Box Jellyfish

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TEXT OF THE FILM

Narrator: The Box Jellyfish is a born killer. Its venom can kill prey within two minutes.
Villager: Unbelievable.
Villager: No, no -- none has died.
Doctor: I have been swimming for ten years without realizing that there is a toxic jellyfish.
Villager: Never, I have never heard that a jelly fish can kill people.
Narrator: The lamentations of relatives and the departure of victims killed by the Box Jellyfish, the underwater killer made a scene at Pha-Ngan Island in Surat Thani province.
Doctor: Approximately seven years ago, no one believed this. Doctor Pojaman from the Ministry of Public Health said there are poisonous jellyfish capable of causing death. So, I wondered if it could actually could kill.
Villager: Yes, this one. Its tentacles can stick to the skin.
Doctor: We have been trying to gather various data as evidence and investigate whether or not it is true.
Villager: This one, as mentioned, someone died at Pha-Ngan Island.
Doctor: Yes. Does it exist here?
Villager: Yes.
Doctor: How big is it?
Villager: The size of a small bowl.
Doctor: Do you find it every year?
Villager: In its season.
Doctor: What is its season?
Villager: During the monsoon in the 7th, 8th, 9th and 10th months. That young man went down to remove a fishing net. When he came up, he felt constricted and had a fever. That same fellow later died.
Doctor: Once we prove its existence, the next step is how we can transfer this knowledge to prevention measures, because it is a new matter in Thailand. After that, we must push forward to policy implementation.
Narrator: There was a fatal case of a female German tourist who was stung by a Box Jellyfish after swimming in the sea at Koh Samui.
Doctor: At the time foreign tourists died, it became a very sensitive political issue. According to international standards, there should be warnings. We cannot say that no one dies, but if there are warnings and surveillance which are acceptable, it an easy and affordable matter. The point is that if we can have a preventative measure, why don't we do it?
Narrator: The Bureau of Epidemiology from the Ministry of Publi Health, together with the Medical Epidemiologist from the Community Medicine Department of Medicine at Chiang Mai University have been studying the epidemic of toxic jellyfish in Thailand since 2008. It tends to increase yearly during the tourist season. The season for spotting the Box Jellyfish varies, depending on each area. In some locations, it is between March and August; some areas are from October to January; some are doing July to October. Health officials and the populace must monitor the incidents of jellyfish stings in their own areas. The high risk area of Box Jellyfish stings is shallow water near the beach, especially the gulf coast when water is calm and just after it rains. Swimming in the sea at night near the light also is a high risk.
Dr. Somchai: There is an example of a previous Australian study about jellyfish larvas that attach to mangrove roots, rocks or shells. Mangrove waters are suitable for schools of young jellyfish. Once they are grown, they float with the water current to an open sea.
Doctor: Yes, when the mangrove forest connects to a beach. If it is an area where tourists play in the water, they are prone to jellyfish stings. The Box Jellyfish has many names. In English it is called "Box Jellyfish". In is called by many names in Thai, such as "Bo-Bo Kaew", "Bo-Bo Jok" or sometimes it is called "Kaphrun Sai" or "Kaphrun Fai", depending on the regional dialect.
Villager: Our village calls it "Bo-Bo Luk Jok".
Doctor: Why call it a box? Because its body is transparent like glass. When we look down, a jellyfish usually has tentacles in the middle of its body, but the Box Jellyfish has tentacles from each of its four sides, like a box. If there is only one tentacle, it is called a single-tentacle (Box Jellyfish). If it sprouts many tentacles, it is called a multi-tentacle (Box Jellyfish).
Narrator: The Box Jellyfish type that has multiple tentacles has many branch tentacles. They can have branches on two sides or only one side. It can have many-- up to 60 tentacles. Its toxin can cause severe pain. These symptoms will decrease within four to twelve hours and will appear as burn marks. In severe cases, it can cause dead skin in the affected area. The symptoms are more or less, depending on the species of jellyfish and the volume of toxin. If the quantity of venom is small, severe pain can last 15 minutes and dissipate within an hour. If the quantity of venom is large, (the victim) may become disoriented, lose consciousness until expiring from heart failure or failure of the respiratory system.
Doctor: Really fast and violent. Like water we see while walking and hear a child screaming for a minute before it goes quiet. In under two minutes (the victim) drops on the beach if stung often. We must pump the heart due to cardiac arrest and cessation of breathing.
Doctor: How do you feel now?
Patient: When I went to catch squids, (the net) got stuck on a rock. So, I dove under to get it and was stung by a jellyfish.
Doctor: How did you know that you were stung?
Patient: It was sore and felt hot.
Doctor: What did you do next?
Patient: I went to find someone to help pour vinegar (on the wound).
Doctor: Between numbers one and ten, with ten as the maximum (pain), what number would you give?
Patient: Number eight.
Doctor: Oh, number eight? That is a lot.
Doctor: The wound looks like many strops of red yarn wound around the skin. It looks like bands swollen red caterpillar tracks, interspersed with normal tissue. If left long it will erode deeper and become a red swollen wound, gradually leaving scabs. Some people feel itchy on the fifth day and there might be blisters. If it is not treated properly, it can become keloid.
Narrator: The distinguished characteristic of single-tentacle Box Jellyfish is that there is only one tentacle at each corner.
Villager: It will be painful; very painful. Painful until stunned; the same as being stabbed with sharp (knives). In the evening, I went fishing. I was had a sudden sharp pain. It was very painful. I raised my leg to view it and used my hand to pull it out. It was two fingers long--not big.
Doctor: When wounded by this type (of jellyfish), it may not be seen easily. We may be a small wound - only two centimeters or one inch long. Sometimes the wound may be unnoticed, but in other cases the marks are seen clearly. For children there will be different symptoms. Some cases will feel immediate pain; other cases will feel a slightly warm sensation. Afterwards, symptoms will gradually increase. In cases where fresh water is poured over the wound, the problem will worsen.
