altruism ('æltru:,ɪzəm) n 1 the principle or practice of unselfish concern for the welfare of others. 2 the philosophical doctrine that right action is that which produces the greatest benefit to others. [C19: from French altruisme, from Italian alturi others, from Latin alterī, plural of alter other]
Now, you may be wondering why it is that I've started off a writeup on small, flying insects with a dictionary definition (Collins English Dictionary btw, 21st Century Edition) of the word 'altruism'. All will become clear as I meander my way through the world of the sandfly.
So. What is a sandfly?
Well, what indeed. That's why you're reading this writeup; to find out what a sandfly is. Well, sorry to break it to you, but it's one of those, 'Hey, it's worked once, let's use it again!' colloquialisms that covers lots of different species of small, biting, blood-sucking insects. What they do all have in common is that they live in sand. And that they fly. Other popular names for them, especially in North America, are no-see-ums or punkies.
Regardless of the different species, all flies that exist under the umbrella term 'sandfly' come from the order Diptera. Dipterans are different from all other insects as they only possess a single pair of wings on the mesothorax; the second pair have evolved into a pair of knob-like structures called 'halteres' that are used as balance organs. It is these that a particularly smart, yet evil, young child will pull off of a daddy longlegs, just to watch it flail around (even more) uselessly. The insect version of Ménière's disease.
Diptera is further divided, and sandflies occupy the suborder Nematocera. Nematocera are bit of a hodge-podge of winged-beasties, containing the soft-bodied flies such as mosquitoes, midges, gnats, crane flies... and sandflies.
From reading around, there are really only two families that contain species that can be accurately described as 'sandflies':
Ceratopogonidae — contains around 2000 species and can be found world-wide, from the Caribbean to Scotland; they are more accurately called 'biting midges' though. Four genera: Forcipomyia, Leptoconops, Austroconops, and Culiciodes. The adult flies are very small, usually about 1.5mm long, but the fact that they tend to swarm together usually means that you'll notice them. It's only the females that bite, as a blood meal is required for egg maturation to occur. The ovarian cycle occurs once every two to four days, and they'll lay 40-50 eggs at a time, usually in wet areas, such as marsh, or shoreline (fresh or salt water.) So. That's a lot of blood sucking that they've got to be getting on with. As with mosquitoes, Ceratopogonidae also act as vectors for various arboviruses (such as African horsesickness, Akabane virus, bluetongue, and bovine ephemeral fever), protozoa (such as Hepatocystis spp. to mammals and Akiba spp. to birds), and filarial worms (such as Mansonella ozzardi to humans and Onchocerca gibsoni to livestock.)
Psychodidae — contains around 700 or so species within two genera: Lutzomyia and Phlebotomus. These are considered to be true sandflies, and occur mainly in the tropics, although some New World species are found mainly in wet forest areas. Again, they are small (1.5 - 4 mm in length), and again, it's only the females that bite. They act as vectors for the protozoan parasites that cause leishmaniasis in man, and in the Andean regions of South America, transmit Bartonella bacilliformis - the causative organism of Carrion's disease in man. Nice.
So, where does the altruism come in?
Yes, yes, I was getting to that bit. I was working out in the Solomon Islands last October. I don't know how medical schools do it in other countries, but in the UK, you get a couple of months to bugger off and do whatever you like under the heading of quoteunquote Medical Elective. Now, don't get me wrong, they do semi-expect you to do some work for this, so I'd arranged an attachment with one of the main hospitals out in the Solomons. When I arrived, I found it had an outpatients (one small room, three desks and an examination bed with a curtain), three wards, and one operating theatre (which had actually had the floor give way a couple of weeks before I'd arrived; I really hope they didn't have a patient on the table at the time.) They only ever had four doctors there at a time (but were a man down because one had resigned his post), and were serving a population of 50,000. What they give, they give for free, but they haven't got a lot to give.
It was an amazing experience. It really opened my eyes up to how much I take for granted; when someone's sat in a canoe for four hours to come and see you for a pain in their leg, it's because they think there's something wrong. Sending them home saying, "sorry, I can't find anything" just doesn't feel good enough, though it's sometimes all that you could do. Those were the days that you went home hating youself.
