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Government hospitals not equipped to deal with rabies.

LAHORE, Aug. 9 -- The government has been unable to check the incidence of the deadly rabies virus in Punjab as there is only one anti-rabies clinic with complete dosage for treatment in the entire province, Daily Times has learnt.

According to a Health Department official, 8,000 patients visit the anti-Rabies clinic annually with 90 percent of the cases caused by dog bites alone. The official said that many people living in the suburbs are still unaware of the "seriousness" of the fatal disease and visit a health establishment only when the "damage has been done". The official further said that government hospitals across Punjab had been provided with only the first vaccination out of a total of five doses, and that doctors referred patients to the rabies centre. The official added that serum was not available for category-3 patients in government facilities. The official further said that the number of rabies patients had increased over the past few years, from 5,000 patients in 2001 to 8,000 reported cases in 2010. Moreover, the official said the vaccination was not available in the District Headquarters (DHQs), Tehsil Headquarters (THQs) and Basic Health Units (BHUs).

The World Health Organisation (WHO) has outlined a three-step protocol to treat rabies patients, including wound management, vaccination and serum injection. Answering a question about the unavailability of serum, the official blamed the high cost of the treatment and the budgetary constraints facing the government.

The on-duty senior medical officer (SMO) at the anti-rabies clinic, Dr Nusrat Nauman, told Daily Times that rabies is an "absolutely neglected" disease and that once the symptoms appear, there is no effective treatment and the patient ultimately dies. Other than dogs, she said, cats, horses, buffaloes, monkeys, bats and wolves can also cause rabies. She said a dog bite should always be reported, the dog should be watched and the incident should be reported to the municipal authorities. She said the patient should be vaccinated as soon as he or she is brought to a medical facility. She further said that the wound should be washed with soap for 15 to 20 minutes, adding that the traditional method of applying turmeric causes further trauma and helps the virus penetrate deeper. She said patients should apply local antiseptic such as pyodine and go to a health facility for vaccination. She said the rabies centre is only for immunisation and not for treatment. Dr Nusrat also explained the symptoms of the disease. First, salivation starts and the patients get fits. They then go into a laryngeal spasm and have difficulty breathing and eating but they remain mentally normal. A patient's saliva contains the virus, she said, adding that rabies patients die because of the fits and spasms. "Rabies is 100 percent lethal and once the symptoms appear, you can only give them [the patients] palliative treatment to reduce pain," she added.

Talking to Daily Times, Health Executive District Officer (EDO) Dr Fayyaz Ranjha said a centre of excellence has been set up in IBH Hospital Bilal Gunj, where the three doses of vaccine had been made available. He said a senior BPS-19 professor was heading the centre. He said that initially, vaccines for 7,000 patients had been made available at the centre, which also had a ventilator, a cardiac monitor and a resuscitation trolley. He said a special ward with 20 nurses and eight MOs had been deputed and an isolation room established for rabies patients. He said the facilities were helpful only in the event of an early diagnosis. He said that once the rabies virus reached the brain, the survival rate, even in medically advanced countries, is only 0.07 percent (7 out of 10,000 patients). He also said a comprehensive plan to kill stray dogs had been implemented to keep a check on further infections.

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Publication:Daily Times (Lahore, Pakistan)
Date:Aug 9, 2010
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