I’m just a vet in small animal practice in Ireland, but for the next week, I’m going right out of my comfort zone: I am travelling to Delhi, to visit a slum, where I’ll be taking a look at the issue of street dogs and rabies.
Rabies is one of those diseases that just flits across the consciousness of most of us: we know it’s a terrible disease, and we feel blessed that it doesn’t exist in the UK and Ireland, but that’s about as far as it goes. The truth is that for many people and animals, it’s a daily curse. Minor dog bites are common all over the world, especially in children. Most often minor first aid is all that’s needed: rarely, a visit to the doctor may be called for. Yet in most countries of the world, the threat of rabies in an additional worry.
If a child happens to live in India, that minor dog bite could have had desperately serious consequences. If he was lucky, he might be taken to a doctor to be given post-exposure anti-rabies vaccination. However, it’d be far more likely that this level of medical intervention would be unavailable to him. Nothing would be done other than basic cleaning of the wound. If the dog was carrying rabies, he would be infected, and in the following weeks, he would develop symptoms of rabies. He might have a fever or a headache at first, with an itching sensation at the site of bite. A few days later, he would develop anxiety, confusion and agitation. As the disease progressed, he would develop abnormal behaviour (such as fear of water), hallucinations, and insomnia. He would go on to suffer a terrifying death.
The most shocking aspect of rabies is that it is completely preventable. Vaccination of dogs in bulk programmes is inexpensive and highly effective: it can cost as little as 50c per dog. In comparison,the cost of a human being treated for rabies after a dog bite is around €40, which is over a month’s salary in the regions where rabies is common.
The World Health Organisation believes that mass canine vaccination programmes are the most effective measure for controlling rabies, and that vaccinating 70% of the dogs in an area where rabies is prevalent is necessary to control the disease in both humans and dogs. Targets are in place to have rabies eliminated from the planet by 2030 but this won’t happen unless we all start paying more attention to achieving this goal
In the recent past, mass dog vaccination programmes have allowed some countries to become rabies-free: there are many examples in South America. In Sri Lanka, this type of programme has reduced rabies deaths from more than 350 in 1973 to just 50 in 2010. Yet in over 150 countries around the world, death by rabies continues to be a threat to humans and dogs. Over 60 000 people die of rabies every year, with over 95% of them in Asia and Africa.
India is the country with the biggest rabies problem, with over 20000 people dying every year. So-called “street dogs” are part of the urban culture. They play an important role in the ecosystem by helping to deal with garbage: in areas where dogs have been forcibly removed, the local rat population has boomed, with bubonic plague then becoming a major public health problem. But street dogs also carry rabies.
The size and scale of India makes this problem seem impossible to solve: it’s the second most populous country in the world, with over 1.2 billion people (nearly 300 times the population of Ireland, or 20 times the UK). Despite the magnitude of the challenge, the answer is still simple: vaccination of 70% of street dogs against rabies, combined where possible, with sterilisation of dogs to prevent breeding. If you think of another comparison: 20000 people dying of rabies every year is the equivalent of 67 people dying in Ireland, or 1000 people dying in the UK. Can you imagine the public outcry if that was to happen? Why should we be any less outraged because the people dying happen to live in India?
I’m being hosted in Delhi by a charity called ASHA, which is primarily focussed on human health and education in the slums. I have persuaded them to help me to investigate the severity of the rabies and street dog issue in one of their slums, and they are providing me with an interpreter to carry out a questionnaire. And the kind and passionate people at Mission Rabies have drafted a questionnaire for me to use. In the space of ten days, I am not going to make much of a difference to anything, except perhaps to my own understanding of the issue, and my own desire to do something about it. If you read this blog for the next while, perhaps you’ll learn a bit too.
Rabies isn’t going to go away by itself: it will take the joint effort of many people with a wide range of skills from a variety of backgrounds. Could you be one of them?