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Malaria - a useful tool box talk

Malaria. We’ve all heard about it, many of us will have taken anti-malaria drugs for our travels, but do we really know what we’re dealing with?

At Red Square Medical, we do love a tropical disease, so we’ve put together this guide on all things malaria to help you and your crew stay safe, whether you’re travelling for work or fun!

Key Facts
  • Malaria is caused by parasites that are transmitted via bites from infected female Anopheles mosquitoes (the pesky blighters).
  • It can take just one bite to become infected. Bites mostly occur between dusk and dawn.
  • There are 5 parasites that cause malaria in humans, with two of these (P. falciparum and P. vivax) posing a greater threat.
  • It is life threatening.
  • It is preventable and curable.
  • Malaria can’t be passed from human to human.
  • In 2020, it was estimated that there were 241 million cases of malaria worldwide.
  • In 2020, there were 627,000 deaths from malaria.
  • 95% of cases and 96% of deaths were in the World Health Organisation (WHO) African Region.
  • Children under 5 years accounted for 80% of all deaths in the region.
  • As recently as 2020, half the world’s population was at risk of malaria.
  • Infants, children under 5, pregnant women, people with HIV/AIDS and those who are immunocompromised are at most risk.
  • People with low immunity moving to areas with intense malaria transmission rates are also at risk - migrant workers, mobile populations and international travellers.
  • Numbers of infections and deaths increased significantly from 2019 to 2020 though disruption from COVID-19 is partially responsible.
Symptoms
As with so many infections, the first signs of malaria are a fever, headache, ‘chills’, fatigue, vomiting and muscle aches, which can be mild and difficult to recognise as malaria. Other symptoms may include yellow skin or whites of the eyes, confusion, lethargy, nausea, loss of appetite.

Symptoms normally appear 7-18 days after the mosquito bite. But one of the parasites, P. falciparum, can progress to severe illness and death within just 24 hours if untreated. Symptoms of P. falciparum include behavioural changes, confusion, seizures, anaemia, respiratory failure, kidney failure, coma and shock.

In contrast, malaria can take weeks or even months to develop. In cases caused by the parasites P. vivax and P. ovale, relapses may occur weeks or months after being infected. Occasionally it can be years before symptoms appear. 


Where is Malaria found?
Travellers going to malaria endemic areas in Africa, South America, and Asia are at high risk, with four African countries accounting for over half of all malaria deaths - Nigeria, Democratic Republic of the Congo, United Republic of Tanzania and Mozambique. 

It is also found in the Dominican Republic and Haiti, parts of the Middle East and some Pacific islands. 

People exposed to malaria in endemic areas who go back to their home country to visit friends and relatives are also at risk due to waning immunity. Although partial immunity is developed during years of exposure to the parasites, no one becomes fully immune to malaria. 

If you’re concerned about the malaria risk for a country you’re visiting or transiting, you can use this link from the Centers for Disease Control and Prevention to check out the risk levels, specific areas and other details: https://www.cdc.gov/malaria/travelers/country_table/a.html

Since 2015, 9 countries have been certified by the WHO Director-General as malaria-free, meaning that they have achieved 3 years or more with no reported infections. These countries are the Maldives, Sri Lanka, Kyrgyzstan, Paraguay, Uzbekistan, Argentina, Algeria, China and El Salvador.

Prevention and treatment
For decades, there has been a global battle to combat malaria. Vital methods of control now include ‘vector controls’ and antimalarial drugs. 
Vector control basically means interventions such as insecticide treated nets and indoor residual spraying, helping to reduce transmission and prevent infection. 

Antimalarial drugs are taken prior to travel to a high risk area and should be used in conjunction with other malaria control activities.
Preventative medications are available for high risk individuals (e.g. infants and pregnant women) in high risk areas, and since October 2021 a vaccine has been available for children living in areas with high P. falciparum transmission. However all medicines should be used in conjunction with other malaria control activities. 

Is it really a risk to mariners and superyacht crews?

Recently, UK P&I Club Members reported two cases of death and two more cases of serious illness, both resulting in a three month hospital admission, due to malaria.

These cases arose despite the crew members being on medication to prevent the disease. It was later found that the crew members either did not have the correct medication, for the countries they were travelling to, or they were unsure about the correct dose they should be taking. You can read more here: https://www.ukpandi.com/news-and-resources/news/2019/crew-health-advice-preventing-and-reducing-malaria-transmission/

So yes, our opinion is that it’s something we all need to be aware of and take the appropriate steps to ensure we protect ourselves to the best of our ability. 

