HIV needlestick!

A good friend of mine who works as a nephrologist was putting in a dialysis catheter. She had done many ‘lines’ before and this one was just routine. The catheter looked like a very large needle with tubing attached. The catheter or dialysis line provides access to the blood stream to provide the patient with life saving hemodialysis. When the kidneys fail, a patient will die in a very short time without dialysis, as toxic levels of metabolites build up.

She accessed the neck veins and got a good flow of blood, indicating the line was in position. She finished up the placement and was preparing to give some fluids to flush the line clean. Now that the ‘hard’ part of placing the line was done, her attention lapsed ever so slightly. While preparing the fluids, she inadvertently stabbed the needle through her glove and into her finger. A lancinating pain ran up her arm – it was a bad ‘stick’ or injury. The needle had penetrated through and through her finger.

My first patient with rabies

I will always remember Joey, the first patient
I ever saw with rabies.

I was a medical resident on a rotation at San Lazaro Hospital, in the heart of Manila, 10,000 miles from home.

Joey was a small boy, not more than 5 years old. Two months ago, he suffered a dog bite on his leg from the neighbor’s puppy. It was just a small nip in the skin, with only a few drops of blood produced. The puppy seemed alright, but it died a few days later – seemingly a victim of the stifling Manila heat. The parents struggled to make ends meet for their family of 5, it would be too much to take Joey to see a doctor – instead they would visit a local faith healer.

After some incantations and a procedure where a black porous stone was affixed to the wound (tandok), the family felt reassured rabies would not strike. The family had heard of rabies, but trusted the faith healer, as he proclaimed to have saved many lives from that cursed illness.

When Joey started to get sick 7 weeks later, the parents thought it was just a cold. He didn’t have much appetite and had some headache. A few days later he had some fever and felt tired. Then, he started to complain about itching on the leg where he had been bitten before. That night, he didn’t eat any dinner. His older sister thought he should at least try to drink something, so she brought him a glass of water. Joey suddenly shrieked and held his hand to his mouth when he saw the water, trying to get away from the threat in front of him. Terrified, the mother realized her son had rabies!

Hoping for a miracle…

Sheila was just a 7 year old kid.

I met her at San Lazaro Hospital, the Infectious Diseases and Tropical Medicine referral center for the Philippines. I had just arrived there to observe the practice of Infectious Diseases that are rare but important in the States – tetanus, bacterial meningitis, measles….

Sheila had come in for treatment, after experiencing difficulty swallowing at home. She was from Bulacan, a province in the southern part of Luzon.

Nine weeks earlier, she had been attacked by a dog. The dog had bit her on the right arm, and died a week later. Her mother had taken her to a local ‘herbalario’ because of the fear of rabies.

A herbalario is a practioner of ‘folk medicine’ and uses various herbs, incantations and concoctions to try and effect a cure. Although not formally trained in medicine, they are respected in their communities. Their rituals have a certain credibility, born out of an ingrained belief in the supernatural. Certainly, for some diseases, such as ‘coughs and colds’, a mentholated poltice or other vile remedy might actually work or ameliorate symptoms. Not for rabies though, which mandates appropriate medical treatment to prevent disease.

Rabies is 100% fatal, and any miscalculation can prove deadly.

Unfortunately, Sheila was showing the physical sign of hydrophobia. When she drank water from a cup, she recoiled with spasms of choking and reported chest pain. When I saw for myself this reaction, my heart sank because I knew she would die.

A new bat species - the Mindoro Fruitbat!

I was very pleased to hear about a recent ’small miracle’ in the world of biodiversity. A new bat species was found in the Philippines according to scientists reporting in the Journal of Mammalogy.

(see Esselstyn JA (2007) A NEW SPECIES OF STRIPE-FACED FRUIT BAT (CHIROPTERA: PTEROPODIDAE: STYLOCTENIUM) FROM THE PHILIPPINES.
Journal of Mammalogy: Vol. 88, No. 4 pp. 951–958

Apparently this is a fruit-eating bat or ‘flying fox’, with orange fur and three white stripes on its face. Flying foxes are quite unlike the bats we have fluttering around over our heads in North America. These animals have fox-like faces with reddish fur and are quite large. Mostly they feed on fruits and are extremely important ecologically, as anyone from Bat Conservation International can tell you.

I remember with fascination visiting the Subic Bay area of Luzon, Philippines and seeing an enormous colony of these creatures, right behind our hotel! It was called ‘Bat Kingdom’ and fortunately was a protected area.