KARACHI: As the Sindh government struggles how to follow court directives on stray dogs, another case of rabies was reported at the Jinnah Postgraduate Medical Centre (JPMC) on Thursday, raising the number of rabies’ victims to three in the first month of 2020, sources told Dawn.

This time, the victim was a 35-year-old woman named Shahina Bibi, a mother of four and resident of Thatta.

She was bitten by a dog two months ago on one of her legs.

“Saddened by the fact that there is no treatment for rabies and the patient would die soon, the family took her to their hometown against medical advice later in the day,” said Dr Seemin Jamali, the JPMC executive director, adding that three cases of rabies had been reported at the JPMC this month.

According to her, the victim had developed visible signs of rabies, including history of fits and hydrophobia — a set of symptoms in the later stages of the deadly infection in which the person has difficulty swallowing, shows panic when presented with liquids to drink, and cannot quench their thirst.

Mother of four from Thatta taken back home against medical advice

“The bite wound had healed, though. Sadly, none of her family members knew that she was bitten by a dog and it was only after she stopped drinking water that they got alarmed,” she explained.

Asked about the rise in dog-bite and rabies cases, Dr Jamali said there was definitely a surge in these cases as the hospital’s data showed that rabies cases had jumped from 8,000 in 2018 to 10,850 in 2019 while the JPMC recorded 11 deaths from rabies at the facility.

“There is a dire need to create awareness of this serious issue as the number of stray dogs has increased multiple times. At the JPMC, we administer anti-rabies vaccine and rabies immunoglobulin free of cost depending upon the nature of the wound. There has never been a case of treatment failure.”

She linked growing cases of rabies and dog bites to the increasing population of the animal, contributing up to 99 per cent of all rabies transmission to humans.

Earlier this month, the hospital received two rabies patients; the first case was of 20-year-old Shahid Iqbal, who had reported at the JPMC from Shikarpur. He was bitten by a stray dog three months ago.

Forty-five-year-old Mohammad Ajmal, a father of six, had got dog-bite injuries two months ago. He was brought to the JPMC with full-blown rabies from Badin, where he worked at a poultry farm. His family lived in Bahawalpur. No health department official was available for comments.

A highly under-reported disease

Rabies is a highly under-reported disease as most hospitals do not maintain its data.

In many cases, according to experts, patients die before diagnosis could be made as families turn to faith healers.

It is estimated that Karachi alone reports 150 cases of dog-bites daily.

Last year, the media reported 24 deaths from rabies, a viral infectious disease which has emerged as a major health challenge in Sindh.

Almost all the victims had been brought from the interior parts of Sindh to Karachi for treatment, indicating non-availability of anti-rabies vaccine at hospitals in those areas.

Experts say these lives could have been saved if the victims were appropriately and in a timely manner administered with this vaccine.

The provincial government has so far failed to come up with an effective strategy and provide immediate relief to hapless citizens despite the Sindh High Court’s repeated directives to act.

While many health practitioners believe that immediate relief could only be provided with mass culling of dogs as their numbers have increased multiple times due to worsening sanitary conditions across Sindh, others say the government should follow the WHO recommendations.

The organisation’s one-health approach seeks elimination of rabies universally by 2030 with the help of mass dog vaccination and controlling [their] population through birth control measures (as studies have proved killing stray dogs as an ineffective method to end rabies).

Published in Dawn, January 17th, 2020