Once bitten, twice shy
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.
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. ‘I ended
up phoning around the private hospitals until I found one that did. Fourteen days later, I went back to a different private hospital for my third shot because the first had
run out. I paid for both.’
Although the government offers the post-exposure vaccinations for free – frequently running out in the process – the cost of petrol for wild goose chases around the island in search of the three required injections is prohibitive to most Balinese, many of whom live on less than £2 a day.
Mass cull
Ignorance surrounding the disease was rife in the early months. The government – in the mistaken belief that vaccinating dogs would result in them becoming infected with the virus – opted for a mass cull. By November 2009, government agencies had exterminated 38,757 dogs. Tourists complained about the piles of dead dogs that began to appear, and owners started to hide their pets from the culling teams.
By the following May, a staggering 44,000 dog-bite victims had received post-exposure vaccine, meaning that about ten billion rupiah (£740,000) had been spent on human vaccination rather than on preventative measures. Eventually, a dog-vaccination programme was established, and 136,090 animals were treated. The only catch was that officials had opted for an Indonesian-made, low-potency vaccine that only covered a dog for three months – meaning that the costly and logistically difficult vaccination programme had to be constantly repeated at unrealistically short intervals. And still the human death toll rose, passing 60 the next month, having doubled every six months since the epidemic broke.
Around this time, an unlikely candidate for the heroine of Bali’s rabies battle emerged. Janice Girardi, a 57-year-old US expatriate, is a successful jewellery designer and, more recently, campaigner for animal welfare. In 2007, Girardi, together with Indonesian vet Dewa Made Dharma, set up the Bali Animal Welfare Association (BAWA). The initial aim was to nurse stray dogs and cats before putting them up for adoption, but as the rabies epidemic took hold – and it became clear that culling and the use of short-term canine vaccines had resulted in more, and not fewer, human deaths – Girardi unwittingly found herself on the frontline of the war against rabies.
Exasperated, she personally invited an international delegation of rabies experts to Bali last year to convince local officials that attempting to use cure rather than prevention wasn’t working. ‘A habitat will always support a constant population of dogs,’ she argues. ‘So it doesn’t matter how many dogs you put down. By killing healthy dogs, you leave the door wide open to feral dogs that are more unused to humans, more likely to bite and much more likely to harbour the virus. Culling simply doesn’t work. The island of Flores tried it against strong recommendations from World Health Organization (WHO) consultants and it failed to eradicate rabies. Twelve years later, there is still canine rabies on Flores, and that’s exactly where Bali’s epidemic originated.
‘What works, and what has been proven around the world to work,’ she continues, ‘is a concerted dog-vaccination programme that creates a territorial core of healthy animals. The WHO recommends vaccinating 70 per cent of a dog population in order to achieve this herd immunity. This creates an effective barrier against infected animals, which will be driven out by the healthy dog population and usually die within seven days of displaying symptoms. The infected dog is also more likely to die far from the human population, without transmitting the virus to people or other dogs.’
Girardi also pushed for the Indonesian government to import the high-potency canine vaccine Rabicine, which lasts for a year and is effective for three more if the dog receives a booster within 12 months. An island-wide dog-vaccination programme was implemented late last year, following a successful pilot project conducted and financed by BAWA in Bali’s central Gianyar regency.
The idea took hold. Bali’s humane rabies-control programme is now being led by the government’s Department of Animal Husbandry, with operational and managerial support from BAWA. Between October 2010 and March this year, vaccination teams injected about 210,000 dogs (70 per cent of the surviving dog population).
The introduction of island-wide dog vaccination using Rabicine has seen the number of human deaths from rabies in Bali decrease by 48 per cent for the first five months of 2011. The number of rabies-positive dogs fell by three quarters during the same period.
Trusted team
I meet Made Suwana, BAWA’s education officer, and a seven-man vaccination team in a banjar (village) a half-an-hour’s ride from Ubud the following morning. Suwana, 31, is an ex-primary-school teacher now educating children and adults about rabies and basic dog care.
Before we’ve finished our early-morning coffee at a roadside stall, a dog-catcher has spotted his first target of the day. He leaps off the bench and within 20 seconds, he has the dog twirled expertly in his net and the team’s vet is uncapping and filling a syringe. As the vet injects the dog, there’s a howl as a second dog is landed further up the road.
