Feature of the Week

Danger on your doorstep

The death of Frank Makuluni in Blantyre this year magnified the risks that rabid dogs pose in communities. The situation is complicated by the shortage of rabies vaccine in most hospitals in the country as Emmanuel Muwamba writes.

Life is so precious, so when you see a stray dog, take the opposite direction and run.

That is the free advice from people who have had a close shave with such deadly animals. But some have not lived to tell their harrowing experiences.

For example, 26-year-old Frank Makuluni was bitten by a rabid dog in October last year and died in January this year.

He is among the victims of the drug shortages that have crippled medical services in Malawi.

Just like any other working day, Makuluni had returned from work to spend time with his family when a stray dog bit him around Wenela Bus Depot in Blantyre.

The sad end to Makuluni’s life

The journey ended fatally and the family was left devastated by his unexpected death after failing to access medication to save his life.

“When we took him to Chilomoni Health Centre, we were told there were no drugs. We then came to Queens [Queen Elizabeth Central Hospital] and we were also told there were no drugs,” said his wife.

Questions have been asked as to why people continue to lose lives when K25 000 would do from the tax payers’ coffers.

‘Vaccine is available’

Ministry of Health spokesperson Henry Chimbali said the anti-rabies vaccine is available at the Central Medical Stores and wondered why people continue to lose lives when medicine is in stock.

He said it is the responsibility of central and district hospitals to buy the medicines from the Central Medical Stores and dispense it to patients.

Chimbali could not provide details of reported rabies in the country, but said district health offices normally have registers of people with dog bites.

Most cases, he said, are reported in Mulanje and Nsanje.

Blantyre-based private veterinarian Dr Kholiwe Mkandawire is on record as having said she has seen cases of dog bites with suspected rabies from patients coming from Thyolo, Chiradzulu, Mulanje, Chikhwawa, Nsanje, Blantyre and Mzuzu, most of whom, she said, were critical because of drug shortage.

“I have been receiving at least 10 people weekly with dog bites, 50 percent of whom have been certified rabid cases. I have failed to treat them because they cannot afford it, so they are sent home,” she said.

“It is government’s responsibility to control rabies. How many people can afford K25 000?” queried Mkandawire.

‘We are still keen on fighting rabies’

But Dr Ben Chimera, director of Livestock in the Ministry of Agriculture, says government has not relaxed its fight against rabies in the country.

“We are still doing annual rabies week or month free of charge. Then, there are cases whereby we have our team that go and shoot down dogs, so we are still doing that,” said Chimera.

He said his department had an anti-rabies month last year in all districts in the country and 2012 is no exception.

Asked why cases of rabies are on the rise in the country, Chimera clarified that recently there has been a lot of awareness in the media on dog bites, but cases of rabies remain minimal.

“What is on the rise is not rabies at all in terms of figures. Normally, in the past no one reported dog bites. Now when you are bitten by a dog it is in the newspapers, so that is not an increase in terms of (rabies) cases but it is an increase in terms of awareness. It is very good.

“Cases of rabies are very few. What is on the rise is the number of dog bites. We don’t record dog bites as rabies. But as per the World Health Organisation (WHO), one death (resulting from rabies) is an outbreak,” said Chimera.

He said where necessary such as emergency situations, his department conducts campaigns in specific areas to stem the problem.

“To control rabies, human beings must be on the lookout always. The more we talk about it, the more we get reports,” said Chimera.

However, it is common knowledge that most rural public health facilities lack anti-rabies vaccines, a situation that poses further risks to people because stray dogs, some of which could be rabid, are everywhere, moving loosely, roaming about and biting people.

Victims resort to herbs

Sometimes, the victims of dog bites in rural areas usually resort to herbs or traditional medicines since hospitals do not have such medication.

And since all vaccines must be kept under refrigerated conditions because they are live organism, it is difficult for health centres in rural Malawi to stock them due to lack of cooling systems.

Rabies is one of the most dangerous diseases in the world. It is also common in many countries.

Dogs account for more than 90 percent of rabies cases worldwide.

Rabies virus infects the brain and this can result in behavioural change of the victim.

Rabies usually starts with symptoms such as fever, irritability, malaise, insomnia, anorexia, headache, tiredness and sore throat.

Other symptoms are pain and burning or heat in all parts of the body. These symptoms are followed by relentless progression to coma and eventual death, often within 2 to 12 days.

Experts say death is inevitable due to cardio-respiratory failure. When one is bitten by a dog, the first thing is to cleanse the wound or the affected area with clean water and soap, then apply an antiseptic, disinfectant or a spirit containing at least 70 per cent alcoholic content.

This should be followed immediately with the treatment with an effective after-exposure vaccine.

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