La Raj du Chien: Confronting the rage of the dog in Haiti

Haiti is the most impoverished country in the Western hemisphere, despite being a mere 600 miles from one of the wealthiest countries in the world. The wealth disparity is obvious when you are in Haiti. Poverty surrounds you; over 70% of the population survives on a wage of $2 USD per day. However, several weeks ago, on a hot August evening, I found myself at the top of a hill in what could pass for a five-star restaurant in the U.S., dining with a group of rabies experts and looking out over the city of Port-au-Prince. We had spent the day marching through dusty roads in an impoverished community only 30 minutes from the capital, capturing and vaccinating stray dogs as part of an effort to curb an ongoing rabies outbreak. Now we were dining on gourmet pizza and specialty iced drinks. Sometime after the appetizers had arrived but before the main course, my phone buzzed. I thought surely it was my wife sending a good-night message from the kids. Expecting a video of three kids bundled in pajamas with a Goodnight Moon book propped between them, my stomach sank when I instead saw a picture of young boy with sunken eyes and a blank stare with the caption: “Is this rabies?” 

Hydrophobia: an irrational fear of water, often associated with the last stages of death in persons succumbing to rabies virus infection. I step away from the dinner table and click ‘play’. The shaky video shows a stream of water jet from a young Haitian doctor’s syringe, and splashes onto the bare chest of a frail 7 year old boy. As the water hits his chest he shrieks in terror, convulses, and writhes in his mother’s arms as she stares back at the doctor with a muted, expressionless face. She has seen her son terrorized by an invisible demon for the past 5 days and now acts numb to the gruesome scene that is unfolding in this rural health center. Confronting patients suspected of rabies with water is a common test in many developing countries; this reaction confirms the doctor’s suspicions – the boy has hydrophobia. The mother reveals that 6 weeks ago the boy was bitten by a stray dog. The doctor relays the grim prognosis and sends the two home; there is no care he can offer. Within 24 hours, the boy is dead.

The video was sent from a veterinarian-missionary in Haiti who has devoted her past five years to preventing these deaths. I happened to be in Haiti working with her on a dog vaccination program. It would be the first of two videos that week of young children with rabies that were sent to my phone, asking if there was any way to help. Twice I had to answer, just as the young doctor told the mother, after signs appear there is no effective treatment.

Haiti has an estimated 130 human rabies deaths annually, yet only about 7–10 are detected due to gaps in surveillance and the healthcare system. Finding and documenting these deaths so they no longer remain hidden has been a priority for the missionary and me. But the best preventive measures are vaccination of dogs, and this August, a team from the United States CDC, Christian Veterinary Mission, Humane Society International, and IDT Biologika, worked with Haiti’s ministry of agriculture to develop a more robust canine rabies mass vaccination program. Over 12 days, a team of 30 staff vaccinated over 10,000 dogs while also collecting critical evaluation data. Over the next several months the team will analyze the data and try to determine the best strategies for canine rabies vaccination in Haiti. This fall the results will be put to the test, when the ministry of agriculture runs a 100,000 dog campaign. And next year there is talk of 700,000 dogs, if the vaccines come in.

Written by Ryan M. Wallace DVM, MPH who has been involved in rabies control efforts in Haiti since 2012 working in close collaboration with Kelly Crowdis DVM of Christian Veterinary Mission who sent the videos.