Early morning, July the fourth

Shots ring out, in the Katete sky.

Weekends around St Francis are not normally overly action packed. So when gunshots woke me from my Saturday morning sleep in, it didn’t look like I was going to get the ten hour night to recover from long days that week. Peering out my window, I was greeted by a hospital security guard brandishing a single barrel shot gun.

Zambia is a pretty safe and stable place, but gunshots always make your ears prick up. Seeing it was hospital staff meant that it was likely the dog cull that we had heard was in progress. The hospital compound had in previous months seen a swelling in the population of stray mutts. Not only were they a nuisance, ripping rubbish open and harassing people, but dog bites are always a potential risk for rabies. Although rabies is relatively uncommon, any dog bite is a risk to spread the virus, and leaves those unvaccinated with difficult decisions. Full post exposure prophylaxis requires several doses of the vaccine, which is available locally, as well as getting rabies immunoglobulin which is an expesive blood product, maybe available in Lusaka but otherwise available only in places like Jo’burg or Nairobi.  Those that have been vaccinated can avoid the immunoglobulin hassle and cost, just needing a few booster doses of vaccine. Once symptoms of the disease set in, it is invariably fatal with only one case of survival in an American patient who was put on a ventilator for months, which has never been able to be replicated again, and is extremely resource intensive. The time to act is when the bite occurs, as when any symptoms occur, the horse has well and truly bolted in terms of treatment.

The difficulty is that the vaccine is about $500, has to be given in a few doses over a month, and often not stocked by all GP practices. And without the vaccine, its leaves those bitten but able to consider travelling to get the immunoglobulin a conundrum to weigh up of significant expense versus the small risk of developing an in curable disease and very unpleasant way to die.

We had a couple of kids die of presumed rabies on the ward, and although I didn’t have any direct part in the their care, they were not nice cases to be involved with. in particular, one young girl who had been bitten by an obviously rabid dog, had subsequently developed the ‘furious’ variant of rabies, bitten her dad, before presenting to hospital. With no known effective treatment, it is a case of keeping them as pain free and calm as possible during what in inevitably only a couple of days at most left to live.

So whilst I am not a big fan of senseless killing of animals, gunshots on a Saturday morning could have meant worse things.

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