I managed to eventually get my script writing down to a fine art; most people got some variation on iron supplementation (anaemia), paracetamol (they have really low expectations of pain medication out there. Show then a paracetamol tablet and they're good to go, broken femur or no), a course of albendazol (helminth infection), and a course of amoxicillin (just... everything). And that's it. That's probably one of their very few encounters with a "doctor" for the rest of their lives. God, I felt guilty. Talk about being short-changed.
The Solomon Islands really was sobering experience that gave me true pause for thought about how much of a difference I could make for people that I didn't even know existed up until then.
Also, there's a lot of good diving to be doing out there.
I am all about the altruism.
But that's not the altruism that I was referring to when I started this writeup; although it is linked to the insane amounts of diving that I did out there. The Solomon Islands were the scenes of a lot of naval battles between Allied and Japanese ships in the years 1942-1943 as part of the Battle of Guadalcanal. I saw a lot of naval wrecks and planes that were shot down; they're fascinating now that they've become one with the coral, but what a waste. There's a particularly good spot for divers at a stretch of water called 'Ironbottom Sound'; a cool and funky sounding name, until you think of the number of military boats and planes that must being lying down there for it to have picked up the moniker. But this is down near the main island of Guadalcanal, and the place where I should pick my story up again is near the island of Gizo.
We had been diving that morning on the wreck of the Toa Maru, and had adjourned to an island for lunch. I know not which island, for there were many of them. I only know it was not Kennedy Island, named after the President, who managed to swim there after 8 hours, bobbing in the sea, dragging an injured shipmate by his lifejacket with his teeth after a Japanese ship capsized his patrol boat (without noticing). I got drunk on that island a couple of times. It didn't have any sandflies – or at least, not those times. The island that I stopped off for lunch after the Toa Maru, however, did have sandflies.
When you've got a baking sun down on you, the last thing you want to be wearing is a skinsuit, so I was wandering around in my bikini. Every now and then I'd brush off the black dots that seemed be sticking to my legs and shoulders. Then, after lunch had gone down, we got back in the boat and went for the afternoon dive.
The itching didn't start the next day. Or the day after that... but some 56hrs after I was bitten, I was in some kind of hell. The insects themselves may only be 1.5mm in length, but they bring up a bright red bump about a cm in diameter – the body's incredibly disproportionate immune reaction to the contents of their salvia used to prevent the coagualtion of your blood when they bite you. I have never itched so much in my life; I seriously thought about just slicing patches of skin off to ease the torment. I couldn't sleep because I was scratching so much. I ran out of Anthisan within a day. I woke myself up scratching, bloody and raw. On my right calf, I could see where one of the little fuckers had wandered along in a small, wavy path, taking little bites as it went trying to find the best bit of me. I could write for pages and pages, and I still don't think I could communicate the torture; I was scratching constantly for three weeks. Let's just say that I can now empathise with those who have severe eczema.
The day that the bites came up coincided one of my shifts in outpatients. I'd already been to the town pharmacy that morning to find they had nothing of any value in stopping me from scratching my legs to bloody stumps, so, in desperation, I'd written myself a prescription for some calamine lotion from the hospital pharmacy (the last bottle, it turned out), which was the best thing that I was going to get, stuck as I was in the middle of nowehere. It was sitting in my bag, waiting for me to take back to the hostel to turn my legs pink with.
My first patient was an 18 month toddler with chickenpox. It had already got over the worst of it, poor duck, but now it just had to get through the itching to let everything heal. I had a flashback to being three years old, sat on a beanbag, dotted in calamine lotion and being scolded by my mother not to scratch, for the love of God, child, DO NOT SCRATCH. Oh, how I wanted to scratch till my fingernails fell off. This was in the temperate climate of the UK; I imagine that the heat of the Solomons would have driven me out of my little three-year-old mind. This actually wasn't that hard to imagine; I was at that exact moment being driven out of my 25-year-old mind.
I contemplated the thought that philosophers argue that there is no such thing as a true act of altruism as I handed mum the bottle of calamine lotion from my bag. But I also contemplated that that was probably the closest that I was ever going to come to it. This gave me no personal satisfaction at all as I went off to find some kind of topical anaesthetic. Failing that, ice. Failing that, cyanide.
Altruism is over-rated.
It should probably be noted that, in itself, calamine lotion is a fairly useless salve at best, and that it shouldn't be used on insect bites. But one must never underestimate the power of the placebo effect, on either kiddies or adults, and by god I was looking forward to putting that stuff on when I got home.
