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Working alongside the risk of rabies
  1. Jessica Briner

Abstract

Third-year veterinary student Jessica Briner spent the Christmas holidays volunteering at the Bali Animal Welfare Association, giving her an opportunity to put what she had been learning at vet school into practice

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WHEN I first arrived at the Bali Animal Welfare Association (BAWA) clinic in Indonesia, I was met by a host of longing eyes. Tails wagged enthusiastically as rows of kennels erupted into excited barking. It took all the willpower I could muster to resist scooping up the closest dog in an embrace. However, without taking necessary precautions and learning the particulars of every dog in the facility first, such a lapse could prove fatal, as something sinister lurked behind these innocent gazes; the threat of rabies was omnipresent.

Rabies has become a serious problem in Bali. Since its first appearance on the island in 2008, over 200,000 dogs have been culled and thousands more poisoned, abused or abandoned as a result of fear. The fear of rabies is still intense but, after an island-wide vaccination programme run by BAWA, canine rabies cases dropped by 45 per cent and human fatalities decreased by 48 per cent in 2011 compared with 2010. As a result, things are slowly beginning to change. BAWA now provides a mobile spay/neuter clinic, a full-time animal hospital, a 24-hour ambulance service and an extensive rabies programme, all free of charge.

Jessica Briner with a dog of known history wearing a red ribbon to indicate that it has been vaccinated against rabies

Precautions

I was born and raised in Asia and my family regularly visited Bali. After hearing what BAWA's work had accomplished, I decided to offer to help there during the winter break. I was given the opportunity to work with the ambulance, in the clinic and on the spay and neuter bus. I spent a week with each team. My duties ranged from helping staff catch stray dogs for vaccination or treatment, prepping animals for surgery, monitoring and maintaining anaesthesia, and administering daily medication, to socialising puppies, cleaning out kennels and walking in-patients in the nearby rice paddies.

I had received the full rabies pre-exposure treatment by the age of six, and at the time I naively took this as a sign that I had free rein to play with all the animals I encountered on my adventures. However, now, as a third-year vet student at the University of Edinburgh, I understand that such a carefree outlook was assuredly optimistic. Rabies is not a condition to be taken lightly, and scared /injured animals should never be underestimated, just as nips from playful puppies should be guarded against.

With the number of animals we were handling, it only took a day before I encountered my first exposure to the risk of rabies … How deep does a cut actually need to be? What do they mean when they say broken skin: a cut or a graze? How at risk am I really? These were the types of doubts and concerns that went through my mind, but I quickly learned that no matter how careful I was, exposure to the risk was going to be inevitable. After all, dogs are playful; it is in their nature to bite, lick and paw.

Under any other circumstances, this behaviour would be encouraged; in this situation it carried an inherent risk. To guard against this risk, dogs caught on the street requiring treatment were handled only when in nets or appropriately sedated. Dogs that couldn't be released immediately were quarantined at the clinic, vaccinated and treated until they were fit to be freed or rehomed. All unvaccinated in-patients were handled with gloves. However, sharp teeth and untrimmed claws meant that gloves were easily ripped, and for many of the puppies in the clinic the task of removing, shredding and playing with gloves was far too attractive to resist!

I wasn't sure that the handwashing technique grilled into me in my first term at university would ever be of any real use, but at BAWA I was using it constantly. In the instance of broken skin, a strict regimen of 20 minutes of scrubbing with antiseptic soap had to be followed. A detailed record of the wound, however minor, was taken, and the animal that caused it or any others that might have contaminated it needed to be documented. If any of the dogs died within 10 days of exposure, a postexposure vaccination regimen was required, something that I later discovered was practically protocol either way. Ultimately, a ‘better safe than sorry’ principle was followed.

Some people cautioned against my participation in the programme as a student, as they felt catching rabies was not a gamble I should take. Despite the possibility of becoming infected, I wanted to get involved, even if only for a short time. The work of BAWA not only improves the quality of life of many dogs, but also serves to strengthen the fractured canine-human relationship on the island. If you accept the risk, as I did, follow instructions, take care and use a bit of common sense, then the experience can be extremely rewarding. Of course, respect and understanding of each dog encountered was key, as were good observation and judgement.

That said, my first year at vet school also helped tremendously. One of the primary courses we undertook was animal welfare and husbandry, which was designed to teach us about how to care for and manage animals. This included behaviour and hand-ling practicals, and it was in these classes that I learned how to approach and handle dogs appropriately under a variety of circumstances. This knowledge, combined with the information I had learned in my clinical foundation course, meant that in addition to knowing the safe way to deal with a dog, I also understood the mechanism and choices behind the treatments we were giving our patients. Understanding the pharmaco-kinetics of drugs, their mechanism of action and their potential side effects ensured that I knew what was being administered, and could not only help in treatments, but could coherently discuss cases and decisions with the veterinarians at work. Therefore, what I have learned and continue to learn at vet school was invaluable in enriching my time with BAWA. It also made me more useful to the team as, with a better understanding of their work, I didn't just stand around and watch, but could take an active role in helping with their efforts.

Powerful symbol

Although I found the daily experiences fulfilling, the implications of my work only really sank in on my last day, on my way to the airport, in fact. That was when I really started to notice all the dogs wearing red collars in the streets, which indicated that the dog had been treated in a BAWA facility and was certified to be free of rabies. Until this final drive across the island, I hadn't fully appreciated that the simple red ribbon I had tied around so many dogs' necks acted as a powerful symbol. Not only did it serve as a tool to reduce fear, but it also provided a visual cue of the strengthening containment of a deadly virus that had previously held the island and its inhabitants hostage.

I have always dreamed of being a wildlife vet, and with that comes the need to immerse oneself in the local culture and to work with the population, as without their support little can truly be achieved. My BAWA experience not only served to encourage my dream of pursuing this type of career, but showed me first-hand what willing, determined and caring vets can achieve, with the support of people around them – even with limited resources. I now know that this is the type of work I want to do, as although it can be testing, it is also ultimately an incredibly fulfilling experience.

More information about the work of BAWA can be found at www.bawabali.com/us/help-us/volunteer.html

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