Boys should not die because of dog bites

Published: June 3, 2011
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Rabies damages the central nervous system which includes the brain and spinal cord.

To see your patient succumb to his last few breaths, while you stand helplessly facing the family is indeed the most testing time for a physician, especially when the patient is a 10-year-old playful child who you have known personally. I recently had the tragic experience of dealing with such a situation.

Helpless as we were, we could not reverse the symptoms of Rabies, a deadly virus which is contracted through a rabid animal contact (zoonotic disease). My 10-year-old patient was bitten by a rabid dog 25 days ago while walking home from school. The unprovoked attack is typical of this condition in infected animals. The dog went on to bite another friend (who survived without contracting the lethal virus) and a few other domestic animals before it disappeared. The tragedy of this incident lies in the fact that it happened in a metropolitan city, and while most children who fortunately receive the vaccine and immunoglobulin survive, my patient did not.

Even more saddening is the fact that this patient reported to the Anti Rabies clinic at Civil Hospital Karachi on the day of the bite and was treated appropriately. He was given the timely vaccine doses at first, third, seventh, and fourteenth days. But on the 26th day, he started having lower limb weakness and paralysis and slight hydrophobia, increasing irritability, anxiety and hallucinations. And even though we admitted him and observed and treated his symptoms, we could not save him. He died of respiratory failure on the 28th night post exposure.

A painful, unnecessary death

Rabies has one of the highest mortality rates. The virus damages the central nervous system which includes the brain and spinal cord. It is described as one of the most painful deaths, especially because of the hydrophobia – forceful, painful spasms of the muscles of the throat that expel liquids taken orally. The purpose of writing these few words is to ask this question:

1. Who should be blamed for the cause of my patient’s death?

2. Is human life in our country worth a dog’s bite?

People die in natural calamities and terminal diseases, and there is consolation to the family that at least, it was not preventable, but how would a child’s parents deal with the cause of his death being a dog bite – which is absolutely preventable, only if the necessary departments do their jobs.

Taking responsibility

According to my knowledge, it is the job of the Karachi Municipal Corporation (KMC) to get rid of stray dogs. This department is clearly not delivering. The statistics at the Anti Rabies Clinic at the Civil Hospital refutes the claim by any government body that is working to get rid of the stray animals.

I lost a young bright boy; many have been lost before and all these deaths could have been prevented if the stray dogs were eliminated from residential areas of Karachi.

I would request the relevant departments to please perform their duties, not just to complete the work hours, but with a little regard to saving lives and helping humans. A little effort on your side can help save a life.

Humanity is a very rare quality in our population. The value of human life is at its lowest ebb. But if we do not deal with our issues, then who will? We can be assured that no NGO or foreign aid will come to our rescue, especially in the current circumstances.

We should wake up before human life becomes worthless.

Jahanzeb Effendi

Dr Jahanzeb Effendi

A young doctor, First Responder and Co-founder of First Response Initiative of Pakistan, FRIP. Training the general public to become first responders. Aspires to be a Cardiac Transplant Surgeon and build Pakistan's first Organ Sharing Network. Believes in writing for change. He tweets as @Jahanzebeffendi (twitter.com/Jahanzebeffendi)

The views expressed by the writer and the reader comments do not necessarily reflect the views and policies of The Express Tribune.

  • Omar

    This issue definitely needs to be taken more seriously and dealt with.
    Nice posting!Recommend

  • http://afisays.blog.com Norwegian Pakistani

    This is so unfortunate. Is it so hard to keep the dogs off the street? If KMC is not doing their job properly it is important that people in their communities get together and do something about it. This can be controlled! Recommend

  • http://Karachi Anwar

    We Do not have the “KMC” department anymore.Recommend

  • Atif Siddiqui

    This is sad and distressing. I never knew rabies could kill. How come the vaccine failed? Recommend

  • http://fruitforbidden.wordpress.com The Forbidden Fruit

    I nearly cried reading this! Yes, a Pakistani’s life is more worthless than a dog’s because dogs don’t get robbed and shot, they aren’t blown up either. My heart goes out to the little boy’s family. Why can’t they just export all stray dogs to China??Recommend

  • Phatty

    @The Forbidden Fruit:
    How would exporting them to China help? :/Recommend

  • parvez

    Reading articles like this is depressing to say the least. Knowing that no one will be held accountable just makes it worse. Thank you for sharing this story. Recommend

  • http://habloid.wordpress.com Habiba Younis

    extremely tragic!!! feeling sorry for the kid and his family….Recommend

  • nafisa

    Reading articles like this one is indeed refreshing.Especially since its devoid of the usual conspiracy theories. We should concentrate on the things we can change regardless of how meaningless it means to a few.
    ” God grant me the serenity to accept the things i can not change, Courage to change the things i can and the wisdom to know the difference”Recommend

  • Jahanzeb

    Thank you all for the encouraging remarks.

