been out in the jungle and start experiencing fever, chills and rigor, tiredness, headaches and muscle ache, get yourself to a hospital where you will most likely be treated with Artemisin, a drug derived from a Chinese herb. He also explodes the myth that malaria lurks in your system forever, recurring many years later. Only one parasite can occasionally survive in the liver – Plasmodium vivax – and there has not been an indigenous case in Sarawak for more than 3 years.
Realistically, your chances of getting dengue fever are higher. Carried by the urban Aedes mosquito, recognisable by the white stripes on its legs, most mosquito control measures are aimed at eradicating this particular species. Sarawak homes are subject to checks for any pools of standing water where mosquitoes can breed. You might even witness the frequent fogging – a faintly apocalyptic scene in which masked men with grumbling motors strapped to their backs churn out huge clouds of Pyrethrin to subdue the savage beasts. Even so, your chances are contracting dengue are also slim, though you wouldn’t want a trip to the hospital spoiling your holiday.
A world without mosquitoes is, naturally, a widely imagined ideal. Associate Professor Peter Morin Nissom from Swinburne Sarawak is researching bio-controls developed from a strain of entomopathogenic fungi (that’s insect-killing, to the uninitiated), Metarhizium anisopliae, which occurs naturally in Borneo. This fungus could be used to wipe out the larvae in urban areas and so, no more baby mozzies. There have even been trials in Malaysia where, somewhat counter-intuitively, more male mosquitos were released into the environment. But these were modified to shoot blanks and eventually, the idea went, no more baby mozzies. But the mosquito has a vital place in the food chain, eaten by insects, bats frogs, fish and countless other species, and with literally millions of mosquitoes, their total eradication seems unlikely. In the end, you might just have to grin and bear it as part of the tropical paradise experience.
As with many things, prevention is better than the cure in this case, both for the possibility of contracting a disease and, for most visitors, the annoyance of incessant itching. Professor Singh gives his five top tips, already well known by most:
– Wear insect repellent
– Sleep under a mosquito net
– Wear long sleeves and trousers in the jungle
– Burn mosquito coils (many eateries will have them if you ask)
– Take anti-malarials if you are extra worried.
For most Sarawakians, the sting is a common occurrence. In fact, in place of mosquito coils and poisonous sprays we have our own indigenous options. Burning egg boxes is a common favourite but we also have a special tree bark from the Serabah tree, known locally as Lukai, which gives off an acrid but not entirely unpleasant smell (though evidently unpleasant to insects) when burned. Citronella oil is another well-known repellent from a plant which grows widely in Sarawak and minyak serai (lemongrass oil) is available in pharmacies to do the job. The Sarawak Biodiversity Centre has also developed a special soap and cosmetics range, derived from the Litsea plant, whose multiple properties, which include insect repellence, are well known to the indigenous people. Either way, it is a luxurious soap and a great gift.
If you are unfortunate enough to fall foul of some tiny beastie, any Sarawak pharmacy will have a well-stocked range of options from hydro-cortisone creams to medicated mixtures. Off the shelf, Tiger Balm is the ultimate Asian cure all, created by a Chinese herbalist at the turn of the 20th Century and used to treat almost any ailment from muscle ache to insect sting. Zambuk, in its jaunty green and white tin, comes originally from the UK though is only really available now in tropical zones. It cools where Tiger Balm heats thanks to Eucalyptus and Camphor and so is better for bites from sandflies and fire insects. Another Malaysian favourite is Mopiko, first formulated in Japan. This, says Professor Singh, really works! Otherwise, happy scratching!
In fact, Sarawak’s own Professor Singh is world famous, in malaria research circles at least. He and his team were the pioneers in identifying monkey malaria in humans, a discovery which has taken him across the globe from Panama to Australia and almost everywhere in between.
Professor Singh is a born scientist, taking a route through a BSc in Biochemistry at the the University of Liverpool, to a Masters in Parasitology and Entomology to a PhD in Immunology and a postdoc at the Liverpool School of Tropical Medicine. But, longing to return to his home country of Malaysia, he followed the funding and took an aptly named BEIT Medical fellowship to study malaria and ended up in Peninsular Malaysia. But as cases there waned, he hopped over to Sarawak 20 years ago where the disease still had a stronghold, taking up a position at UNIMAS.
This was to be the site of a great but somewhat chance discovery. Noticing a cluster of cases in the Kapit division, up to 40% of Sarawak’s total, and almost all of these in adults instead of spread evenly across the age groups, his team were intrigued. They tested five patients using a molecular detection test who all turned up positive for malaria but negative for the particular parasite originally identified as the culprit through visual inspection under a microscope – Plasmodium malariae. The mystery deepened. Either their tests were faulty – all five of them – or else they were dealing with a different parasite.
Eventually, further research unmasked the pesky parasite in question as Plasmodium knowlesi – visually similar to P. malariae but genetically distinct – and further distinctive because this is the malaria most commonly found in monkeys. Lethal in Rhesus macaques and uncomfortable for Long-tailed and Pig-tailed Macaques, it had never been identified in such numbers in humans until this point. Suddenly, the reality that the disease can be passed by mosquitoes between humans and their genetic cousins became clear and cases throughout Southeast Asia have since been identified thanks to the molecular detection assay developed by Professor Singh and his team right here in Sarawak.
In fact, with better detection perhaps and possible environmental factors, this has now become the most common form of malaria found not only in the state, but also in Sabah and Peninsular Malaysia and while P. malariae multiplies in your red blood cells every 72 hours, P. knowlesi eclipses that at every 24 hours, meaning that early treatment is even more essential. That being said, however, Professor Singh goes to Kapit on a regular basis for research, never takes anti-malarials, and still has never had a dose of the disease. He wishes every visitor to the interior of Sarawak happy, healthy travels!