How to protect yourself…
  • Check out the malaria risk for countries you’re due to visit well in advance.  https://travelhealthpro.org.uk/countries
  • Some antimalarial drugs must be taken for a few days or weeks prior to travel, and a few weeks after you return, so make sure you speak to your GP early enough.
  • Make sure you have the correct medication for the geographical area.
  • Make sure you have enough medication on board to last at the right dose for your whole trip, plus extra in case you are delayed. 
  • Wear long sleeved shirts and trousers in the evening when the mosquitoes are most active. 
  • Use 50% DEET based insect repellent on your skin. It smells bad though, so may repel more than just mosquitoes!
  • Sleep under nets treated with insecticide, or use over doors, windows and ventilation holes.
  • Use insecticide in cabins. 
  • Don’t sleep on deck.
This White Paper from the International Association for Medical Assistance to Travellers give some great tips on all things malaria too: https://www.iamat.org/how-to-protect-yourself-against-malaria 

It’s been well proven that early diagnosis and treatment reduces the risk of malaria and prevents deaths. So if you have travelled to a country with malaria and start to feel unwell, make sure you seek medical advice sooner rather than later. 

It’s also worth remembering that malaria can reoccur, sometime years after the original infection. 

Our Paramedic trainer, Rachel, has treated a patient who called for the ambulance himself but was unconscious by the time the crew arrived. He had a fever and was sweating profusely. He did recover sufficiently to answer questions and had felt unwell and getting worse for a few days. Symptoms were consistent with malaria but it was only when his wife arrived and mentioned the patient having had malaria previously that it was considered he could be suffering a relapse many years after his initial infection. 

So if you’ve had malaria once, and you experience symptoms that feel ‘a bit like that time I had malaria’, be alert and get checked out asap. 

Of course, if you need any further information, please get in touch, we’d be happy to help. 