    The vaccine and Immunoglobulin failed to work although it was given to the child. His immune system was weak too and again there are multiple reasons why Rabies could not be stopped in this patient.

    Point is, Primary Prevention should be taken in such cases. The elimination of stray animals is the best way forward ( and not sending them to China.. I am sure they deal with many of their own.)
    If KMC is not there anymore then there must be some other Govt. body looking after this issue. I am trying to raise this issue on all forums, including the Local bodies, Governor Sind etc. If any of you find information on a forum that may be helpful to this cause, do feel free to post this piece. Maybe somewhere some ‘high-ups’ will realize their jobs.

    Sincerely,
    Jahanzeb.Recommend

  • Iqbal Khan

    One way to handle chronic situations like these ie “Stray animals’ and potentially Rabid animals would be to plan and form a group whose purpose is only the program for which the group was formed.
    The ‘group’ or the ‘association’ can achieve its target by concentrating on the project and involve likeminded people.
    If one can start from their own neighborhood and expand with the help of people the problem may be controlled.
    Education for people and effort from the ‘group’ would be necessary.
    Of course City officials could be a help in facilitating this.
    Pictures taken by citizens of stray animals in thier neighborhood could be a starting point.
    I took pictures of a stray dog in our neighborhood in Houston suburbs in 1998 (which was a new development and had open land) and kept eyes open but the animal disappeared eventaully but my next option was to inform neighbors and local city officials.
    Owners of pet animals should cooperate also and should know their pets can contract disease if left raoming around.
    The story is very sad and tragic and irreplaceable loss for the family
    Jehanzeb has touched on a common problem for which we did not do anything (prevention) when I was there but had seen cases like these in ‘Isolation’ ward of CHK.
    May Allah bless the kid and the family

    Iqbal Khan,MDRecommend

  • http://Karachi Anwar

    The reason this child died is probably because the vaccine or the immunoglobulin were fake. Pakistan is one of th few countries with rampant use of fake medicines for life threatening diseases.. Recommend

  • Jahanzeb

    That is indeed a very good starting point for prevention of potentially lethal disease. To start from the locality and neighborhood where these animals are sighted and then reporting.

    I am raising this issue at the level of the City District Govt Karachi. If they have a group with a helpline where people can report rabid and potentially rabid animals, then things can change for the citizens.

    Thank you for your suggestions Dr. Khan, they will help us shape a ‘diagnosis and treatment’ – prevention in essence for the future.

    Sincerely,
    Jahanzeb.Recommend

  • Jahanzeb

    Anwar,

    I agree with the possibility of the Immunoglobulin not being potent or the vaccine being used had a cold chain break. I did go to the anti Rabies unit in Civil Hosp. Karachi and had an inspection of all their vaccines. None were expired and the protocols being followed were at par with the WHO protocols. The fact is that we have treated 27000 cases of dog, jackal, fox etc bites at the clinic and the treatment failure rate is very low, this being the 2nd case who got all the vaccines and IGs on time and yet did not make it.

    Anyway, my focus was more on primary prevention because it is something that will affect more people. Treating again has its own drawbacks, but being protected from the rabid animal bite should be our primary goal.

    thank you for your comment.Recommend

  • Nabeha

    This is so scary. My 5 years cousin just got bitten by a dog in Karachi, and he is still under observation. I don’t know why your government don’t take responsibility for such things because this is not something which should be ignored. Karachi is the hub of Pakistan, free it from dogs as there is not enough place for humans to live there Recommend

  • Faria Syed

    @Nabeha
    Prayers for your cousin.

    Recommend

  • Jahanzeb

    Nabeha,

    I suggest you take your cousin to a private hospital and get the complete set of vaccine and IGs, do not miss a day. Observe the child for symptoms. Recommend

  • Farrukh Abdi

    Jahanzeb !
    you are very right in saying that Primary precautions must be taken first ,treatment comes later,
    If Government bodies do not do anything to prevent dog bites ,then as a citizen we all should form a community to take preventive measure and fight against dog bites incidents , tomorrow he could be our own child ,its not just mere saying , if any body has some idea to form community and its modalities then he /she can share with me ,I offer my services to prevent dog bites.
    Jahanzeb ! you are doing a wonder full job ,I m sure that if we such youngsters in our nation ,then one day we will come up as exemplary nation on the globe.
    Well Done and Keep it up !Recommend

  • Rafat Hussain Farooqui

    Amazing article. i wish you success in your mission.Recommend