The Tragedy of Rabies

Dr Abdus Salam Khan, FACP, Director of the Emergency Department. Shifa International Hospital, Islamabad in Pakistan shares his perspective.

As emergency room physicians we come across patients who are faced with death and need our help to fight this battle. Most of them are success stories, but when I see a patient with rabies, I know that we have lost the battle without even trying anything.

I recently had sleepless nights over one particular case. A 28 year old lady with a two year old child was chased by a stray dog and ultimately the dog bit the child on the face. She was taken to a local doctor in her remote city, and the doctor instructed them to go to the big city hospital for the vaccination and the immunoglobins. She came to the city hospital with her family and she was vaccinated, but without immunoglobins. Fast forward 18 days and she presented at our emergency department with signs of rabies. Now it is irreversible. Nothing can be done. How do you tell a two year old? Can we comfort them that it is OK?. How do we tell the mother to see her child for the last moments, and then it will be over for her? This case is especially tragic in that the patient and the family came to the hospital on time and the medical community failed them. I am speechless and ashamed.

Although rabies and its devastation have been known for a long time, we are still not able to lessen its impact in my part of the world. We see patients showing the signs of rabies, and we cannot offer them anything. They eventually die in their home or other places.

We have failed as a medical community to address this disease in a meaningful way. Although we do education campaigns and celebrate World Rabies Day, using print media and electronic media, we have not yet been able to put a significant dent in the incidence of Rabies. Our emergency responder physicians sometimes don’t know the latest guidelines and treat based upon their own understanding, which may result in a bad outcome.

Efforts are needed to educate the public regarding vaccination of their pets and the treatment of bite wounds. Government-run facilities see the majority of dog bite cases, but because of the lack of policy, resources and most important of all lack of emergency medicine training, this results in a less than optimal level of care. Private institutions also serve these roles and do a relatively better job, but their care is mostly out of the reach of common people due to the costs.

Being a member of the emergency medicine community and also involved in training of physicians, I am sure that persistent effort will ultimately improve care. I use my blog to propagate this educational aspect at www.emergencymedicineforum.org. I am working on forming a group to offer educational support along with logistic help to people with dog bites. We can start a rabies registry and update it on the net so that we can calculate the burden of disease in a more accurate way. I would also like to start a 24 hour active hotline to generate information and create awareness to act in the responsible way against dog bites and rabies.

Rabies control is a team effort and requires input from all stakeholders, but in the case of Pakistan unfortunately it has been neglected by too many.