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Rabies: Traveller beware

Tragically, the British woman recently bitten by a dog in India died at the weekend, in hospital. Having been through a course of post-exposure vaccines with my, then 6 year old, daughter last year, I have strong views on the UK’s handling of returning travellers who may have been infected with this potentially fatal disease.

Last year, I was in the position of having unlabelled rabies vaccines in my fridge and having to beg various doctors in the town to give my daughter the injection on the *correct day in the complicated post-exposure timetable. At least one doctor refused. My GP was no help, because the day fell on a Sunday. So much for the Hippocratic Oath.

If you are travelling abroad to an area that has rabies, get yourself informed. You will have to take steps if you are scratched or bitten by a warm-blooded mammal. Don’t rely on anyone else and don’t take any chances, it’s not worth it. Once symptoms develop, as in this grandmother’s tragic case, it’s too late – the vaccine won’t work, death is inevitable.

Personally, I think a new education campaign is well overdue – I still remember the skull posters plastered all over the cross-channel ferries in the 1970s. They may have been a blunt instrument – I thought I would die of fright when a dog came near me – but it gave me a healthy respect for animals abroad. It seems to me that airlines flying to areas that have rabies (many, many places) should inform you, your travel insurance should inform you, your travel agent should tell you (but they won’t because it won’t fit well alongside the glossy brochure description). Being told something ten times too many and being aware of the risks is better than travelling in ignorance.

It is worth remembering that, worldwide, children are the most frequent victims of rabies death, probably because they don’t always report an incident with an animal. My child, thank goodness, mentioned she had been scratched by a cat about three hours after the fact. If this happens to you, or your family, wash the wound immediately and go to a doctor. Don’t panic, because post-exposure vaccines are fully effective. Please though, don’t ignore it. It’s not a chance worth taking.

*The UK Health Protection Agency’s vaccination schedule does not count the days in the same way as other countries. It might be as well to get the regime clear in your head before you go, just in case. Otherwise, you will be like me, and be trying to make sense of the anomaly where some countries count the day of exposure as day 1 and others count it as day 0 – which has a knock on effect for the whole course of injections thereafter.

State Hospital (Marmaris)

Since the recent holiday in Turkey, I have learned the hard way that it is a high risk country for rabies, up there with India or Afghanistan. My children were given the lecture about not touching animals whilst on holiday, but given the outcome of the lecture I now wonder if I should have taught them to be scared to death of all animals abroad, like I was as a kid. My extreme fear back in the day was partly due to watching an Information Film at school of some poor person in the last stage of rabies dying a horrible death; this horror backed up by all those X-ray skull posters they used to plaster on the stairwell walls and car decks of channel ferries in the 1970s.

Anyway, on Easter Sunday during the holiday, due to a combination of happenstance and bad luck (probability taken personally, remember) the youngest daughter was scratched by a street cat. A pretty sick looking street cat with quantities of drool hanging out of its mouth.

And so it was we visited this hospital on Sunday, Monday and Tuesday whilst away. Easter Sunday for the first rabies vaccine, the second day for reasons that are still unclear but involved a policeman carrying a gun telling us that we should return the following day. Then we went again on Tuesday because, according the UK Public Health Agency, we should be getting another rabies shot that day. It transpired that, in fact, the shot was not due until Wednesday (that is a Letter of Complaint waiting to be written).

Please note dear blog reader that I could now go into a lengthy, confusing and LOUD rap about all the shortcomings of how the UK handled this whole deal and how I have had to fight, whilst containing my ferocious temper, to get my daughter’s subsequent vaccines administered in the UK on a Sunday but I don’t think you need to know about the vagaries of days 0 and 1 in the schedule or indeed how I… Anyway, I am sparing you all that. For now.

So we became fairly closely acquainted with The State Hospital Marmaris. In Turkey there do not seem to be appointments. Everyone waits in the corridor. Then when they have had enough of that they get up and try the doors to the consulting and treatment rooms. If a door is found to be unlocked, everyone piles into the room waving their paperwork. Then everyone is shooed out again, apart from one lucky patient. It is all quite good humoured, mixed with a little resignation perhaps.

This was the tea tent. We tried to make a day of it.