Killer rabid dogs on the prowl

Just like any other person from his village, Lewis Harry woke up cheerfully on April 4 2019 and went on to do the job that was putting bread on his table—charcoal business.

For the 43-year-old, this was just another day.

As he walked home, that afternoon, a stray dog lunged out of the dense bush and bit him on the crus. But with blood oozing ceaselessly from the open wound, Harry limped back home. 

“He told me a stray dog had bitten him and asked me to buy kachasu and soap to wash his wound while waiting to visit the hospital for rabies treatment the following morning,” recalled Harry’s widow, Regina, in an interview last week.

The following day, Harry and his wife sought anti-rabies medication at Mdeka Health Centre in Blantyre, but they were told there were no drugs.

He was referred to Queen Elizabeth Central Hospital (Qech), from where he was further told to go to the Gateway Clinic under the Blantyre District Health Office (DHO).

“Unfortunately, it was the same narrative at all hospitals—no drugs for him. We went to Gateway Clinic on two occasions, but to no avail,” explained Regina.

The family’s efforts to try nearby health facilities, Changa Health Centre and Lisungwi Community Hospital in Neno, yielded nothing as they did not get any help either.

After failing to access PEP, and languishing at his matrimonial home—Mwasiya Village, Traditional Authority (T/A) Chigaru, Blantyre—Harry started exhibiting signs of the disease—excessive salivation, hydrophobia, hallucinations and agitation, among others.

He became extremely fatigued and was admitted to Qech on June 30 2019. However, since treatment had become ineffective, he died two days later.

The late Harry’s case is just one of the many untold miseries that rabies patients endure and succumb to.

Rabies is a viral disease transmitted mainly by a bite and exposure of saliva from an infected animal, generally dogs and cats.  It is preventable, thanks to the rabies vaccine that can be administered before or after the bite.

According to neurologist associate professor Macpherson Mallewa of College of Medicine (CoM), a constituent college of the University of Malawi (Unima), rabies incubation period may take few days or weeks, depending on the site of bite and in unvaccinated humans, the disease is fatal and once signs begin to show there is no cure.

“Rabies is a very serious public health problem in Malawi, mainly because death is 100 percent in those with infection. Once a patient starts to show features of rabies infection, death follows within two to three days, rarely one week,” he said.

When a person is bitten by a suspected rabid dog, he or she is given post-exposure prophylaxis (PEP). This is an immediate treatment of a bite victim as it prevents virus entry into the central nervous system where it ravages the brain and spinal cord resulting in imminent death. 

According to information Weekend Nation has gathered, the day Gateway Clinic failed to treat Harry, the facility had just received 50 dosages (250 vials) on March 28 2019—eight days earlier. Could they all have been used?

Speaking on condition of anonymity, a nurse technician at Qech confirmed that the hospital is recording a rise in number of deaths caused by rabies.

“The vaccination that is supposed to be administered after the bite is usually out of stock. So, rabies patients are admitted here, naturally just to die,” lamented the nurse.

But the vaccine is available in pharmacies and private clinics. Those with money procure it but many are less fortunate, they cannot afford the prohibitive out-of-pocket cost.

Weekend Nation spot check shows that a dosage costs over K100 000. According to the World Bank, an ordinary Malawian lives on about $1.60 (about K1 200), meaning that most Malawians cannot afford the vaccine.

Ministry of Health spokesperson Joshua Malango said the anti-rabies vaccine was one of the essential drugs and hardly runs out of stock.

According to him, government spends in excess of K150 000 to treat a single patient.

But commenting on the late Harry’s incident, Malawi Health Equity Network (Mhen) executive director George Jobe wondered why he could not be helped and queried the facility why it did not refer him to another hospital.

“We are saddened that a life was lost. This case shows system failure if, indeed, Blantyre DHO had the vaccine, but turned away the patient who needed help,” said Jobe.

According to reliable sources, public referral hospitals such as Qech have a Service Level Agreement with some private hospitals, where patients who cannot be assisted at the referral facilities are referred to for treatment.

Speaking to Weekend Nation during Harry’s burial at Sumbuleta Village, at Mdeka in Blantyre, his uncle Petro Grant, who was the guardian at the hospital until his death, said poverty killed his nephew.

“Our relation died because of his status. If we had money we could have saved his life,” lamented Grant.

Harry’s demise has left the future of Regina, a house wife, and her five children grim, as he was the family’s sole breadwinner.

“I still think of how my husband was treated and died. It pains and always gives me fear that these health facilities are not for the poor,” said Regina, fighting back tears.

In an interview, Qech acting hospital director Samson Mndolo said as a referral facility, the hospital does not stock anti-rabies vaccines because they are primary healthcare medicines, supposed to be administered by health centres through DHOs.

Mndolo explained that rabies patients are only referred to Qech once the disease has fully developed and the patients are put on palliative care waiting for their time.

But without directly referring to Harry’s case, director of health and social services for Blantyre District Council Gift Kawalazira, confessed that in some cases the district operates without anti-rabies vaccine.

“Over the past 12 months there were, indeed, been instances when we did not have the vaccine, mainly because CMST [Central Medical Stores Trust] run out of stock. Cumulatively, the number of days without the commodity was less than 60,” he said in a written response.

However, CMST public relations officer Hebert Chandilanga, in an e-mail response, argued that the trust supplies medicines upon receipt of an order and stocks a minimum of six months and a maximum of 12 months stock of anti-rabies vaccine.