Chipata Cujo

Written By: The Lowdown - Jun• 29•13

front cover small“Oh…unfortunately, we don’t have the rabies immunoglobulin at our chemist.” These were words I didn’t want to hear after being bitten by a rabid dog and twelve hours of frantic travel by road and air to get to a clinic that had told me it WAS available.

On January 19, the sun had just risen over Chipata, it was 6.30 am and I was just about to finish my early morning power walk. The light was gorgeous on the maize fields, birds were chirping, the previous night’s rain was still dripping from the leaves. My husband Dale had just finished his morning jog and had passed through the yard gate … I was plodding along about 30 feet away, thinking about a nice cup of fresh brewed coffee when …

Suddenly, I felt a sharp pain on my upper left thigh. I looked down and saw a village dog savagely biting down on my thigh in a death grip. I shouted at it and reached down to pry its jaws open to release me. The dog, a skinny brindled mongrel was growling while I opened its jaws and when it released me, I kicked it away, tearing open a big hole in my shorts. It snarled and barked at me and then launched another attack, biting me a few inches lower on my thigh. I kicked it off and luckily, it trotted away as I walked to the safety of our gate. I looked down at my shorts and saw the bleeding wound … OH MY GOD! RABIES! I’ve been bitten by CUJO.

Mr Ngoma, our night watchman, was preparing to leave his night shift when he heard me shouting. When I reached the gate, Mr Ngoma decided to confront the dog and before I could stop him, he started chucking stones at it. Cujo then turned his fury upon Mr Ngoma and in horror, Dale and I watched the two battle each other with the man trying to throttle the dog and receiving a nasty bite on his hand. Mr Ngoma finally got a firm grip on the dog’s neck, carried it over to the brick wall and bashed its head against the bricks until it went limp. Dale ran to get a shovel to break its neck but just like in a horror flick, Cujo suddenly leaped to his feet and took off down the road.

Rabies! Rabies! Rabies! These were the only thoughts flashing in my mind as I cleaned my wounds and disinfected them with Savlon. I tried to squeeze more blood from the wounds but I knew that I was in serious trouble. About three years ago, I had another rabies scare from a bite by a baby squirrel. That experience had taught me that what I needed more than anything else was 5 ml of rabies immunoglobulin (RIG) and that none would be available in Zambia and to make things worse, I needed to be injected with RIG within 24 hours of being bitten.

I called a veterinarian friend of mine and asked about RIG … she told me there was nothing in Zambia or Malawi and I could only get it in South Africa. I then quickly checked airline tickets to Joburg … next available flight was out of Lusaka at 1.20 pm. (A red digital clock started counting down in the back of my mind.) Mr Ngoma had no passport and would not be able to travel to S.A. so we made sure his bite wounds were cleaned and gave him money for a taxi and meds then instructed him to get to Chipata General Hospital to start a rabies vaccine series. Rabies vaccine is readily available in Zambia and is a good preventative but after being exposed, it is not a 100% guarantee to stop the virus from taking hold. RIG was what was needed. To catch the 1.20 pm flight, we could not waste a single minute. We frantically raced around the house, handing over to our housekeeper, got passports and cash and by 7.15 am, Dale and I were speeding down the road to Lusaka. Dale normally drives fast but on this morning he became a Formula One driver. Our average travel time from Chipata to Lusaka was about six and a half hours but Dale’s goal was to do it in five hours and get us to the airport by 12.30 pm. So after a quick fuel stop … we were OFF, averaging about 140 kph! Lusaka International Airport was a long 567 kilometres away.

During that five hour frantic drive, we were on the phone to various people who could help us get to South Africa. Tickets were organised and a diplomat friend offered to meet us at Lusaka airport to expedite immigration and check in. A veterinarian friend recommended that I start the rabies vaccine series as well as getting the RIG and offered to meet me on the road to the airport and administer the first injection of rabies vaccine. Another person found a clinic in Johannesburg that had the RIG and arranged for someone to meet us and take us there. Now, all we had to do was get to the airport before the plane departed.

There was not much traffic on the road that Saturday morning … we didn’t hit any goats or pigs but we did pass a few lorries on blind corners … YIKES! We stopped for all road traffic roadblocks but the tsetse control gate … SCREW THAT! and went completely around it. No time to stop to go pee with every minute needed to get us closer to Lusaka. But I remembered a trick I learned on a boat. I found a plastic water bottle, cut the top off and helped Dale fill up the bottle, his hands being preoccupied with speeding down the road. My situation was a wee bit more complicated but I managed to make a deposit and all was tossed out the window. No time for pit stops! We flew over the speed bumps and pot holes but for the most part, the five hour drive was uneventful except for the long periods of silences … the two of us deep in thought … the red digital clock in my head ticking away the minutes.

