I am constantly amazed at the amount of ignorance regarding the rabies outbreak which is still in full swing in Bali and has been for over two years. Almost everyone that I talk to (and in my job I talk to a lot of people, mostly expatriates) seems to be vaguely interested in or totally ignorant of what you can do to protect yourself and your family against this FATAL disease. They come up with all sorts of excuses. “I’m not really at risk”, “I don’t keep pets”, “We don’t go out much”, blah blah blah. For this reason I am going to write about rabies AGAIN.
Just a few weeks ago I was minding my own business getting into my car when a dog flew out from under my vehicle and chomped my ankle good and proper. Apart from then immediate pain and embarrassment the thought of contracting rabies was indeed frightening. Luckily I had just completed the course of the pre-exposure vaccine and all I needed was a few extra doses of the vaccine and a pat on the back. Did the dog have rabies? I guess I will never know. I had never seen the dog before, and after biting me it took off into the night never to be seen again. Now I would call myself a pretty low risk candidate for being exposed to rabies, but my story just shows how easy it is to be bitten.
In my opinion if you do not take measures to protect yourself or your family against the disease then you are just being irresponsible. The initial pre-exposure course of the Verorab is three shots on day 0, 7 and then on day 21 or 28. This should set you back about Rp 400,000, depending on where you go. If you are waiting for a free vaccine from the local government or Sanglah hospital you will probably die waiting for it.
Free vaccine is generally reserved for local people who have been bitten and need the post exposure program (the same vaccine administered 5 times as opposed to 3 times). Ideally someone who is bitten by a suspect animal (and all animals are suspect unless proven otherwise) should also receive the immunoglobulin. This is an injection which will give you instant protection against the disease however its action is short lived, so you should also receive the vaccine which will encourage your own immune system to build up your own long-term protection.
The immunoglobulin injection is in dire short supply perhaps because of its prohibitive cost (7 to 15 million rupiah per treatment depending on the weight of the patient). Take note that many insurance companies do not cover for vaccines and immunoglobulin’s so read your policy carefully if you think that you will be covered for this very costly treatment.
The immunoglobulin treatment is also quite painful as it does need to be injected around the wound (ouch!). In fact I have heard many people say that they will not have the vaccination because it is so painful. This however is a misconstrued rumor and a half truth. It is the IMMUNOGLOBULIN that is painful; the VACCINE (Verorab) is almost painless.
So the message in this week’s article (just in case you missed it)? Get vaccinated.
RABIES TAKES NO PRISONERS, once you exhibit symptoms of rabies infection a slow and painful death will certainly ensue.
What to do if you are bitten, scratched, or licked by a suspect animal.
First, thoroughly wash the wound with soap and running water. Gather as much information about the animal as possible. Then go to your nearest clinic or emergency room. If the clinic does not seem to be giving you good information then go somewhere else. (Many local clinics are suggesting that treatment may not be necessary. This is incorrect. Find somewhere that at least has the Verorab). Keep yourself well informed on the risk of rabies in your area. Rabies is now Island wide so don’t let anyone tell you that their particular area is rabies free. Download and print the correct treatment plan (CDC website) for rabies should you need it one day. If the doctor at the local clinic is not aware of the correct treatment plan you can show this to him.
Kim Patra is a qualified registered nurse and midwife who has been living and working in Bali for almost 20 years. She now runs her own private practice and medical referral service from her Kuta office. Kim is happy to discuss any health concerns with you and she may be contacted via e-mail at info@chcbali.com or Hp. 081 2366 0000.
