KARACHI: It was a usual Infectious Diseases Clinic that day: complex referrals, difficult diagnoses and frequent power shutdowns. Many patients in the waiting area had been waiting for over two hours and were becoming agitated and quarrelsome. In the midst of all this, I got a phone call from the Emergency Department (ED): “I have this 12-year-old boy with rabies. What should I tell the parents?”
“Oh God,” I thought. “This is the most difficult of today’s work.”
I left the clinic with the feeling of apprehension that the word “rabies” always evokes in my mind. The boy’s uncle who sensed the danger of his nephew’s symptoms but wanted to confirm the diagnosis met me at the ED. “I have to see the boy first,” I said.
On the stretcher was this handsome boy, alert and observant; his face was flushed and he was breathing with difficulty. Interns, nurses and doctors in training were around him. I took permission from the boy and his uncle to make a video clip of my conversation with him on my mobile phone. I asked his name and the circumstances of his illness. “My name is Umar. I am 12 years old and am a student of class six in Hyderabad.” He spoke fluently, but in short sentences as he was breathing heavily and fast.
“I was playing in the park; there were many children there, may be 40 of them. A bitch suddenly came from, I don’t know where, and started running around the park and it bit many kids.”
“Where did she bite you?”
“I tried to run, but I fell and she bit me here and here and here and here ….” He pointed to his hands, upper arm, and thighs. He then lifted his shirt to show wounds on his chest and back. Do you know this happened more than two months ago?”
“What did your father do then?”
“I don’t have a father. My uncle took me to a hospital. They washed me up and gave injections in both my arms.”
I then put to him an important question: “Did they inject anything into the wounds?”
Umar looked perplexed. “No, but I went back at least three more times to get the shots, and they said I would be safe.”
“Are you thirsty? Would you like to drink some water?”
“I have not had food or water for two days now. I can’t swallow. But I can try.”
A nurse brought him some water in a cup. Umar took the cup, hesitated, and then attempted to drink the water. Immediately, he began to choke and the water regurgitated through his mouth. “Please, please, no more. Doctor, I am frightened, please help me get better. I haven’t slept and I don’t know what will happen to me.” His eyes were wide with fear and he took deep, heavy and fast breaths.
I stroked his forehead and said: “Everything will be fine; just close your eyes and relax.” He gave me a faint smile and said, “Doctor, please send me the video on my email. It’s email@example.com.”
My heart could take it no more. Some young nurses lowered their moist eyes, while others simply walked away to hide their tears. I composed myself and spoke to the uncle about the futility of further care. We could only give him terminal comfort and care, with heavy sedation, so that he would suffer no more. His mother would just be left with her eight-year-old son. The uncle was prepared for the worst. That night Umar was dead.
No one recovers from rabies once its symptoms set in. Treatment of dog bite, if begun immediately and correctly, can prevent rabies. The first step is to scrub all wounds thoroughly with soap and water, apply antiseptic and head for a centre of excellence (which, unfortunately, are few in Pakistan).
The trained healthcare worker should carefully examine all wounds, and if deep enough to cause bleeding, he should infiltrate each and every wound with Rabies Immunoglobulin (RIG), which neutralises the virus at the site of the bite, and then follow with a schedule of vaccine. Umar’s treatment fell short of the correct management and led to the agonising death of the sweet child.
I have seen rabies in persons of all ages, though mostly in children, and each death touches me deeply.
Today being World Rabies Day, we should remind ourselves that it is preventable, if treated early and correctly.
The only effective way of eliminating the deadly disease is by Mass Dog Vaccination. Dog population can be controlled effectively only by Animal Birth Control, and not by killing.
This is doable only with collaborative efforts at all levels of health services, and bolstered by philanthropists from civil society. We must put an end to this horrific disease.
The writer is an Infectious Diseases specialist
Published in Dawn, September 28th, 2017