A vet in Delhi day 7: summary and conclusion

I’ve spent my final day in the slum and it’s time to draw it all together and reach some conclusions. What’s it all been about, what have I achieved, and what’s going to happen next?

First, to explain: the rationale behind my work has primarily been human health. It’s shocking that rabies is still a major killer in India, despite the fact that it’s completely preventable. If 70% of the street dogs in an area are vaccinated, the disease dwindles and disappears to insignificant levels. Surely this is a goal that is achievable?

The current estimated incidence in India of around 3 deaths per 100000 people per year means that over 20000 people, mostly children, die unnecessarily every year. In a slum like Mayapuri, with a population of 12000, there’s probably around one death every three years. Feedback from my questionnaire suggested that this may be close to the truth. Rabies is common enough to be a constant threat, but rare enough that it’s easy for people to forget about it. Yet it is such an horrific, unnecessary death that everything possible must be done to prevent even one fatality.

ASHA deals effectively with many health and welfare issues in the slums, vaccinating children with BCG, MMR, Hepatitis, Tetanus and Polio: before ASHA arrived 15 years ago, no babies were being vaccinated – the uptake is now 100%.  ASHA also treats adults for TB under the DOTS programme, and offers a range of birth control methods.

There’s no doubt that the charity’s work has transformed the lives of the slum dwellers. But what about rabies? When I asked this question last year, it seemed that it was a bit of a grey area: ASHA is so busy with other priorities that it’s easy for rabies to slip under the radar. When I discovered this, I felt that there was an opportunity for me to use my background as a vet to look into the issue when visiting the slum with a group of volunteers from my local church.

Mission Rabies – who are already in the process of vaccinating millions of dogs around India – do not have an immediate plan to focus on the Delhi area, but they were exceptionally helpful in assisting me with this project. They drafted a questionnaire for me to use while here, and they advised me on important aspects such as informed consent and male/female interpreters.

So what did I discover? Well, I found out how difficult it is to do social research. I had thought I might gather several hundred questionnaires over 3 days, but the process took longer than I had expected: up to 15 minutes for each interview via an interpreter, then time spent seeking out the next candidate. I ended up with just 40 completed questionnaires: not as many as I’d have liked, not enough to be significant in a formal sense, but still perhaps enough to gather valuable feedback about the subject.

What did I learn?

First, I discovered some interesting socioeconomic facts.

  • 75% of households live in just one room, shared between an average of four people: no kitchen, no bathroom, no hot water
  • 95% of slum dwellers own a mobile phone
  • 90% own a television
  • 65% own a bicycle.

Second, I discovered that street dogs are a significant part of the slum community, with an average estimate of one dog per 17 humans (the range was one per 5 to one per 20 people). The only way to get a more accurate figure would be to do a detailed dog census, which would be a major logistical challenge in itself, but the estimates are enough to make the point that there is a substantial population of dogs..

While only 15% of people said that they “owned” a dog, 57.5% said that they feed local dogs at least once a week. This ties in with the reported attitudes to dogs: 40||% said that they “liked” dogs, 15% were indifferent t while 45% of interviewees said that they “did not like dogs” (presumably the latter never feed them).

Third, I investigated the local people’s knowledge about rabies. I found a low level of awareness of the disease. 80% of respondents had not heard of rabies, and only half of the 20% who said that they had heard of rabies were able to explain the disease to someone else. Some people thought that rabies would make them “bark like a dog”. Furthermore, only 45% of people thought a dog bite could be fatal, with 55% of people disbelieving this. There’s clearly a need for community education about rabies in order to prevent future cases.

More positively, despite the lack of knowledge about rabies, 90% of people would go to hospital if bitten by a dog (where they would be given the post-exposure rabies vaccination). As well as doing this, some people would take other action, including putting red chilli powder on the wound, and resorting to “witchcraft”. The 10% who “did not know what to do” if they were bitten by a dog are worrying: they would be very vulnerable to developing clinical rabies if bitten.

What’s going to happen next?

If nothing is done, nothing will happen. The situation will remain the same, and people will continue to die of rabies at a rate of around one person every three years.

Clearly this cannot be allowed to happen.

ASHA already have an effective network of community health volunteers on the ground, keeping an eye on the health of inhabitants in their local area, and passing on information to them about health and disease using handouts and flash cards. On my last day in the slum, ASHA kindly arranged for me to give a presentation to a dozen community health volunteers from Mayapuri and another nearby slum. I was able to pass on the initial results of my survey, and to discuss the challenge of rabies awareness with them. I …

A vet in Delhi – day 6: a selection of photos

I’ve been busy this evening working through my survey results so that I can give a presentation to ASHA about them tomorrow, so I have not had time to write a blog. But to give a sense of the past day here, I’ve put together a selection of photos. The captions should be enough to tell their stories….