Villager: When I returned home, I thought it was nothing. I took a shower and soaped up. About half an hour later (the toxin) took effect. Muscle pain increased steadily until it reached my heart. The heart beat faster and more forcefully.
Doctor: What I have observed from most cases in Thailand, they express heart pains and difficulty in breathing.
Villager: It was constricted. It was difficult to breath. I was afraid of shock. Then I became frightened and I began to worry.
Doctor: Some people felt dizzy. They had high blood pressure.
Villager: I have lived here 20 years and have never seen anyone who was stung. But I have a friend who lives on the mainland. He got out of a boat and said one (a jellyfish) was stuck in the net. He shook the net and it stung his chest. He collapsed. Believe it.
Narrator: First aid for victims of the Box Jellyfish is:
First Step: The rescuer must consider being safe from the jellyfish. When sure of that, pull the victim from the water and call for help or call an ambulance. Do not leave the injured person alone. You must advise the victim to lie still. Do not rub the area affected by the jellyfish because any movement or rubbing will stimulate more injection of the jellyfish toxin. When first assessing conditions, if the injured is not breathing or has no pulse, perform CPR resuscitation immediately. After that continuously pour cooking vinegar over the area for at least 30 seconds. Then immediately take (the victim) to a hospital.
Doctor: If still conscious, continuously pour cooking vinegar at least 30 seconds. If I pour the vinegar, it takes about 30 seconds to empty most of the bottle over the area. Do not splash or spray it. Upon finishing this step, you must reevaluate the victim. If he feels fine, he can resume water play or remain in place. But fi we are not sure, advise to refrain from going in the water. Relax at least 45 minutes for observation. The important thing to be careful of is: do not let anyone rub with sand, scrub, pull, splash or pour fresh water on the wound. Because these can stimulate injection from the venom sacks and can cause death quickly.
Villager: Previously I believed in country folk's use of sea morning glory.
Villager: They believe washing with rain water as soon as struck will cause the toxin to come out.
Doctor: This is important because the wrong aid can cause death. Torn tentacles will have small glandular sacks. Each sack will contain a venomous needle. When the sacks are stimulated, they will fire the needles. One tentacle may contain 5,000 (venomous sacks). They say if there are many tentacles, there may be hundreds of thousands or a million (sacks). Thus, they will fire continuously when struck. If 50%, which is half of the skin, the risk of death is likely to be high due to toxin in the heart, the nervous system and skin. Vinegar does not lead to a cure. This is important. It does not treat the toxin, but can suppress further firing from the sacks.
Narrator: Prevention and surveillance together with appropriate first aid can reduce injuries and death.
Doctor: There are numerous preventative measures. One method is install a net to block the beach area. This net means that the upper rim needs to float with on the sea water, preventing jellyfish from entering and the lower part is attached to the sea bed. We should ensure that it floats. Otherwise, they can cross over if it is not done like this. If is is open at the bottom, they can pass underneath.
Villager: Extra, shorten it. This means increase more buoys.
Villager: Because if it is too long, it will be slack and the jellyfish can pass over.
Doctor: Another thing is the use of clothing. Professionals usually wear long-sleeve and long-leg wet suits. When they are stung, the venomous needles cannot penetrate to the skin. Another thing, we should have a life guard. Having life guards in the area where they can observe, they can immediately rush to help -- not only for toxic jellyfish but in case someone is drowning. During periods of high alert, a group of jet ski riders can warn against going in the water. If there are warning signs, they should not cause fear. What has proved successful are signs that explain and inform what to do in the event of being stung and that there is vinegar for such use.
Resort Official: We installed a First Aid Station, which we call the "Vinegar Station" in case of emergency. We will use vinegar as a first step in such cases.
Doctor: I give assurance based on my seven years of experience. Tourist feedback will be positive if we have signs that do not instill fear, that inform and that there is vinegar in the vicinity of installed nets.
Narrator: Accurate knowledge is important for appropriate first aid treatment and preventive methods against injury and death from jellyfish toxin. There should be training for knowing the danger of toxic jellyfish and first aid to those involved, whether they are physicians, nurses, rescue teams, health volunteers, public health officials at beaches, teachers and the general population who make a living in a risk area. This includes communicating this risk with stakeholders and community networks who are involved in surveillance and prevention.
Male: When tourism comes up, we must take more responsibility. we must find methods to help them-how to prevent them from being stung, or if they are stung, what methods do we have to help them.
Villager: If there is continuous training until people can distinguish between non-toxic jellyfish are the poisonous ones. In the past, people thought there were two types. If they can do that, the goal can be achieved to the level that everyone realize and can correct the problem.
Narrator: Another important thing is community networking from national to international levels, working together in prevention, surveillance and developing knowledge to solve the problem and push forward a national policy.
Doctor: It is good for the national image for us to create a good public health system to support this problem.
Doctor: There are two points that I want to leave with you. First, correct information that we want to disseminate, to whomever admires or is involved in this matter. Second, the matter of sustainability. If entrepreneurs, seaside villagers or various concerned organizations could provide vinegar stations and have anti-jellyfish nets (installed), it would be extremely good and create sustainability. Besides that, it will be worthwhile for tourism and various entrepreneurs. Sometimes, our life actually is worth only one bottle of vinegar.

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