Rabies dispatch from Malaysia

Just a few days ago, I arrived here in the heart of Malaysia. 

The capital, Kuala Lumpur, is a clean, orderly and modern city. KL, as it is affectionately known, is a thriving gateway to Southeast Asia. 

Shiny sky scrapers are clustered about the city center, motorcycles and cars pulse through the streets, banyan trees and thickets of bamboo offer oases of shade, while thick humid air enshrouds everything in unbearable heat.  At night, the Petronas towers shine like crystal. Wow!

I came here for the 13th annual International Congress on Infectious Diseases.  Doctors and scientists from all of the world met to review the latest drugs, emerging diseases, HIV/AIDS, parasitic infections and tropical medicines - it was an exciting time. 

Luckily, there is no rabies here.  Decades ago, the government resolved to eliminate that threat.  Dog control with vaccination and round-up of street animals was authoritarian but effective.  Rabies had no place to hide.  The WHO officially recognizes Malaysia as rabies-free.   Occasional rabies cases may cross over from border countries, but are quickly stamped out.

Many countries in Asia still struggle with rabies. Depending on resources and commitment, the situation varies. In Thailand, for example, the government curbed human rabies by providing free anti-rabies vaccines to anyone exposed. Expensive, but effective, human rabies cases number only a dozen or so per year. In the Philippines, reductions in rabies suffering are anticipated with the passage of the “Anti-Rabies Act of 2007″ (Republic Act No. 9482).  This law commits to wiping out rabies by 2020 from those islands.  Hopefully it will occur sooner, and with more resources it certainly could. 

RFW is gearing up to support more dog vaccination projects in the Philippines through our click2vaccinate program.  Dispatching rabies from the Philippines remains our primary goal.  We have alot of work ahead of us!

Travelers to Malaysia should check out the CDC website and confer with a travel medicine specialist before their trip.

RW

“March Madness” - Rabies awareness month

Rabies.  The sound of the word sends a chill down
my spine. I have seen what this virus can do, and it’s very very frightening:  Hydrophobia, ‘foaming at the mouth’, psychotic screaming, savage agression, immunity to pain.  These are symptoms of a dark, terrifying Force - a Fury unleashed.

It astounds me to know that in this 21st century, such an ancient, Evil disease can flourish in so many parts of the world.  It truly is ’madness’.

Rabies is one of the ‘neglected’ diseases of our time.  It is 100% vaccine preventable, yet 100% fatal once symptoms are present.  No other infectious disease has such an unforgiving mortality rate.  Ebola, by comparison, carries at least a 10% chance of survival. 

Miracles do occur (see Jeanna Giese) but certainly not enough of them.  We need more miracles out there, especially for the 55,000+ people who die from rabies every year according to the World Health Organization (WHO).  The fear, the terror I’ve seen in children’s faces suffering from rabies haunts me.  I wish somebody would do something…

Was Bear Gryll’s exposed to rabies?

I’ve been watching that show ‘Man vs. Wild’ on Discovery channel. If you haven’t seen it yet, you might want to tune in. Discovery has a schedule on the web (see http://dsc.discovery.com).

I first happened upon ‘Man vs. Wild’ just channel surfing, but within a few minutes of watching, I was hooked. Here was some great TV – which is hard to find these days. I don’t know why television in general is so pandering – I often wonder why the networks just don’t strive to make great programs and worry about the audiences secondarily. I think ‘build it and they will come’ should apply –even though it might seem riskier. Just consider the “Lord of the Rings” trilogy for example – what a Masterpiece!

Anyway, here’s this guy Bear Grylls, who by some miracle survived and recovered from a broken back after a parachuting accident. Now his assignment is to lead the viewer through some harrowing wilderness challenge. The show is a great mix of adventure, amazing natural beauty, perseverance, intelligence and ultimately triumph. I think this program inspires hope. I may not get outdoors that much, but I feel like I could spring into the back yard at any time, climb over the fence and into the wild mountains beyond.

I’ve seen many ‘cord’ victims in my career, since my training hospital had a spinal cord center. I dreaded to see them, since paralysis is such an awful curse. As a doctor, you wish you could do more, but with devastating neural injury, sometimes there was just nothing you could do. Bear must have been very lucky and I’m sure a miracle occurred there.

I’m hoping Bear’s luck holds out. Last week I saw his ‘Panama’ episode, where he and the crew traverse through a bat infested cave in pitch darkness. He didn’t report the species of bat, although he suggested they were vampire bats – Desmodus rotundus. Whether or not that was the correct species is irrelevant, since rabies is actually a ‘bat’ virus and could be transmitted by any number of bat species.

Saving the street animals in Bangkok

It was mid-April in Bangkok and I was visiting Thailand to help educate the public there about the dangers of rabies. 

I was thrilled to be going around this city with Mali - a friend of mine who worked in film.  What a far off place this was - exotic temple architecture, huge sky scrapers, amazingly good food, crowds of people everywhere.  Traffic clogged the streets.  The noise from tuk-tuks - small carriages with motorbike engines- buzzed through the air.  It was the hot season, but I didn’t mind, it just added to the mystique of this steaming metropolis, the gateway to beautiful Thailand.

Mali wanted to know all about rabies, since she knew it was a real danger.  There were plenty of street dogs in Bangkok.  You could see them roaming and foraging for scraps of food.  They appeared similar to the street dogs I’d seen elsewhere in Asia - a rather thin mangy breed.  There were of course other animals too, including a small elephant brought along one of the main tourist streets for the farangs to gawk at.

My friend peppered me with questions about rabies.  She was concerned about her sister, Pho, who loved street animals and was always trying to care for them.  Pho had actually taken in six cats.  She was constantly getting scratched and occasionally nipped by the street animals since she was taking care of them whenever she could.  I became somewhat alarmed to realize that Pho was at a real risk for rabies.