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

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.