My first rabies mentor

When I first came to the Philippines, I was introduced to many of the doctors at San Lazaro Hospital.

My first rotation was with Dr. Camino. He must have been in this early fifties. He, like many Filipinos, was rather small. He sat behind a small old wooden desk, which was stacked with papers on each corner. He wore a wry smile and joked in Tagalog with the other doctors and patients which frequented his office. His office door would swing open, and a patient and family members would pour in, sometimes bearing gifts of sticky coconut cake or other ‘merienda’.

He wore a white polyester blazer and black polyester pants, with polished red-brown leather shoes. A stethescope hung over his shoulders, its chromium frame glinting under the fluorescent strip lights. The strong smell of nicotine washed over me as he laughed, all too perfect bright white teeth flashing behind a peppered mustache.

Dr. Camino had an infectious flamboyance, encouraging others to laugh at his silly jokes. He was a brilliant man, sharp of mind, but seeming unabsorbed with his genius. Laughing was his preoccupation. Caring for the patients on the ward seemed to be done automatically.

It was Dr. Camino that gave me the idea and the means to film the rabies patients I was seeing every week. I never even thought to bring a video camera on this rotation, but he lent me his – a solid Sony Hi-8 camcorder. I remember him telling me ‘They’ll never believe this’ – referring to the incredible disease manifestations of human rabies. He was right.

Rabies and the miracle of ‘Starfish’ palliative care

I was back in Manila, headed towards San Lazaro hospital, a veritable mecca for Infectious Diseases in the Philippines.

 

Stepping down onto the platform of the LRT (Light Rail Transit) into a throng of people, the thick humid air  descended on me immediately.  The steam bath was oppressive.  I pushed through the crowds, cringing as the train screeched away.

 

I worked my way through the turnstiles, passing a gaggle of beggars dressed in rags with dirty, tousseled hair.  Mostly young children, four, five years old.  What a future…  Motorcycles sputtered by like annoying kazoos.  Sometimes 4 or more people were seen variously packed onto these bikes.  How they ever didn’t fall off, I wasn’t sure.

 

Hulking shiny metal jeepneys, brightly hand painted, revved up and down the roads.  Filthy soot belching from their exhaust pipes.  Most of the female passengers held handkerchiefs to their faces to limit the particulate inhalations.  Ten, twenty, maybe even more passengers were crammed into the back.  Hundreds of children in school uniforms, everywhere, walking linked together at the arm.

 

I looked up at crowded houses and shops, laundry-lines criss-crossing the skies.  Webs of hundreds of wires interconnecting everything – it was an electricians worst nightmare.

 

This was my new home for the next month, and I just loved it.  Despite the outward appearances of an over urbanized mega-metropolis, the human heartbeat of Manila was palpable all around….

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!

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.