BENGALURU: Twenty-six-year-old Praveen’s eyes are feverish and wild as he hyperventilates on a hospital bed. As his words tumble out in a breathless babble, he explains to a doctor that months earlier, a three-month-old puppy had bitten his leg. Showing the scars, the youth says he was given injections at that time by a local doctor.
He tries hard to drink water, but screams at the very sight of it. Tormented by thirst, he brings it to his lips again and again, only to convulse and gag at the last moment. Lying alone in a dark room of Isolation Hospital in Bengaluru, Praveen pleads for the lights to be switched off, as they hurt his eyes. It’s a horrible sight for his family, as they watch him suffer. The hospital staff knows there is nothing they can do now. A few hours later, Praveen passes away.
This was the recent case of a youth from Ballari dying of rabies on January 1, after he developed the symptoms, strangely, eight months after being bitten. Dr Ramesh Masti said, "Rabies is a unique horror among diseases, yet, it is surprisingly common. Though the death rate, according to WHO, has come down from 20,000 in India, several cases go unreported or undiagnosed due to a lack of basic knowledge about rabies prevention, and many a time, with no facilities."
A team of researchers lead by Dr MK Sudarshan, founder and president APCRI and former Dean of KIMS, Bengaluru found that facilities for facilities for washing wounds and antiseptics -- a critical first step in treating animal bites -- were inadequate in at least 19 of 35 clinics assessed. The results of the survey, funded by the World Health Organisation’s India office, were published in a health journal in October 2019.
The team collected samples from 27 government and 8 private anti-rabies clinics in Bengal, Bihar, Gujarat, Himachal Pradesh, Kerala, Madhya Pradesh and Manipur. The team found that the anti-viral, Rabies Immunoglobulin (RIG) for local wound infiltration was available at only 19 of the 35 anti-rabies clinics sampled.
There are many primary healthcare centres in Karnataka too, where the staff lacks knowledge on how to administer the vaccine, even if it is available, say doctors. In Praveen’s case too, doctors were surprised to see the symptoms of rabies develop eight months after the bite, which experts say, is rare.
Explaining that there are many people who are either misguided by doctors or don’t know what to do, Dr Masti said that sadly, the standard protocol for rabies treatment requires that wounds be washed with water and soap, or detergent for several minutes, followed by a local injection of the anti-viral rabies immunoglobulin (RIG) directly into the bite wound.
After this, patients need to take a course of anti-rabies vaccines for local wound infiltration. In many cases, rural hospitals just give tetanus (TT) injection and call it a vaccine, while patients remain ignorant.
Though there is no shortage in RIG in Karnataka, injecting it is a messy procedure, he explained. "In case of local infiltration of RIG, the substance has to be injected using small syringes into and around the bite wounds. Many doctors fail to and give it in the hip area instead of intramuscular. This does not have any impact. If done properly, rabies is a preventable disease," Dr Masti said.
Praveen’s family feels he too may have been given a tetanus shot instead of a vaccine.Dr Ansar Ahmed, District Surgeon and Medical Superintendent, Isolation Hospital, said in many cases, especially people from rural areas, resort to home remedies or the curative powers of faith healers and shrines. “They eventually make it to hospital, but by then it’s too late. The virus spreads through the nervous systems to the brain. It is invariably fatal,” he said. There have been efforts by WHO to ensure India is rabies-free by 2030.
WHAT TO DO IF A DOG BITES YOU
Do not apply limestone, coffee powder, ekke halu (white aak) plant liquid, cow dung on the wound
Do not tie a cloth or bandage above the bite
Wash the wound with soap under running water for 15 minutes
Apply antiseptic solution and see a doctor immediately
Take anti-rabies vaccine and injectable solution of Immunoglobulin on the wound to complete the course, which has four to five doses, even if the wound heals
Do not consume alcohol while on medication