By Qaisar Khosti
KHOST, Afghanistan, August 13, 2014 (ENS) – Sari, a resident of Motun in the Khost province of southeast Afghanistan, wept as he described how he could do nothing but wait for his son to die.
Nearly a month ago, the boy was bitten by a stray dog as he made his way home from school. He did not tell his parents about the bite, and became increasingly weak until he was almost paralysed. By then, nothing could be done to save him.
“When I took him to the doctor, the doctor told me he had been bitten by a rabid dog and could not be treated,” Sari said. “I took him to Pakistan as well. Doctors there told me that it was too late. Now I am awaiting my son’s death and I’m consumed with grief every moment of the day. I only have hope that God may help my son recover.”
Rabies remains a major public health concern in Afghanistan. Although the disease is present in many wild animals, most cases in humans are caused by dog bites, with packs of strays a common sight in towns and villages.
Khost residents say the officials need to do more to clamp down on the threat these dogs pose to both humans and livestock.
The director of the Khost provincial hospital, Dr. Abdul Majid Mangal, said that 1,300 people were treated there for dog bites last year. Most of the animals would not have been rabid, but people still needed to be vaccinated as a precaution, he said. This is because the only post-exposure treatment consists of multiple doses of vaccine given within a week or so. Without this, rabies is fatal, with few recorded exceptions.
However, as Fazel Rahman, the owner of Khost’s Sehat medical laboratory, explained, rabies treatment was expensive.
“If a mad dog scratches a human, it cost 40 dollars to treat it. If the wound is bigger, it costs from 200 to 300 dollars,” he said, adding that sometimes people who could not afford the vaccine only came to them when it was already too late.
“We cannot help such patients at all,” he said.
For most people, their only hope is to receive free treatment at a state hospital, although supplies of the vaccine often run low.
Dr. Hedayatullah Hamid, the director of public health in Khost, said his department had run out of serum after vaccinating 250 people bitten by dogs in the last three months alone. They had no choice but to send people to seek treatment elsewhere.
“Most patients might not have been bitten by rabid dogs,” he stressed. “They might have just been bitten by street dogs, but people demand vaccination because they suspect the dogs might be mad.”
The financial consequences can be severe. Abdul Wahed, a resident of the village of Khalesi, said that he and three other family members had sought help at a state hospital after being bitten, only to be told vaccine supplies had run out. The treatment they were forced to seek at a private hospital bankrupted them.
“We spent more money than we will be able to earn in a year. We are poor people. The government must provide affected people with services. It is the government’s fault; why does it not get rid of the street dogs?” he asked.
“The only solution is for the government to monitor house dogs and euthanise street dogs,” said Badshah Zar Abdali, director of Khost’s Motun Baba Hospital, adding that on average three people a day arrived at the clinic with dog bites.
Although dogs are often considered unclean by Muslims, many people in Afghanistan keep them as guard dogs, for hunting, to protect livestock or simply as family pets. All these provide opportunities for transmission of the disease, which presents in two forms: furious rabies, which results in aggression, high fever, hallucinations and fear of water, as well as the less common paralytic rabies, which leads to muscle weakness and loss of sensation.
Symptoms of rabies usually appear within a month, although incubation can be much longer.
Locals say that wild dogs present a threat to their livestock as well.
Qasem, a vet who heads a clinic in Khost city, said that more than 50 cows bitten by stray dogs had been brought in for attention last year, as well as buffaloes, sheep, dogs and donkeys.
His practice had managed to save them with immediate vaccination, but he added, “These figures are only from the centre of Khost city and it is much higher in the districts.”
Local authorities insist they are trying to address the problem through vaccinating pet dogs and euthanising strays.
Municipal officials said they had destroyed 650 street dogs last year and Naqibullah, head of the veterinary department at Khost’s directorate of agriculture, said that his team had vaccinated 3,000 pet dogs last year and were planning to start another province-wide campaign. In addition, 258 pet dogs infected with rabies had been put to sleep so far this year.
“When dogs are thirsty or hungry, they fight and bite each other,” he explained. “The rabies virus… is transferred to other dogs through the wounds.”
However, Khost city mayor Mohammad Rasul Bawari said that these efforts had now been suspended as the municipality had already run out of the bait used to kill dogs.
Blaming the directorate of public health for providing poor-quality poison, he said, “There is no doubt that the number of street dogs in Khost city and the districts have increased, but we don’t have the poison to kill dogs and our campaign has ground to a halt.”
Hamid, the director of public health in Khost, blamed municipality workers for spreading the poison too liberally and exhausting their supplies.
Public awareness campaigns are also needed, as many people do not take action until the disease has progressed to an untreatable stage.
“A rabid dog bit our pet dog, which bit my daughter,” said Aziz Gul, who lives in Khost city. He lost his small daughter to rabies two months ago. “We thought everything was normal and only went to the doctor after a month. He said that it was too late. Eventually, my daughter died.”
{This article was originally published August 11, 2014 by the Institute for War and Peace Reporting}
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