Saving a kid from rabies

It just so happened I was traveling with a fellow doctor in the Philippines.  We were on the outskirts of Manila, a mega-metropolis pulsating with the life of 14 million souls.  We had stopped at a road-side stand for a cool drink because of the oppressive heat.  The humidity was stifling and sweating didn’t help much. 

My friend was conversing with some people in the shop.  They soon learned we were doctors, as Filipino’s are an interested and inquisitive lot.  One of the men claimed a rabid dog had been seen around the neighborhood just recently.  We were surprised and quite interested to know more, because of the significant public health threat for that neighborhood.  The man said the dog had bitten two people before it died.  We asked if the people had gotten anti-rabies treatment, but he didn’t know.  We realized we had better find out.  One more draught of iced cold coconut juice and off we went!

The man took us to the neighborhood or barrio where the dog had roamed the streets.  The locals confirmed that indeed a mangey street dog had been staggering around the area just 3 weeks ago.  The dog had bitten a man and a young girl, before it died several days later.  Certainly the description of the dog sounded rabid:  foaming at the mouth, running and biting at everything in its path.  These bite victims were in real trouble unless we could confirm they were getting anti-rabies treatments.  After 3 weeks of incubation, it would be quite possible these victims could develop clinical rabies at any time unless properly treated.  There wasn’t much time left.

After asking around further, we found a matronly woman who knew the girl and where her home was.  Her name was ‘Jeny’ and she was 11 years old.  We followed the woman down small alleys, ducking under washing lines and skipping over stagnant pools of waste water.  Puffs of blue exhaust and blasts of noise from passing motorcycles accompanied us.  Finally, we arrived at a small brick house with open windows and a cement floor.  We were greeted by the child’s mom.  We asked her about the circumstances of Jeny’s exposure.  Apparently she had been walking home from school, when the dog bounded up to her and bit her on the foot, without any warning or provocation. 

Because the dog was already sick by that time — weakened by it’s disease– Jeny was able to escape without other injury.  She had bled the wound but because of ‘cost’ issues, the family didn’t do anything more.  I was rather amazed and wondered if the mother knew that she could lose her child to rabies if nothing was done.  I knelt on the ground so I could look in her eyes and slowly tried to explain just what this risk was. 

She smiled, it was a defensive smile.  She could not afford the (roughly)  fifty dollars that it cost for the preventative treatment, so she decided to let Jeny ‘chance it’.  The other man who was bitten, she told us tearfully, had been able to afford the rabies treatments and already had his third shot.   Putting food on the table remained a difficult burden, and spending money for health care often was secondary.  I explained that Jeny’s overall risk of dying from rabies was low, but clearly not zero.  Bites on the lower extremities often take longer to incubate and are less likely to lead to disease, but no chances should be taken with this fatal disease, and she didn’t  have any time to lose.

We waited until Jeny came home from school.  She was a shy girl, tall for her age. Her smile revealed big teeth.  We explained to her that we wanted to help.  We looked at her foot and could see where the dog had ripped into her skin.  The injury was scarred now, but we knew the virus could be at work beneath the surface.  Jeny was afraid but we reassured her and took them with us to our hospital.  Jeny was now a V.I.P.!

There were already many other patients awaiting preventative rabies treatment from around the city.  We spoke to our doctors colleagues to help with the cost of treatment.  We would work something out so that Jeny could be saved.

I checked on Jeny and her family weeks later.  She finished the treatment and never developed rabies.  Whew!  What a miracle!  I’m glad we stopped for a drink on that hot day in Manila.
RW