A vet visits a Delhi slum day 5 – asking about dogs in the world’s biggest motor workshop

When I return to the slum each morning, I’m repeatedly reminded of a type of hell: there is mud, grime, and two other aspects that are difficult to convey via a blog – a strong “workshop” smell (oil, fumes, solvents etc), and most of all, NOISE. Maypuri is known as the biggest motor workshop in the world, and wherever you go, there are deafening sounds of metal beating against metal, metal drilling through metal and engines roaring. Unemployment here is not the highest in the world, at 20%: there is work, but it’s tough, noisy, dirty work. Beat-up vehicles litter the streets, where they are picked at by people with spanners, screwdrivers and sledge hammers. I saw a dumper truck being reduced from a slightly bashed but otherwise perfect vehicle to absolutely nothing at all after being picked at all day by a small army of hard working labourers.

Nothing is wasted. People collect 5cm lengths of wire, random nuts and bolts, springs and anything at all. Children as young as five are sent by their parents to search for bits of metal, using wooden sticks with big magnets on the end. The oily grime on their skin is permanent: hot showers or baths don’t exist here.

I have found myself questioning my priorities as I walk through them holding a questionnaire to ask about the stray dogs. Many of them seem bemused: nobody has ever asked them about dogs before. Why dogs, when people are clearly suffering?…

A vet visits a Delhi slum day 4: getting down and dirty with the questionnaire

We are staying in the YWCA close to Delhi city centre, so every morning we are collected by a minibus and dropped at the slum. I was faced with the first shock of the day as soon as I stepped out of the minibus. Most street dogs lift their heads to look at you as you walk past: this young one didn’t, so I stopped to get a better look. I called to him, then I gently touched him but he didn’t move. I picked up his hind foot, aware that I could be bitten if he was frightened, but he remained motionless. He was still breathing, but he was unconscious: he was dying.

I couldn’t do anything to help him. I called back an hour later, and as I ‘d expected, he was dead. At the end of the day, I looked again, and his body was gone. This type of incident must be a daily occurrence out here, but for a newcomer like myself, it’s hard to get used to….

A vet visits a Delhi slum: day three- a different slum, different problems

Today (Monday) was the first official day of our pre-organised slum project: I am one of a team of nine volunteers from Ireland hosted by an inspiring human health/education charity called ASHA. I’m the only vet: the rest are from a varied background, including a doctor, nurses, educational workers and members of the public from our local church. If you’d like to read my summary of the background to ASHA, I’ve written another blog entry which you can read by clicking here.

The deal was straightforward: we committed to raising a certain amount of funds per team member to give to ASHA as a donation (and we paid our own airfares and costs out of our own pockets). ASHA then agreed to use us for a week as volunteers in one of the slums that they’re based in.

Most of our team are doing work in the ASHA community centre in the slum. With my particular interest in animals, I’ve chosen to take time away from these activities to investigate the street dog/rabies issues.

After our briefing at ASHA HQ, we travelled by minibus into the slum that will be our base this week: Mayapuri. Situated in West Delhi, this slum occupies a narrow strip of land immediately adjacent to the main railway line out of Delhi. Measuring around 3km long and only 50m wide, this strip of land has been a landing pad for immigrants arriving in Delhi from other parts of India for over forty years.

Mayapuri is an industrial zone, known as a massive car scrap yard where you can buy any spare part for any vehicle. As we walked into the area, we were surrounded by noise: metal banging against metal, drills, engines and shouting. There was grime everywhere, from ankle-deep mud underfoot to men with oil stained clothes, hands and faces. The ASHA community centre is an oasis in the centre of this mayhem: a high-walled courtyard of relative peace….

A vet visits a Delhi slum: day two – educating young people about animal welfare

After an overnight flight from London, I was delighted to be welcomed to Delhi this morning by a remarkable lady who works on the coal face of the street dogs/rabies issue. Bondana Dutta (or Bondi, as everyone calls her) is the founder of a small but rapidly growing NGO charity called Alliance of Animals and People (AAP).

Bondana resigned as a regional director for CRY ( one of the major Childrens Rights NGO’s) to pursue her work with AAP, and she has brought many skills and strengths to her new role. She believes that the way to improve animal welfare in the slums of Delhi is to start with the children: if she can convince young people of the importance of valuing animals, the rest will follow naturally. The children will pester their parents to do more for animals, and in due course, they will mature into a new generation of adults who are strongly pro-animal.

As an introduction to the educational projects she’s created, I travelled with Bondi to one of her projects, in a slum in South-West Delhi.

The cross-city drive to the slum gave me a taste of the lunacy of Indian traffic: half a dozen lanes of a mad mix of vehicles (from cattle-drawn carts to tuktuks to cars to trucks) barging against each other to get ahead, beeping horns instead of using indicators, yet somehow, all keeping going and reaching their destinations.

We pulled up outside the slum, and walked in through narrow laneways past people sitting outside their homes in small groups. The weather in Delhi at this time of year is pleasant: 20°C with crisp clear sunshine rather than the humid 30°C plus of mid-summer. For people and animals alike, it’s a comfortable climate to be outdoors.

