When I pick a place to be sick and die, it ain’t gonna be India.
So, the irony that today I found myself standing in line at one of their Public Health Clinics, for the second time in a year, was not lost on me. Don’t get me wrong. India offers so very many colorful and effectual ways to die, I’m glad the public health system is here, I just don’t like having to take advantage of it.
The first time was way back in January after I was bitten by a dog. Being bitten by a dog, at that time, was quite unfortunate indeed considering I had just finished self-administering the rabies vaccine series while backpacking India because I was clawed by a stupid, stupidstupidstupid cat.
For the cat story you can look HERE, but barely had I finished up the five shots in that story when I was bitten by a dog in the southern state of Goa.
I don’t mess with animals here. Really I don’t.
Buuut, I was on my way to run on the beach and saw a tiny puppy tied up under a bush. I knew this puppy, barely 8 weeks old, who had been adopted by a cafe owner. For two weeks I had watched it being dragged around by the cafe owner’s children and petted by patrons, so when I saw him shivering and whimpering tied to the bush, the thought “perhaps you shouldn’t pet it” only flitted through my mind, and then was gone. I did pet it. The little thing took comfort in me, whining and nestling into my arm like any baby dog would. But then, suddenly, he turned into gremlin dog and chomped down on my skin leaving me with seven tooth holes and an arm dripping with blood. I could hardly believe it. It was just a puppy! Gremlin Dog lasted a only long enough to inflict a good hard bite, and then he changed back to cheerful puppy.
I found the cafe owner and showed him my arm. “Yes,” he told me, “He started biting people yesterday. He has bitten 10 people.”
On my run down the beach I began to grasp what this would mean for me. Another series of five self-administered shots and that was really bad news. Because I’m a nurse and a big baby, I started to cry. When I saw my friend Matt, with tears still flowing, I held up my arm. “I’ve just finished giving myself all these shots,” I sobbed out, “and now I have this bite and I’m going to have to do it all over again!” He patted me on the shoulder. “LeAnne! It’s just a dog bite! It could be so much worse! I’m sure he doesn’t have rabies!”
But, he did.
We quarantined the baby dog until animal control could get there from a neighboring city. They took him away for observation and the next day called to confirm the diagnosis.
12 people were bitten in all including the 5 year old son of the cafe owner, two 12 year old girls and a Russian woman who had already left the village without knowing anything about it.
The cafe became the gathering place to discuss the situation. A German man tried to put my fears at ease. “You do not have rabies”, he told me, “if you did you would have had symptoms by now.”
I knew this was wrong.
The incubation period can be up to six years, and, if you get rabies, you foam at the mouth, want to bite people, become afraid of water, are unable to swallow and go generally insane. It’s as close to an alien take over of your body as you can get, which is basically what happens. This gruesome stage lasts three days before it ends and you end with it. Like I said, India offers great ways to die.
“Are you a doctor?” I asked Reassuring Guy.
“What kind of doctor are you?”
“Just a general M.D.”
Turns out, he was an insurance salesman.
So began a plethora of misinformation passed around. Some Indian doctors told us we needed to do one thing, and others told us other things…all the European and western doctors agreed with each other, but only half the Indian docs agreed with them. The western docs said we needed Human Immunoglobulin within 24 hours, unless we had been previously vaccinated, which increased the window to 48. After that, we needed to follow up with a series 5 other vaccines. Half the Indian docs said we only needed the 5 vaccines and not the immunoglobulin, but if you had been previously vaccinated, you need a booster shot before, or maybe after the immunoglobulin.
Confused yet? So were we.
The group could make no joint decision, and it looked as if some bite victims were going to do nothing, in hopes their bodies would just deal with it and it would turn out all right (Yikes!) but in the end, all 12 were talked into taking at least some of the vaccines.
I opted for western thought in medicine, as did the mothers of the two 12 year old girls. Combining forces, we shared a taxi ride all over the state of Goa to find the immunoglobulin because it was not readily available. We looked all day at many hospitals in many cities and did not find it.
The World Health Organization reports roughly 36% of the world’s rabies deaths occur in India each year, (an estimated 20,000 people) and most of those are children. This fact makes the other fact that we couldn’t find the right drug, simply amazing. The search was terribly long and hot and the girls finally got tired and went home with their mothers while I continued looking into the night. Finally I found it at Goa Medical Collage in the city of Bambolim, but only enough for the two girls. The pharmacist charged me an outrageous fee but, seeing as the girls had now gone over the 48 hour window and had not been previously vaccinated, time was of the essence. I got the vaccine back to them about 10:30 that night, but that still left me to worry about Me. “You know, if you go back to the medical college clinic and stand in line you can get that vaccine for free” my taxi driver told me. So, the next morning, that’s what I did.
It wasn’t one line but three lines I stood in before I got treated. Amazingly the whole process took only an hour and a half, with me ending up in the cheerfully named Casualty Department where the nurse was to “kindly do what was needed” to me. I looked at her expectantly and glad I wasn’t her x-husband.
She took the paper boldly declaring I was a Casualty, turned around to a vial behind her that was already open, grabbed the syringe that was already sticking out of it and told me to get ready for a shot.
“No,” I told her, “I need something different”. Granted, I had no idea what she was about to give me, but I knew for sure the right stuff would not be open, ready and waiting with a needle hanging out of it.
“I need Human Immunoglobulin”
“I’ll have to get the doctor for that” she told me and disappeared around the corner. Sitting on a gurney I waited and eventually a cute, young female doc showed up with the right stuff.
The thing about Human Immunoglobulin is that half of it is injected IM into your arm muscle, but the other half has to be injected, in even amounts, into EVERY TOOTH HOLE. I had seven tooth holes. Seven times a needle had to go into a bite hole. OUCH!
In my whole year of traveling alone, that was the only time I wished I were not and that someone was there to hold my hand.
I haven’t gotten rabies yet.
I am probably a walking fortress against the disease considering how much serum has been dumped into my system.
I never found out if the Russian woman who had already left the village was found and told, though I know the authorities were trying to find her.
All these memories came back today…
as Amy Caroline and I stood in a another health clinic waiting for the Doc. She has flu symptoms. The flu is going a around here and I’m pretty sure it’s just the flu. We have already and independently ruled out malaria, ebola, dengue, Japanese encephalitis and mono. But, our hotel owner insisted she be seen by a doctor. He hooked us up with a Tuk Tuk driver and off we went.
Amy Caroline tried to stand in line at the clinic like everyone else, but giving her VIP treatment (because she is a princess) they ushered her right to the front and got her checked in.
The most sketchy moment was walking into the second waiting room and coming face to face with a old woman on a gurney looking distraught and as if she was having a hard time breathing. AC shot me a glance that said “I kind of want to leave now,” but before I could respond, they ushered her past the crowd and seated her by the doctor who asked her some questions.
Then he prescribed her antibiotics, cold medicine and another medicine we haven’t looked up yet.
The cost, Doc visit and everything, came to five rupees or eight cents. Eight American cents. Eight.
Doc said she should be ok in a couple of days. He repeated all of this to the Tuk Tuk driver in Hindi, who then gave a full report directly to our hotel owner on our return, so that we could be watched over properly. The hotel owner seemed relieved.
So ends our outing to the medical clinic and I hope, hope, hope, to not have another. If you are worried, don’t be. Mamma Bear is keeping a very close eye.
But, I still can’t get over only paying eight cents.