As Bali braces for an influx of holiday makers this summer, Australian doctors are training their Indonesian counterparts to identify an insidious killer: methanol.
The toxic form of alcohol is related to ethanol, which is found in beer, spirits and wine.
But methanol is used in jet fuel and radiator coolant, and is often substituted into drinks made from home-distilled spirits, with potentially fatal results.
And with one million Australians holidaying in Bali each year, the risk of methanol poisoning is increasing.
Dr Mark Monaghan is a toxicologist at Fremantle Hospital and has travelled to Bali with the National Critical Care and Trauma Response Centre to run toxicology workshops this week with 300 Indonesian medical staff at the Sanglah Hospital in Denpasar.
He says it’s impossible for drinkers to know they’re consuming methanol.
“You get intoxicated the same way, you won’t notice while you’re drinking it, (but) you’ll certainly notice when you’re getting sick from it,” he says.
And it doesn’t take much - half a millilitre per kilo for the drinker, which equates to 30 or 40mls, or about half a glass.
“It’s absolutely lethal,” Dr Monaghan says.
“You can end up with a permanent brain injury if you don’t die, or blindness.”
Perth carpenter Liam Davies, 19, died in January in Lombok after drinking what he thought was a vodka and lime but was in fact methanol.
Last week a young man returned to Australia from Bali with severe visual problems after drinking methanol-laced alcohol, and a group of ten British girls were recently poisoned.
There’s a need to educate Indonesians about the dangers of methanol, says nurse Di Brown, who runs the sister hospital program between Royal Darwin and Sanglah hospitals.
The Indonesian Government recently tripled the tax on imported spirits, pricing them out of reach of most locals, who have turned to adding methanol to drinks to make a quick buck.
“The goal is to get funding for nurses to go out as outreach workers to communities so we can stop the supply,” she said.
“We need to explain to them that it’s really poisonous; they don’t understand the danger of it.”
The treatment for methanol poisoning is surprisingly counter-intuitive - victims need to be given ethanol, or more alcohol, as it’s metabolised by the body before methanol and stops the formation of formic acid, which causes blindness.
But because ethanol slows the metabolism of methanol, it can be two or three days before symptoms of poisoning occur, which is why it’s hard to know just how many cases there are, with many going unreported or unattributed.
And Ms Brown says convincing hospitals in predominantly Muslim areas such as Lombok to keep ethanol on hand to treat those poisoned can be a challenge.
“There’s a cultural resistance to admitting there’s a problem,” she says.
Schoolies kids are particularly vulnerable to the appeal of a $1 drink, says Dr Len Notaras, executive director of Australia’s National Critical Care and Trauma Response Centre.
“They’re here to let their hair down and don’t have a lot of money, and after one or two drinks can forget their inhibitions,” he says.
“If it seems too good to be true - a $1 cocktail that would be $16 in other places - it is too good to be true. And it’s deadly.”
He says the Indonesian health system is excellent and more than capable of treating methanol poisoning, but needs to be aware of the symptoms, which include erratic breathing, terrible headaches and blurred vision.
Dr Monaghan says Australians need to be more aware of the risks involved in buying cheap drinks in Indonesia.
“Beer is readily available, you can buy duty free spirits, or spirits from plenty of hotels or restaurants where it will cost you $5 instead of $1,” he says.
“Don’t leave your brain at home when you travel to Bali.”