After walking a few hundred yards, we came to a fenced off courtyard in the middle of an open area: around fifty children were waiting for us there. This was Bondi’s community: children aged between five and fifteen who have signed up for regular classes in animal welfare. An AAP worker, a former teacher, was giving a class when we arrived. She acted as an interpreter (the children speak Hindu, with just a smattering of English) to allow me to talk to the children.

I asked a few questions and learned a lot: most of the children cared for street dogs which they view as their “family dogs”. They feed them a mixed diet of scraps, and they make sure that they are vaccinated against rabies and where possible sterilised. I asked about what should be done if a person was bitten by a dog: the children knew all about washing a wound thoroughly then seeking post-exposure rabies vaccination.

I then asked the children if they kept any other animals as pets – cats are popular (but they aren’t as visible as street dogs here), some children kept pet fish, and one girl disappeared for a few minutes, astonishing me when she returned cuddling her pet hamster, Pooni.

I stayed for half an hour talking the the children, and the end, they sang a song to me about the importance of looking after animals well. I came away feeling full of hope and optimism: in the three years that she’s been visiting this slum, Bondi has created a population of young people who care passionately about animals, and in the process, they are taking the necessary steps to ensure that they – and their pets – are protected against rabies.

The AAP model is only being used on a small scale at the moment – Bondi would like to have more full time employees to visit more slums running classes like this, but funds are scarce. Bondi has great vision, and with the right support, her dream of all Indian children being taught about the importance of caring for animals will come true.…

A vet visits a Delhi slum: day one – an introduction to street dogs and rabies

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?

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Getting to the Heart of the Matter – Heart murmurs in dogs

February being the month of luurve I thought I would write about matters of the heart. The actual heart. Sorry if anyone got excited there!

Whenever you take your dog to the vet, your vet will listen to their heart and chest. They are checking to make sure the heart beat is strong, regular and that there are no murmurs. A heart murmur occurs when the clear drum beat of the heart (often described as ‘lub dub’) has a swooshing sound. This is caused by the blood not being pushed cleanly through the different chambers of the heart, most often escaping through leaky valves back the way it came. It is one of the commonest signs of heart disease and I am going to concentrate on them in this article.

The breed we see most often with heart murmurs is the gorgeous Cavalier King Charles Spaniel. They often develop them fairly early in life, between 4 and 6 years old is average, but don’t usually develop associated heart failure for at least a couple of years. However, they can occur in any dog and are occasionally heard in puppies (but most will grow out of them)

Heart murmurs are graded from 1-6, with 1 being the quietest and 6 being so loud the normal beating of the heart is drowned out completely. In general the louder the murmur, the worse the leaking of the valves and as the disease progresses the murmurs will get louder….

Marius the giraffe – right or wrong? The great divide

“Danish zoo kills healthy giraffe and feeds it to the lions”
The headlines are appalling, and the international outcry has been almost as dramatic as if the Danish zoo authorities had fed a human to the lions. Do the protesters have a point, or is the zoo simply being honest about an unfortunate but necessary situation?
The answer to this question highlights a major divide in the broad community of animal lovers: those who are in favour of animal rights, and those who believe in animal welfare.

Animal rights people believe that animals have similar rights to humans. Animals are sentient, living individuals, often referred to as “non-human persons”. They have a right to exist and to be granted the Five Freedoms – freedom from pain and disease, freedom from hunger and thirst, freedom from discomfort, freedom to express natural behaviours and freedom from fear and distress. They also believe that animals have the right to life, and that humans do not have the right to take that life away. People who believe in animal rights really  ought to be vegans, since they do not believe in the right of humans to exploit animals for meat or milk. They believe that animals should not be viewed as property, or used for food, clothing, research, entertainment or as beasts of burden. They believe that animals deserve equal consideration to humans: if animals are not given equal rights, this is “speciesism” which is as bad as racism. They believe that in the future, we will look back on our time and see our attitude to animals in the same way as we currently view human slavery….

The truth about your dog’s food? Or sensationalist entertainment dressed up as “the truth”?

Feeding your pet properly is one of the most important aspects of good pet care: in an online Twitter discussion this week, there was broad agreement with the statement that “Nutrition is the single most important environmental influence on a pet’s health and well-being” . But how should an owner choose the best way to feed their pet?  The much-anticipated programme on Channel Five this week, “The Truth About Your Dog’s Food”  is bound to make people reconsider how they feed their pet pooches.

There are many different types of pet food available, from a variety of sources, and it can be confusing for pet owners. There are many “right” ways to feed a pet, not just “one true way”, but it’s common for people to find a way that works for their pet, and then to believe that this is the best way for every animal. I believe that this is the reason why people sometimes become fanatically passionate about certain ways of feeding pets (such as “raw meat and bones”)

I know that my profession – a veterinary surgeon – has been criticised for selling pet food, and there are conspiracy theorists out there suggesting that vets are influenced by the pet food companies that offer financial support to some educational programmes. If you are a believer in such wild nonsense, then don’t read any further – it’ll just be a waste of your time, because you already know that you are not going to agree with what I say….

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