Magazine article Geographical

Once Bitten, Twice Shy: The Worst Rabies Epidemic in Living Memory on the Indonesian Island of Bali Has Left 120 People Dead and Led to the Culling of Thousands of Dogs. Following Several Failed Attempts to Stall the Lethal Disease, an Unlikely Heroine Has Managed to Convince the Government That Prevention Is Better Than Cure

Magazine article Geographical

Once Bitten, Twice Shy: The Worst Rabies Epidemic in Living Memory on the Indonesian Island of Bali Has Left 120 People Dead and Led to the Culling of Thousands of Dogs. Following Several Failed Attempts to Stall the Lethal Disease, an Unlikely Heroine Has Managed to Convince the Government That Prevention Is Better Than Cure

Article excerpt

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Traditional Balinese treatments for dog bites have a certain romantic appeal: 'Eat some rice, spread the last mouthful on your wound and give it to the dog: you'll get better and he'll never disturb you again'; 'Rub red chili into the bite until it hurts.' Although prevention is always better than cure: 'When a dog wants to bite you, grip your tongue between your teeth and grin, and the dog will surely shy away.' But with the island in the grip of the worst rabies epidemic in living memory--with more than 120 deaths recorded since November 2008--locals are going to need more than folklore to keep them safe.

As the epidemic took hold, with dozen of victims identified, the local media began to point the finger at Western expatriates importing pure-breed dogs from next-door Java. But as the death toll mounted, and with the Bali nightclub bombings of 2002 and 2005 still fresh in the collective mind, others chose the darker theory of extremist Islamic bioterrorism. The reality is more banal.

In May 2008, a 32-year-old taxi driver named Thomas Aquino emigrated from the eastern Indonesian island of Flores to the famed Bali beach resort of Kuta in search of work. Accompanying him was a friend, Freddy, who has never been fully identified, and Thomas's dog, which, unknown to them both, was incubating the rabies virus.

A few months later, the dog attacked Freddy and Thomas; within days it had also bitten a passing three-year-old Balinese boy named Ketut Tangkas. By the following January, Thomas was dead and Freddy had disappeared. Ketut, too, had passed away, his father's frantic calls to hospitals for the life-saving immunoglobulin and post-exposure rabies vaccine having fallen on disbelieving ears.

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And why would anyone have listened to a three-year-old's distressed father? After all, it had been centuries since rabies had reared its ugly head on an island paradise better known for its smiles and surf.

DETERMINED DISEASE

Paul Burton, a 34-year-old British nurse on holiday in Indonesia, was bitten by a dog while motorbiking around Lake Batur in the Balinese highlands in February last year. 'I had been pre-vaccinated against rabies in England, so although I knew there was a reasonable chance the dog was rabid, I wasn't particularly worried at first,' he says. 'When I got to the next village, I scrubbed the wound with some borrowed clothing detergent and bottled water. There wasn't any iodine, so I bought a bottle of 80 per cent arak [palm alcohol] and doused [the wound] in that until I couldn't feel it anymore. That was the easy part.'

Rabies is a slow, clever, determined disease. As it sets in, sufferers experience an extreme fear of light and moving objects, of noise, water and wind. Convulsions, excessive saliva production and severe psychotic episodes follow. Dogs often embark on a biting rampage.

From the bite site, the virus winds its way through nerves at two millimetres per hour, heading for the spinal cord and, eventually, the brain. Incubation can last from a few days to several years, but three to 12 weeks is more common. Once it has gained a foothold in the brain, it's 100 per cent fatal.

Burton knew that he had to receive the first of three VAR post-bite vaccinations in the next 24 hours or he could die. The nearest clinic was 40 minutes away. 'I rode off an hour later for the clinic,' he continues. 'When I got there, they told me that they were out of VAR and advised me to try the clinic in Kintamani. They were out, too. Next, I was sent to a district hospital. They had also run out, and I waited for five hours while a car made the round-trip--which I paid for--to the general hospital in Denpasar to collect my first dose. They cleaned the bite, gave me my first shot, and sent me on my way.'

But it didn't end there. 'When I went to the general hospital in Denpasar seven days later for my second shot, they didn't have any VAR in stock,' Burton says. …

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