As we approached Lusaka, I estimated that we would probably arrive forty minutes before departure. Parking the vehicle at the long term parking area would waste valuable time so we arranged for someone to meet us at the parking area and we would just jump out and hand over the keys. My vet friend agreed to meet us on the road before the first security road block to the airport and our timing was perfect. We met, hugged each other, got my injection, jumped back into the vehicle and raced to the airport. Tick, tick, tick … we were five minutes behind schedule. There was a bit of panic when the automated parking meter stall had a sign posted on it …OUT OF ORDER. Couldn’t they display the sign BEFORE you entered the stall!? We had to back up to get into the aisle of the one that that did work. Where’s Lance? Where’s Lance? OH … there he is! Lance handed us the air tickets and we handed over our car keys … tick tick tick. We raced to the security stall and the man at the Airport security looked at our tickets and said, “Sorry, its 20 minutes to departure …you are too late”. AHHHHHH!!!!! But before we could perform a public freak out, our diplomat friend met us, flashed his security badge and INSISTED on getting us thru. A few words spoken loudly and we were allowed to enter … check in … no checked luggage … immigration … and we were escorted to the plane where the other passengers were just being loaded aboard. Whew, we made it!

A two hour flight allowed us some badly needed downtime. It was a miserable wet rainy day in Joburg but we got thru immigration and customs without a glitch and were pleased to find a person waiting for us at Arrivals. Before we knew it, we were on our way to the clinic. Things were looking up.

The ARWYP clinic was very impressive … clean, computerised administration, helpful staff. I checked in and waited some minutes to be seen by a physician … tick, tick, tick. I finally got to see a nurse who asked lots of questions and gave me a tetanus shot … but Dale and I were starting to get a nervous feeling about the place … no one was mentioning that they had RIG. Eventually, I got to see a doctor, nice confident young man who looked at my wounds and asked a few questions. I couldn’t wait and had to ask THE question that had been bouncing around my mind ever since I arrived …”You do have rabies immunoglobulin in stock.” The doctor stopped, thought carefully for a second and said, “Hmm … let me go check the chemist.” CHECK THE CHEMIST?!!! We had specifically asked the clinic if they had RIG and they confirmed and said they would be expecting me. I felt my stomach ball up … Oh no … they don’t have it! Dale went with the doctor and a few minutes later it was confirmed … they DID NOT have RIG after all! OH MY GOD! I was doomed!

As Dale left to go pester the chemist, the doctor told me that they could look for another source for the RIG … or I could just have a “leap of faith” and hope for the best. F*** the leap of faith! I NEED RIG!! Of course, I did not say that exactly, but I did express my intense desire to find another source of RIG. Happily, Dale returned and announced that the chemist found another source about 25 kms away and he and the driver set off to collect it.

The problem with RIG availability is that Joburg hospitals have little need to keep it in stock because the city has very strict rabies vaccination rules and rabies cases are rare. Most of the RIG supplies are sent out to rural areas where rabies is more prevalent. In Zambia I heard that RIG was not available because it’s too expensive and had a short shelf life but that meant that an unknown number of people must die of rabies each year. It’s criminal that hospitals and even high end clinics do not keep RIG in their stores.

After a LONG one and half hour wait, Dale returned with the RIG on ice and I FINALLY got the injections I needed … well within the 24 hours after the attack … the red digital clock in my head gratefully shut off.

When things finally calmed down and I did some more research … I learned that I actually could have received RIG up to 10 days after being bitten but the sooner it is administered the better. Also in my favour was my previous vaccination against rabies was only three years previously which was still effective. I completed the four rabies vaccine shots which are no longer injected into the abdomen, just the arm. I talked to a doctor in Lusaka about my ordeal and questioned him about rabies. He says that there were cases of rabies breaking thru even if the patient had previous vaccinations and had received the RIG, but he says that those were very rare incidents … I sure hope so.

As for Mr Ngoma, he seems to be fine and I am praying that the rabies vaccines work and he dodges the virus. And Cujo? After he bit me and Mr Ngoma, Cujo ran down the road and bit a neighbor’s dog and a donkey and was never seen again, probably dying within a few days but who knows how many more people or dogs he bit. My neighbor’s dog was vaccinated and survived but the donkey died two months later of rabies. The virus marches on.

My final advice, if you want to be safe from rabies … get the rabies vaccine shots which are available in most clinics and chemists, are not expensive and don’t hurt. If you do get bitten by a rabid dog start the rabies vaccine series and call AWRYP in Johannesburg(+27 (0)11 922-1000) and tell them you need Rabies Immunoglobulin shots and ask them to please check their chemist to make sure it is available before making the trip down. They are reluctant to give out RIG unless you can convince them it is a bonafide rabies case, getting nipped by your Jack Russell just won’t do. Then get your body to SA as fast as possible and … GOOD LUCK!

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