by Rachel Smith 08 May, 2024
At Red Square Medical, we’re keen to support those who have a passion for maritime medicine. While we can’t provide placements for everyone, occasionally a request pops up at just the right time and we can provide some experience and insight into our unique and specialised world. Last year we were contacted by Jordan Lin, a medical student with a love of the ocean. This is his story… When I was a boy, my dad and I used to go fishing with a local fisherman off the Norfolk coast. I absolutely loved being on the sea and so for quite a long time, I wanted to be a fisherman. When I got a bit older I kind of forgot about this and think I may have been slightly put off by watching the TV series ‘World’s Deadliest Catch’! But I have always loved being on the water and spent a lot of time sailing dinghies; I was also a swimming teacher for children back in high school and college. Later, I decided to study medicine and I’m now a final year medical student at the University of Bristol where I completed an intercalated degree; a Masters in Health Sciences Research. I’m now looking forward to starting work as a qualified Doctor in August. Though having spent 6 years training, my next 2 years will be spent working for the required two foundation training years that must be completed before being able to work independently as a Doctor in the UK. At university, I joined the VITA network which is a group dedicated to developing a health and public health approach at the heart of any response to human trafficking and exploitation. I became the blog coordinator for the organisation and you can read the blogs, including those that I have written, here: https://vita-network.com/blog/ In my spare time, I have been involved with the Bristol University Hot Air Ballooning Society and trained through the society to get my Balloon pilots licence. So, I often spend weekends during the summer flying in a leisurely fashion over Bristol and the surrounding area!
by Rachel Smith 24 Apr, 2024
At Red Square Medical, we’re fascinated by the learning process - it’s key to our business after all. But we often wonder what happens when our students leave the classroom. Do they remember what they’ve learnt? What if they’re faced with a real emergency, will they know what to do? Is there a lightbulb moment when it all clicks into place? Skill fade is a very real issue, as we wrote about in this blog , and we know that setting up drills and practice scenarios when you’re back in your environment, with your kit and crew, can make a massive difference. It’s great to get some feedback from our students too. Last year, we received photos from the Southern Ocean from a solo round the world sailor who was able to successfully steri-strip a cut eyebrow closed. Or the Captain who recognised a heart attack in a crew member because they looked just like the guy he saw in the video on one of our courses.
by Rachel Smith 03 Apr, 2024
You might wonder about the title of this month’s guest blog, as Worse Things Happen at Sea is also the name of our monthly newsletter. But this month, we’re delighted to introduce Andrew Edwards as our Guest Blogger, and we felt his amazing story about life at sea really deserved a dramatic headline… Dysentery... In the summer of 1966, I was a cadet on a cargo ship that loaded in the UK for 9 ports in West, South and East Africa. Our first port of call was Luanda, the capital of Angola – which was then a colony of Portugal. Next, 300 miles down the coast we called in to Lobito – also in Angola. In Lobito two of the ship's company contracted dysentery; myself and a big Irishman called Reg. The shoreside Doctor we saw simply diagnosed the condition (amoebic dysentery) and said, ‘sorry but I have no antibiotics for this!’. Thankfully the ship’s purser stood our corner and demanded that the Doctor find some. The following day the antibiotics were flown in from the Belgian Congo. The Doctor gave us no advice as to how to deal with the condition, not a word about how contagious it was, not a word as to the importance of thoroughly washing our hands and maintaining scrupulous personal hygiene. Thankfully both Reg and I were quartered just a short sprint from the heads, and we were left to get on with it by our shipmates. It took about a week to get over the dysentery, by which time I had lost several stone in weight and was as weak as a kitten. By the time we arrived in Walvis Bay, South West Africa (now known as Namibia), a further 1000 miles south, I was just about fit enough to play football for the ship against a local team. Their football ground had a main road going right through the middle of it which made for some challenging moments, but they still beat us comfortably and they were playing in bare feet!
by Rachel Smith 20 Mar, 2024
As it’s Easter, we thought that it would be a very appropriate time, what with all that chocolate around, to take a closer look at the subject of Diabetes and why it’s such a huge problem in the UK and across the world. The Easter Bunny always looks so cute and cuddly, but is he a diabetes case waiting to happen? Or does his diet of grass and all that hopping around for the rest of the year make an important difference? According to the WHO, diabetes is a chronic, metabolic disease which is characterised by elevated levels of blood glucose (or blood sugar). Over time, this leads to serious damage to the heart, blood vessels, eyes, kidneys and nerves. The most common is type 2 diabetes, and it usually develops with a late onset in adults. It occurs when the body becomes resistant to insulin or doesn't make enough insulin. Worryingly, in the past 3 decades the prevalence of type 2 diabetes has risen dramatically in countries of all income levels and is closely linked to obesity, poor diet, and an unhealthy lifestyle. Symptoms for type 2 diabetes are generally similar to those of type 1 diabetes (need to urinate often, thirst, constant hunger, weight loss, vision changes and fatigue), but are often less marked. As a result, the disease may be diagnosed several years after onset, after complications have already arisen. For this reason, it is important to be aware of risk factors. Effective approaches are available to prevent type 2 diabetes and to prevent the complications and premature death that can result from all types of diabetes. These include policies and practices across whole populations and within specific settings (school, home, workplace) that contribute to good health for everyone, regardless of whether they have diabetes, such as exercising regularly, eating healthily, avoiding smoking, and controlling blood pressure and lipids. Type 1 diabetes, once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition in which the pancreas produces little or no insulin by itself. Normal onset is in younger people, but can also be in adults. Symptoms of type 1 diabetes include the need to urinate often, thirst, constant hunger, weight loss, vision changes and fatigue. These symptoms may occur suddenly. Type 1 diabetes cannot currently be prevented. It’s thought to be caused by an autoimmune reaction which destroys the cells in the pancreas that make insulin. It can also be caused by genetics, viruses, trauma, tumours, removal of the pancreas or other damage to the pancreas. About 422 million people worldwide have diabetes, the majority living in low-and middle-income countries, and 1.5 million deaths are directly attributed to diabetes each year. But the number of cases and the prevalence of diabetes have been steadily increasing over the past few decades. The starting point for living well with type one or type 2 diabetes is an early diagnosis – the longer a person lives with undiagnosed and untreated diabetes, the worse their health outcomes are likely to be. Easy access to basic diagnostics, such as blood glucose testing, should therefore be available in primary health care settings. Patients will need periodic specialist assessment or treatment for complications. A series of cost-effective interventions can improve patient outcomes, regardless of what type of diabetes they may have. These interventions include blood glucose control through a combination of diet, physical activity and, if necessary, medication; control of blood pressure and lipids to reduce cardiovascular risk and other complications; and regular screening for damage to the eyes, kidneys and feet to facilitate early treatment.
