Dr Anna Holmes
I first encountered rabies in Trincomalee, Ceylon, in 1947. The father of one of my friends at school died suddenly. I remember sitting quietly while the adults talked in hushed voices about “hydrophobia” and how “their throats close up when they want to drink”. The other thing they said was “The treatment is ten days of injections into the tummy”. I felt sad for my friend and her family, and anxious at the thought of ten injections – I loathed being stuck with needles. I was also upset that the puppy, which our mother had found for us, was sent away. In those days there was no immunisation for dogs.
Later, at medical school in Edinburgh, we were told about rabies and what a scourge it was in many parts of the world. The treatment was serial injections with immunoglobulin as soon as possible after infection.
In 1964 I was in Maghnia, Algeria, a fifth year medical student working as a volunteer with a group from the British United Nations Association. I had been seconded to the local hospital to help the sole doctor there. There, in the hospital’s dungeon, I met an eight year old girl.
“Why is this child in the dungeon?” I asked. She was feverish and restless. I put my hand on her forehead. There was a gasp of horror from the nurses. “Just like my mother,” she muttered, and settled a bit.
All the staff were standing well away from the bed. There was a lot of shuffling of feet. Eventually a nurse said, “She has rabies.”
“How did she get this?” I asked. A babble of French and Arabic followed.
“Well,” said the nurse who I knew best, “there was a donkey in her village. It was bitten by a fox and it got “enrage” [the French for rabid]. The donkey bit a goat which then bit this child. Now she cannot swallow water.”
I had not realised that non-carnivores could transmit rabies. That was not part of the teaching at Edinburgh Medical School. The local doctor said sadly, “There is no treatment except sedation for this disease. We will send her to Tlemcen” (the nearest large hospital). She was given a sedative and settled to sleep. I felt totally helpless and useless. All I could do was insist they left the light on for her in case she woke. Next day she went to Tlemcen where she died three days later.
The last case of rabies I heard about was in Bangladesh, 1992. An American priest working in a nearby mission was bitten by a dog. He did not seek immediate treatment because he knew the local people could not afford it. He died six weeks later.
Rabies is a now a preventable disease. It is endemic in most African and Asian countries. Anyone travelling or working in those areas where rabies is still common is wise to be vaccinated before they start their journey. This is particularly true of children who are more likely to pat dogs, which infect 99% of all human cases of rabies. I was pleased to read that Bangladesh has had a rabies elimination programme since 2010 which has reduced rabies deaths by 50%. This includes free vaccine for humans, and a dog vaccination programme.
Dr Anna Holmes: Dr Holmes has been a General Practitioner in Africa, the Chatham Islands, Kaitaia, Lincoln, Diamond Harbour and Mosgiel. She worked as Assistant Medical Superintendant in Chief for the Canterbury Hospital and Area Health Boards. She spent ten years working as a medical officer in the Otago Community Hospice. A lifelong interest in spirituality in human development, health and healing led to a PhD in Spirituality in General Practice completed at the University of Otago in 2012.