Heading into malaria country

Papua New Guinea has sobering malaria statistics. It has the highest incidence of malaria in the Western Pacific. Internal problems with infrastructure, resources and funding give malaria victims an unnecessarily high mortality rate. We'll travel from PNG to Indonesia, and continued endemic malaria: it's not like anything we've experienced to date.

So it might seem strange that we're not going to take any anti-malarial drugs in PNG and Indonesia during our journeys in the coming year.

Mosquito tip #432: avoid dark clothing, which attracts the critters. Oh, and don't breathe, because so does carbon dioxide. 

If you know us, you know we're not big risk takers. We recently visited a travel doctor as part of our preparations. We brought our bias to avoid prophalyctics and were expecting to have to "discuss" it. To our relief, was consistent the advice she gave us.

What are we doing, then? Lots of preventative measures.

There's screening:

• Repellent-treated nets and screens will be on our hatches and ports. We have the screens and nets, and will soak them in a solution of permethrin. The treatment is supposed to be good for about a year, and we have enough to re-treat if it seems necessary.
• We have additional nets, also treated, to drape our bunks at night. The romantic Out of Africa look is a bonus.

There's repellents:

• Chemical free is best. We have little ultrasonic devices that are the size of a thumb. Battery powered, they emit a high pitch sound which mosquitoes don’t like. They don't have a big range- just 8 or 10 feet- but that's enough most of the time. 
• Good ol' repellent lotion. First line of defence is based on essential oils; we have several to use.
• As much as I hate using chemicals, especially directly on our skin, it's a risk trade off with malaria that we have to weigh. If we aren't finding success with the natural repellents, DEET based lotion is stashed too.
• Coils. Hate em.... but have them, just hope not to use.

There's basic behavior and smarts:

• Avoid areas with lots of bugs  (anchor awaaaaayyyy from the mangroves!)
• Choose light colored clothing, not dark. 
• No perfume/fragrances. Easy, since we mostly think they literally stink.
• Stay put from dusk to dawn. This is when malarial mosquitoes are primarily active; we'll plan our activity to try and ensure being inside the well screened boat during those times. Since we'll be in islands without power, I don't think it will be hard.

And if we think anyone even MIGHT have malaria:

• TEST. We have 20 test kits: if anyone shows a sign of fever, they get tested. It’s a simple finger prick that you measure on a card. Pleasantly dummy proof.
• TREAT. If malaria is indicated, we begin treatment. There's enough Malarone on Totem for multiple courses. In fact, it's probably an overkill quantity. I'm OK with that.
• Take off! We’d head for a clinic the second anyone is diagnosed. Just because we can handle starting treatment doesn't mean we think we should play doctor. Our medical kit is oversupplied if anything; the bigger problem then is the distance to a clinic that will have trained staff.

I can't help worst-case-scenarioing on this. What if Jamie and I are both infected? I know from experience it can make you completely non-functional. It's one of the reasons we're hoping to find buddy boats who are also headed on this route, which is a big stretch from the beaten path.

In the grand scheme of things, we don't think we're taking a risk here. Feel free to disagree.