by Rachel Smith 21 Feb, 2024
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by Rachel Smith 07 Feb, 2024
Today we start the first in a series of blogs in conjunction with our friends at the Maritime Skills Academy, and kicking it all off is a Guest Blog from MSAs Head of Training, Sam Kelly. Sam is 37 and lives in southeast Kent, in the quaint seaside town of Deal with with his wife, two children and a ‘Golden Doodle’ called Pringle. He has lived in the area ever since his father, a serving Royal Marine at the Deal Depot, and mother decided this was the place to raise their family. And it is, quite frankly, an excellent place to live. Here is his story… I’m the Head of Training for the Maritime Skills Academy, based in our head office in Dover. I oversee a team of Maritime Safety Instructors who deliver all STCW training for seafarers. Outside the Dover base, we have MSA Gibraltar. This location is operated in partnership with the University of Gibraltar and delivers Basic Safety Training and most recently Operational Firefighting, We are actually in the process of building a state-of-the-art Fire Training Module on ‘the Rock’.
by Rachel Smith 17 Jan, 2024
So Christmas seems like years ago, and we’re all well into the New Year now. Did you make any resolutions? Some love to, some don’t. At Red Square Medical HQ, we love a goal or two and think the turn of the years can be a good prompt to make some positive changes. But, it’s well known that New Year resolutions don’t last. Forbes magazine tells us that 21% don’t make their resolution stick for even a month. While 34% state that it lasted for between one and three months. Is that a failure though? Or could it be all it takes to make some small changes that have a lasting impact? We thought it would be good to take a closer look at one of the most popular resolutions… Dry January! Now, let’s get one thing straight, the Red Square Medical team are not averse to a tipple or two! But as medics, we’re very aware of the short and long term benefits of giving our livers a little breather every so often. Of course, everyone responds differently to stopping drinking for a month, so the timeline below is just a guide. But it might help you to decide whether it’s a good idea to give the booze a break for a while, or work towards reducing your intake - we know it’s easy for it to creep up over time!
by Rachel Smith 03 Jan, 2024
What I miss most about the Ambulance Service… It’s been 12 months since I left the Ambulance service after 8 years of working frontline, and to be honest it’s flown by. A few weeks ago the team at Red Square Medical HQ were chatting about how life has changed in that time and what, if anything, I was missing from my former life! The list might just surprise you… Most of all, I miss my old colleagues and I definitely miss the patient contact. And driving on blue lights… that was one of the best parts of the job! Working in the ambulance service with regular partners who you get on well with really does create friendships for life. Or even doing a tricky job with someone you don’t know well provides a common bond forever. Every day you’re facing stressful situations and sometimes split second, life changing decisions. You rely on each other totally and make sure you keep each other safe in some difficult and challenging situations. I worked with 3 very different partners most of the time for my last few years and I miss them all. Happily though, I have some great new colleagues at Red Square Medical and Outreach Rescue, the other company that I work for.
by Rachel Smith 03 Jan, 2024
I was born in a tiny village in Northamptonshire but had a fairly nomadic childhood, eventually settling in the industrial town of St Helens in the north west. As a child I was horse mad, so boats never got a look in. Apparently ‘horse’ was the first word I said and despite the fact that we could never afford a horse, my dream was always to ride and work with horses. It’s perhaps an early indication of my goal-oriented side that I got a Saturday job as soon as I could. At the age of 13, I’d cycle a 12 mile round trip, twice a day, just to go and ‘muck out’ at a local farm where they bred Welsh ponies and Arab horses! There wasn’t even any riding. Later, I found myself working for the family of a young girl who would go on to represent Great Britain in dressage at the Olympics. The work was physically hard and the standards high. No corners were cut and I learnt the skills I needed the old fashioned way. I got to travel all over the UK in the branded horsebox which was pretty exciting for a teenager. But I think I will always be grateful for the solid work ethic and sense of responsibility that this job instilled in me. I always planned to leave school at 16 and go to ride racehorses. But I got quite reasonable exam results and a new degree course was announced in Equine Science and Business which changed the plan. So, after taking the required year out, when I worked in an eventing yard in Yorkshire, I started the 3 year course. For the two work placements, I opted to go abroad, to Italy and the USA, which supercharged my desire to travel. I continued working in the equestrian world for a couple more years, but the poor pay and prospects, plus a dose of pneumonia pushed me onto a different path. I got a job in telemarketing for a bank, and after putting forward the idea of finance for horses, I found myself transferred to Marketing for 6 months. 16 years later, I was still there!
by Rachel Smith 20 Dec, 2023
Christmas is coming and the season of parties is upon us. Of course this means that most of us will overindulge in large amounts of luscious food and, of course, a tipple or two. At Red Square Medical HQ, we have a method of categorising drunk people. During our combined careers, we’ve dealt with more drunks than we can remember; it’s easily running into several hundred. What we’ve learnt, amongst other things, is that most people who are drunk fall into one of these categories. Now please don’t judge as it is purely observation and also makes for an interesting chat when delivering the STCW Medical training, because we all know at least one person from each category and sometimes… a person can be in multiple categories depending on many other factors, or, we might even have been there ourselves! Once we have established these categories there is a serious note to this blog so please do keep reading.
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