The first has a red collar tied around its neck – proof of vaccination – and the record-keeper gets its name from a young mother who has come to check on the commotion. She receives a certificate noting the date, her dog’s characteristics, the vaccine used and the dog’s address. On the back is a description of rabies and what to do in case of a bite. The dog is set free with a deft twist of the net and tears past the woman’s legs into the safety of her walled compound.
This is the second round of vaccinations, again piloted by BAWA in its home regency of Gianyar. Where once they hid their dogs from culling teams, locals now welcome the conspicuously white-T-shirted teams and queue to have their pets vaccinated. By lunchtime, the team has treated 64 dogs. ‘The only problem we have during this second round isn’t from the public,’ says Suwana. ‘The dogs immediately recognise our T-shirts and the smell of our nets from last year and run a mile. They’re so much more difficult to catch.’
A two-man BAWA survey team had estimated the banjar’s dog population the previous day, and the team vet has come prepared with the correct number of vaccines in his cool box. After the vaccination team has finished, the same survey team will again ride through the neighbourhood to assess vaccination penetration. The vaccination team will then return until everyone is satisfied that at least 70 per cent of the dogs have been injected.
Changing times
Later that morning, the team stops to vaccinate a dog by a busy main road. As the dog-catchers dodge the stream of cars and motorbikes, a middle-aged man asks: ‘Why don’t they just kill them?’
Suwana immediately approaches him with a smile, and by the time the dog has been treated, collared and released, he has convinced him that vaccination, not culling, will
save his life. The man returns to his coffee and friends; a deep conversation ensues.
Times are changing. The dogs that have survived the culls appear a far cry from Mexican painter Miguel Covarrubias’s 1937 description of Bali’s feral dogs as ‘the miserable
ones, the scavengers, the thousands of homeless living skeletons that reproduce unchecked and bark and wail all night in great choruses’.
Covarrubias suggested that Bali’s dogs were provided by the gods to keep Bali from perfection. Today, it seems, vaccines are here to keep the island from financial annihilation.
October 2011
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.
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. ‘I ended
up phoning around the private hospitals until I found one that did. Fourteen days later, I went back to a different private hospital for my third shot because the first had
run out. I paid for both.’
Although the government offers the post-exposure vaccinations for free – frequently running out in the process – the cost of petrol for wild goose chases around the island in search of the three required injections is prohibitive to most Balinese, many of whom live on less than £2 a day.
Mass cull
Ignorance surrounding the disease was rife in the early months. The government – in the mistaken belief that vaccinating dogs would result in them becoming infected with the virus – opted for a mass cull. By November 2009, government agencies had exterminated 38,757 dogs. Tourists complained about the piles of dead dogs that began to appear, and owners started to hide their pets from the culling teams.
By the following May, a staggering 44,000 dog-bite victims had received post-exposure vaccine, meaning that about ten billion rupiah (£740,000) had been spent on human vaccination rather than on preventative measures. Eventually, a dog-vaccination programme was established, and 136,090 animals were treated. The only catch was that officials had opted for an Indonesian-made, low-potency vaccine that only covered a dog for three months – meaning that the costly and logistically difficult vaccination programme had to be constantly repeated at unrealistically short intervals. And still the human death toll rose, passing 60 the next month, having doubled every six months since the epidemic broke.
Around this time, an unlikely candidate for the heroine of Bali’s rabies battle emerged. Janice Girardi, a 57-year-old US expatriate, is a successful jewellery designer and, more recently, campaigner for animal welfare. In 2007, Girardi, together with Indonesian vet Dewa Made Dharma, set up the Bali Animal Welfare Association (BAWA). The initial aim was to nurse stray dogs and cats before putting them up for adoption, but as the rabies epidemic took hold – and it became clear that culling and the use of short-term canine vaccines had resulted in more, and not fewer, human deaths – Girardi unwittingly found herself on the frontline of the war against rabies.
