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A Letter from Dr. Ghani to the 'Langkawi Gazette' about the Box Jelly fish situation in Langkawi
Dear Mark,
I read with much concern of the demise of the Swedish tourist as a result of the box jelly fish sting as appeared in your Langkawi Gazette Newsletter website recently.
Box Jelly fish had been spotted on many occasions in the sea of the north and western coast of Langakwi. There was a report sometime in the mid 90's of two Chinese boys dying of similar mishap. However, during the course of my medical practice in Langkawi I had seen a number of local fishermen surviving the incident with no residual effects. Modern medicine has no answer to the problem apart from the very expensive anti-venom which is only obtainable direct from Australia.
During the times I was the resident doctor at The Datai and The Andaman I developed a protocol for the treatment of jelly fish stings in general which is focused on box jellyfish management. The staff of The Datai and The Andaman especially those at the recreations dept. are very well trained and alert for such emergency. I do not believe anyone else on the island except for the local fisherman has any knowledge of how to handle this not even the hospital. No other hotels are interested in the protocol. However, during the time of Jamie Case as the GM of these two hotels we made sure that drills were done on a regular basis and the nurse subsequently took responsibility of retraining the staff. I have left the hotel 4 years now and do not know if the ritual is still followed. The Datai is the only hotel in the region that has 2 vials of the anti venom that was refreshed every time it reached expiry.
Below I append the procedure which probably could be of use to the Langkawi community.
1. Box jelly fish come in during the beginning of the South-west Monsoon (Musim Barat) being blown into the Straits of Malacca from the Great Barrier Reef. So the months from March to July is the time when they are sighted in the waters of the northern and western coasts of Langkawi. Hotels should place nets enclosing their beach area to prevent the inflow of box jelly fish and other less harmful jelly fishes. Recreation staff should remain alert of the impending dangers.
2. Never touch or play with any jelly fish found on beaches. They should be removed with care and destroyed. Even dead box jelly fish is dangerous as their venom remains active and the trigger mechanism of envenomation is very much active.
3. When encountering an incident the rescuer should NOT PANIC. Remain calm and composed and attend to the victim immediately. Only one person should be in charge of the management while the rest should only help. One should remain focus and not listen to other people's opinions (opinions are not needed at this time). A lot of reassurance should be given to the victim who is in severe pain due to the envenomation. This is a very critical situation.
4. DO NOT ATTEMPT at rubbing the jelly fish off the skin of the victim. Rubbing will trigger the envenomation and can be FATAL. Instead pour copious amoount of VINEGAR over the jelly fish for at least 30 seconds. This will deactivate the triggers and stop envenomation. Only then cover the injured site lightly and carry the victim to a safe place. If vinegar is not available at that moment in time URINE is the next best solution that could help. DO NOT pour WATER over the jelly fish especially FRESH WATER (this will trigger the envenomation)
5. The AMBULANCE should already arrived and the victim should be transported to the hospital immediately where supportive treatment could be initiated.
What is important is the first 2 minutes of the sting. Proper handling and deactivation of the trigger mechanism would help save the life of the victim. Ignorance can kill the victim almost immediately. VINEGAR and URINE are very useful to have handy when at the beach anywhere in the world. Tell your yatchtie friends about this.
The fishermen of Langkawi has their own remedies - they take plenty of PISANG EMAS (Gold banana, red.) when in such situation and this is followed with applying the inner surface of the banana skin over the lesion. Another remedy is the use of the juice of the plant Ipomoea pes-capre which grows along the beaches.
I miss my Langkawi
ghani
Dr. Abdul Ghani Hussain MBChB (Cairo), CTM
Principal Consultant
Herbwalk Consultancy
A comment from Andrew by Mark on 08 Apr 2010, 10:26 pm
Thank you Dr Ghani for excellent advice based on your experience in the local area.
The training of staff in the hotels mentioned should be a practice adopted by ALL hotels and resorts on the beaches as well as ALL restaurants, cafes and shops that front the beach - stock a large quantity of vinegar and ensure at least one staff member is ready for an emergency should it occur. There is no doubt that guests and patrons would feel much more comfortable and safer in the knowledge that help is at hand if required.
Anti-venom is very expensive and there is a big question mark over its effectiveness considering the speed in which the venom acts. According to reports of the most recent fatality the woman collapsed within seconds late at night and ambulance arrived 15 minutes later. Most fatalities are very quick and administering the anti-venom is most often too late.
Dr Ghani's procedures as outlined should in my opinion be adopted by all businesses based beach side as they are simple to follow and could save a life one day.
I do understand however that urine is not the second best option to vinegar. Coca-Cola is a reasonable option if no vinegar available but urine due to the pH level could be completely ineffective.
Placing banana skins or morning glory on the lesions AFTER applying vinegar could slightly ease the pain but the coastal morning glory has been scientifically tested to be little more than a mild analgesic.
The theory that the box jellyfish blow up from the Great Barrier Reef to the Straits of Malacca I think requires some research. I am not aware of any. The more likely scenario as speculated on by marine scientists is that a lethal Chironex type box jellyfish native to the immediate area breeds in the mangroves and due to Langkawi's proximity to the equator is present most if not all year round. I am not aware of any research supporting this theory either. Note that box jellyfish are swimmers not floaters and move as fast as a human would swim.
Dr Ghani's points relating to safety and treatment are invaluable and I urge all of those in the tourism and hospitality industry if they are by the sea to seriously consider adopting his recommendations as a courtesy to those who support your business.
Andrew