CASE STUDIES
Living with Rabies in Rural Africa
The following case histories have been compiled from recent research, led by the University of Edinburgh, on the impact and control of rabies in Tanzania. Sources: Flying medical service, Arusha, Tanzania (1), Katie Hampson, Princeton University (2,5,6,7) Magai Kaare, Ministry of Livestock Development, Tanzania (3,4)
Please be aware that some of this information is of a disturbing nature.
(1) An 11 year old girl carrying water with her aunt in rural Tanzania was pounced upon by a rabid hyena. The aunt tried to pull the hyena away, and suffered a wound at the shoulder. A Maasai warrior killed the hyena with a spear and took the girl to the Wasso hospital. The 3 very experienced doctors who received her were horrified at the extent of her injuries, one even prayed that she would die quickly to be out of pain. The hyena had ripped open her face and throat, she could see nothing and felt only pain. With her head totally wrapped up, breathing through a tube and her pulse racing, she was transferred by air ambulance across the border to Nairobi in Kenya. Surgeons worked from 5pm to 2am to reconstruct her face and neck. Astonishingly, she survived this ordeal, and further operations to reconstruct her jaw and skull with titanium plates. Post-exposure rabies prophylaxis treatment was administered in time and saved her life. She can now talk, see and has recently married.
(2) L's 5 year old granddaughter was herding cattle near the mountain top in late November 2003 when she was bitten on the ear and scratched on the head by an unknown dog. She went to the dispensary in Sale and then to the dispensary in Malambo where she was referred to the district hospital in Wasso, some distance away. However, the wound had healed by then, so she didn't go. Two and a half to three weeks after the bite she started to show symptoms of rabies and so was taken directly to Wasso. This was more than 6 hours by car, and it is unusual for more than one car to pass through the village in a day. Unfortunately, by this time it was too late. She died in late December 2003.3.
(3) EM, a 10 year old female primary school student from Kijima village in the Mwanza region, lives in a mud and grass thatched house. The household has a total of 8 people and spends US$ 18.5 per month on expenses. EM was bitten by an unknown suspected rabid dog on the head and ribs on the morning of 03/02/03, while on her way to school. The bite wound was not washed at the time, and the girl reported to the district hospital 5 days later. The delay was because she had to wait until her father had sold one of his three cows to get money for post exposure prophylaxis treatment, accommodation and the bus fare. The money raised from selling the cow was not enough to meet all the costs, so she received only 2injections of anti-rabies vaccine. She could not attend school for a week, but at the time of the interview she was doing well and attending school as usual.
(4) MM is a 30 year-old married man from Kemange village in the Mara region of Tanzania. He is a farmer with a family of 5 and a monthly household expenditure of $32.40. He was bitten on his leg by an unknown, suspected rabid dog at his homestead. He reported to the district hospital the next day for post exposure prophylaxis treatment, but didn't receive it because he did not have the $23 the hospital staff demanded he pay for the first injection. He went back home to try and borrow money. After 3 days, he had enough money and went back to the district hospital for treatment. He could not get the treatment again, this time the vaccine was out of stock. Friends advised him to travel to Kenya, a neighbouring country, for treatment. He went back home and borrowed more money to pay for the travel costs. He managed to get enough money and travelled to Kenya where he got his first injection (10 days after the bite) at a cost of $13.8 per dose. To avoid going back to Kenya he also bought a thermos flask at a cost of $ 3.70and 2 more doses of the vaccine, which he stored in the thermos flask with some ice he got from a pharmacy where he bought the vaccine. He was doing well at the time of this interview.
(5) JG's mother tearfully relayed the following story. At 9pm one evening in May 2002, JG, an 11 year old boy was playing outside his house, when she heard him cry out and went to see what had happened. He said he had been bitten on the right thigh by a dog and so she took him to the local dispensary. The nurse there said that he didn't need any treatment because he had no obvious wounds, and that he should go to school. Two weeks later he started to get headaches but the tablets that they bought from the dispensary didn't help. After 3 weeks he developed skin rashes and would ache whilst he was sleeping. He wasn't able to sleep properly and developed nervous symptoms, screaming out whenever somebody touched him. On the fourth day of these symptoms she took him to hospital where he was admitted but he died of rabies later that evening. The same dog had bitten two other childrenas well as other dogs. Both children received post exposure prophylaxis.
(6) MM, an 8 year old girl was bitten on her hand by a dog on her way home from school around midday on the 21st July 2004. The owner of the dog showed the girl's father and the doctor at the local dispensary the vaccination card of a dog which had been vaccinated against rabies. Therefore the doctor did not agree to vaccinate the girl because he believed the dog could not have had rabies. MM developed symptoms of rabies on the 20th of August and died on the 25th. Before dying, she bit her father causing deep wounds on his left shoulder and onto his back, and on his left forearm, wrist and hand. The dog owner later admitted that the vaccination card was from another dog, and the dog which bit MM had not been vaccinated. He said he had only acquired the 2 year old male dog which bit MM in June 04. After the injury, he didn't kill the dog, it actually disappeared and we therefore presume it died of rabies. The dog owner had not wanted to pay for the adminstration of post exposure prophylaxis which at that time would have cost around 30,000 Tanzanian shillings (around $30). He later paid for the father's post exposure prophylaxis.
(7) JS's dog, a 3 year old female, developed signs of rabies in late August 2004 and its own 3 month old puppy and one of JS's goats. The family didn't know where the dog had contracted rabies from and killed her on the second day of abnormal behaviour. Two weeks after the goat had been bitten, it developed symptoms which continued for 3 days until it was killed and buried. Six days after the mother dog bite the puppy, ir also developed symptoms of rabies and subsequently bit JS (a 45 year old man), scratched his father and his ten year old daughter. The puppy was killed and buried. After the bite JS visited his local dispensary and was told he would have to pay to get vaccinated, but because he had no money he decided not to bother. He had been bitten on the left hand in the middle of his finger and he had two small but deep puncture wounds. On the 5th of October, 29 days after the bite he started showing symptoms such as shouting, feeling feverish and not being able to eat, so he was taken to the regional hospital in Musoma. He was not admitted because the staff recognized the signs were classical of rabies and said that there was nothing they could do for him at this point. His family took him to the district hospital in Mugumu, where he was also refused. He was brought home and died on the 9th of October. On the 4th of October 2004 an unknown dog appeared in the village of Nyamatoke and bit another girl from JS's extended family, aged 14 years on her right calf as she was coming from school. After hearing about JS's death she told her own father about being bitten, was rushed to hospital and received her first dose of post exposure vaccine on the 22nd of October.
To watch activities undertaken in Tanzania to raise awareness around World Rabies Day 2007 please click here.
To donate to the Alliance for Rabies Control's activities, please click here.