Exasperated, she personally invited an international delegation of rabies experts to Bali last year to convince local officials that attempting to use cure rather than prevention wasn’t working. ‘A habitat will always support a constant population of dogs,’ she argues. ‘So it doesn’t matter how many dogs you put down. By killing healthy dogs, you leave the door wide open to feral dogs that are more unused to humans, more likely to bite and much more likely to harbour the virus. Culling simply doesn’t work. The island of Flores tried it against strong recommendations from World Health Organization (WHO) consultants and it failed to eradicate rabies. Twelve years later, there is still canine rabies on Flores, and that’s exactly where Bali’s epidemic originated.
‘What works, and what has been proven around the world to work,’ she continues, ‘is a concerted dog-vaccination programme that creates a territorial core of healthy animals. The WHO recommends vaccinating 70 per cent of a dog population in order to achieve this herd immunity. This creates an effective barrier against infected animals, which will be driven out by the healthy dog population and usually die within seven days of displaying symptoms. The infected dog is also more likely to die far from the human population, without transmitting the virus to people or other dogs.’
Girardi also pushed for the Indonesian government to import the high-potency canine vaccine Rabicine, which lasts for a year and is effective for three more if the dog receives a booster within 12 months. An island-wide dog-vaccination programme was implemented late last year, following a successful pilot project conducted and financed by BAWA in Bali’s central Gianyar regency.
The idea took hold. Bali’s humane rabies-control programme is now being led by the government’s Department of Animal Husbandry, with operational and managerial support from BAWA. Between October 2010 and March this year, vaccination teams injected about 210,000 dogs (70 per cent of the surviving dog population).
The introduction of island-wide dog vaccination using Rabicine has seen the number of human deaths from rabies in Bali decrease by 48 per cent for the first five months of 2011. The number of rabies-positive dogs fell by three quarters during the same period.
Trusted team
I meet Made Suwana, BAWA’s education officer, and a seven-man vaccination team in a banjar (village) a half-an-hour’s ride from Ubud the following morning. Suwana, 31, is an ex-primary-school teacher now educating children and adults about rabies and basic dog care.
Before we’ve finished our early-morning coffee at a roadside stall, a dog-catcher has spotted his first target of the day. He leaps off the bench and within 20 seconds, he has the dog twirled expertly in his net and the team’s vet is uncapping and filling a syringe. As the vet injects the dog, there’s a howl as a second dog is landed further up the road.
The first has a red collar tied around its neck – proof of vaccination – and the record-keeper gets its name from a young mother who has come to check on the commotion. She receives a certificate noting the date, her dog’s characteristics, the vaccine used and the dog’s address. On the back is a description of rabies and what to do in case of a bite. The dog is set free with a deft twist of the net and tears past the woman’s legs into the safety of her walled compound.
This is the second round of vaccinations, again piloted by BAWA in its home regency of Gianyar. Where once they hid their dogs from culling teams, locals now welcome the conspicuously white-T-shirted teams and queue to have their pets vaccinated. By lunchtime, the team has treated 64 dogs. ‘The only problem we have during this second round isn’t from the public,’ says Suwana. ‘The dogs immediately recognise our T-shirts and the smell of our nets from last year and run a mile. They’re so much more difficult to catch.’
A two-man BAWA survey team had estimated the banjar’s dog population the previous day, and the team vet has come prepared with the correct number of vaccines in his cool box. After the vaccination team has finished, the same survey team will again ride through the neighbourhood to assess vaccination penetration. The vaccination team will then return until everyone is satisfied that at least 70 per cent of the dogs have been injected.
Changing times
Later that morning, the team stops to vaccinate a dog by a busy main road. As the dog-catchers dodge the stream of cars and motorbikes, a middle-aged man asks: ‘Why don’t they just kill them?’
Suwana immediately approaches him with a smile, and by the time the dog has been treated, collared and released, he has convinced him that vaccination, not culling, will
save his life. The man returns to his coffee and friends; a deep conversation ensues.
Times are changing. The dogs that have survived the culls appear a far cry from Mexican painter Miguel Covarrubias’s 1937 description of Bali’s feral dogs as ‘the miserable
ones, the scavengers, the thousands of homeless living skeletons that reproduce unchecked and bark and wail all night in great choruses’.
Covarrubias suggested that Bali’s dogs were provided by the gods to keep Bali from perfection. Today, it seems, vaccines are here to keep the island from financial annihilation.
October 2011
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