“Your child will be dead before the end of the day”

Karachi in Pakistan is a mega city of nearly 20 million people. It has sprawling homes surrounded by high walls and fragrant flower hedges. Chauffeur-driven cars take ladies to elegant shopping malls and tea parties and bring home their children from elite schools. It is not uncommon to see armed guards escort them while on road.

And then there are shantytowns, surrounded by mounds of garbage; dilapidated buses lurch over potholed roads. Men, hurrying towards mosques to catch the early morning prayer, stop to buy fruits and vegetables piled on rickety pushcarts. Packs of mangy dogs roam the streets, scrounging for food out of garbage dumps. A group of boys is playing football. One of them playfully aims a stone at a bitch guarding her litter of puppies. She growls, he stones her. She is angry and approaches him menacingly. Other boys join in the stone pelting till the mother lunges at the boy, nips his calf and draws blood.  

Emergency Departments in Karachi’s three major hospitals report over 100 dog bites a day, but most victims stay home and literally rub salt into the wound. “Better this, than get fourteen injections into the abdomen. Never let water touch a dog bite wound,” quips the grandmother. Others may find it tedious to reach a hospital where the doctor would only clean the injury with antiseptic solution and apply a bandage; there is no concept of infiltrating immunoglobulin. If there is vaccine, the doctor may inject it into the arm or into the thigh.  Further advice may be given, depending upon the doctor’s knowledge and aptitude and practice; often both are pathetic.

The Indus Hospital (TIH) was established in 2007 to provide free but quality health care in various disciplines of medicine. We opened a dog-bite-management center, equipped it with a wound wash area complete with disinfectants, eRIG and vaccine. We have trained, and continue to train, nurses and doctors through video and slide presentations on hands-on training for post-exposure prophylaxis (PEP). TIH has earned a reputation for proper care and was awarded the status of Training Center for the entire province of Sindh (pop. 35 million). Doctors and paramedics arrive from different parts of the city and province to acquire training and return to practice in their parent institution. At least five other PEP centers in the city are functioning satisfactorily and have taken the load off existing centers.

Unfortunately, we continue to see victims of rabies encephalitis from medical centers whose physicians have not received proper training, or lack vaccines or RIG.  I have watched helplessly, time and again, the agony of parents, imploring me to save their child who is gasping and choking before their eyes. That same child, who was playing football, just a few weeks back, will be dead before the end of the day.

Ever since GARC initiated WRD, Indus Hospital, supported by other societies, has launched a blitz of awareness and instruction campaigns. For WRD 2016, we reached out to tens of thousands of individuals, through a massive drive via television, radio, newspapers and magazines, visits to schools, board games, billboards, walks and street announcements through a megaphone, and freely distributed flyers, posters and teaching aids to health care workers. Through unrelenting advocacy, NIH Pakistan has finally discontinued the production of the odious sheep brain vaccine and is now importing a low cost Vero cell vaccine.

Sadly, the local government has still not woken up to the tragic situation. It is the poor and the homeless street children, sidewalk vendors and such lesser mortals that fall victim to this incurable disease. Periodic dog-killing campaigns will never contain stray dog population. Only concerted efforts of civil society, physicians, city government and veterinarians, approached in a scientific manner will reduce the scourge of rabies.

Contributed by Dr. Naseem Salahuddin, Head of the Dept. of Medicine and Infectious Disease, The Indus Hospital, Karachi