Bitten by dog

Here's one more article by AV Ramani, a doctor I know who spent several years working in rural MP (now Chhatisgarh) and Orissa. (Previous ones: Death in the dispensary and This one child).

***
Bitten By Dog, Bitten By Man
AV Ramani

One evening in March, Somaru was brought to the dispensary in Bhainswar, in the western part of Surguja district in (then) Madhya Pradesh. As was usual among the Gonds in this area of MP, Somaru had married early and at 17 was the father of a six-month-old baby. A gentle, well-built lad, he had been learning irrigation techniques from Father Alex who lived opposite the dispensary.

Now, he was quite unrecognizable: a wide-eyed, desperate boy, babbling incoherently, clutching at Father Alex's arm and asking repeatedly for water to quench his thirst.

Five months ago, on Diwali night, Somaru was bitten by a dog on his right ankle. The wound took weeks to heal. As the dog had been stoned to death immediately, there was no way of telling whether or not it was rabid. Somaru paid no heed to our pleas to get vaccinated against rabies at the Primary Health Centre in Sonhat. We worried too much, he said. Besides, he did not want to cycle 13 km through the forest to the PHC for any injections.

As the wound healed, Somaru resumed work, tending his field. Exciting things were happening in Bhainswar. For the first time, the villagers were growing a winter crop of wheat, thanks to the irrigation system they had devised which lifted water from the river that flowed past the village. Somaru had no time to worry about his ankle.

All of a sudden, he had begun to feel feverish and could not swallow water.

The evening wore on. I watched over him in the fading light with a feeling of helplessness. I knew Somaru had contracted rabies. He was, quite literally, beyond help. Nothing anyone could do would save him.

Somaru talked incessantly, begging Father Alex to save him, crying out in fear that he did not want to die. Again and again he asked for water and when we did give him some, he spat it out and turned violent.

Father Alex and I explained to Somaru's relatives that he had a serious disease and would probably die within a few days. We advised them to take him home and keep him quiet, warning them that he could turn violent. They could not accept this. How could a five-month-old dog bite cause this madness? Besides, the wound had healed completely, and he had been perfectly well till just two days ago. "He is possessed by spirits," they said.

While two of the younger men borrowed the dispensary jeep and drove 80 km into the jungles to fetch a vaid (traditional healer), Somaru's family carried him home and kept an all night vigil, chanting and praying while he tossed in his tragic delirium. By morning, Somaru's in-laws and other relatives from the surrounding villages had arrived and joined in the prayers. Then the vaid came in, took one look at poor Somaru and declared that this was not a devil he could exorcise.

Somaru died late that evening, 24 hours after he had been brought to the dispensary, in an agony of fear and thirst. When we heard the news, a wave of relief washed over me. No one should ever die such a death, and at least it was over for Somaru.

Just then, his uncle and father rushed into the dispensary, fear writ large on their faces. Somaru was very violent just before he died and when they tried to restrain him, he had bitten them both. His father and uncle, I realized, were also possibly infected.

Father Alex and I went to Sonhat to get the rabies vaccine from the PHC and bring it to Bhainswar where the nurse could administer it to the two men. This would save them from having to find a place to stay in Sonhat until they completed the course of vaccination. The vaccine available in the market cost nearly Rs 300 a dose, and the villagers could not afford that. Only the subsidised vaccine from the PHC was within their reach.

There was no vaccine available at the Sonhat PHC, so we drove a further 40 km to Baikunthpur, a large mining town. Here we were informed that the only anti-rabies serum available was at the district headquarters, Ambikapur.

Three hours and 120 km later, we were at Ambikapur. There, the district hospital authorities told us that they had no vaccine and it had to be obtained from Indore, nearly 750 km away!

In despair, we went to see the collector. Not that he could do anything, but we wanted to tell him what had happened. He was extremely sympathetic, got in touch with the hospital authorities and asked them to send someone to Indore right away to get the vaccine. He also told them to hand it over to Father Alex for transportation to Bhainswar. If the vaccine did not arrive in a few days, he told us, he would sanction funds to buy it in the market.

Over the next ten days, Father Alex returned three times to Ambikapur, to the district hospital. Each time, there was no vaccine. Finally, he went back to the collector only to find that he had been transferred out of the district. Eventually, we spent nearly Rs 1800 each on Somaru's father and uncle for a full course of the rabies vaccine. I am happy and relieved to report that both are well.

Some weeks later, Father Alex happened to be at the Sonhat PHC and found it stocked with the rabies vaccine, supplied from the district headquarters.

"It is always available at Ambikapur," he was told. "But how did you hope to get it without bribing someone at the hospital?"