I was not able to rest that night. Although I was not oncall and was off from work. That sunday I got a call from my colleague that put chills in my spine.
Let me start the story from the beginning. Twenty eight year old married female with a two year old child was chased by a stray dog and ultimately the dog took a bite on her 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 comes to the bg city hospital with her family and she was vaccinated without immunoglobins. Fast forward 18 days and she is in our emergency department with the signs of rabies. Now it is irreversible. Nothing can be done. How do you disclose that to a two year old. Can we comfort him that its OK. It was inevitable. How do we tell the mother to see her child for the last moments, and then it will be over for her.
Since then I kept on wondering who’s fault is this. From having the stray dogs in a community to lack of available resources and then lack of understanding regarding post bite treatment called post exposure prophylaxis. This case is specially tragic in that the patient and the family came to the hospital on time and and the whole medical community had failed them. I am speechless and ashamed.
Another irony was that she was unaware that is just inches away from dying. We made sure that we tell her what she is about to face, so that she will prepare whatever she can before she meets the tragic end to her life.
I have given speeches on rabies day, done television programs and participated in conferences on rabies. I have advised doctors, nurses and common people regarding rabies and all that we know about it, why am I feeling hollow inside and feel that I am lost for words.
The patient and her family did what they were supposed to do, that is come to the doctor and come on time. But we as physician community failed to do justice. May Allah have mercy on us and give her a peaceful death and her family comfort.
Since then I am constantly thinking how to help others in similar situation. It is not enough to feel bad and move on. The best way to feel better is to do good for the others in that similar situation. We know that once the rabies is set in it is 100% fatal, yet if treated on time after a dog bite, it is almost 100% preventable. This means we should be concentrating all our resources to prevent rabies in all dog bite cases. When we talk about prevention we can..
- Eliminate stray dogs/cats from our society.
- Vaccinate all dogs and cats.
- Report all dog bites to local authorities.
- Get post exposure prophylaxis. We know in high risk cases only vaccination is not enough and immunoglobins needs to be administered.
Also with the talk of prophylaxis comes the discussion about caring for the person who has the rabies set in. What happens to them. Do we have any idea where do they die, and who cares for them. People who care for them are lay person that resort to non-medicinal and unsafe ways, and sometimes are at risk of contracting rabies from the victim. We need to find a way to educate them as how to care for the patients and be safe. May be in that regard we need to address end of life care from a religious perspective.
I am working on forming a group to offer educational support along with logistic help to people with dog bite. We can start a rabies registry and update it on the net. I know we can do that and maintain it to a point that we can calculate the burden of disease in a more accurate way.
With the educational initiative, I would like to start a 24 hour active hotline to address the dog bite and rabies issue. This way we will be able to generate information and create awareness to act in the responsible way against rabies. With the same token, I an contacting my friends all over the world to help us create a fund to help the dog bite victim receive financial assistance in specific cases for the immunoglobins. This will help needy people get proper treatment after a dog bite.
I was speechless but will not remain indifferent, as that is not the option. We all need to pitch in and do our part.
I could be reached at erdoc@shifa.com.pk