By Juma Seyyid
TORORO
Victims of wild animal bites in Eastern Uganda are resorting to witch doctors due to Shortage of Rabies vaccines in most government health facilities.
There are reports of increasing numbers of people being bitten by suspected rabid wild animals since the beginning of the year.
The districts of Tororo, Busia and Namayingo are the most hit by shortage of rabies vaccines coupled with high cost of vaccines in private health facilities.
Some of the victims are stuck at homes dying slowly while others have opted to visit witchdoctors for interventions.
In the three districts mentioned above, treatment for rabies can be found at few government health facilities that include Tororo government hospital, Rubongi military hospital Tororo, Mulanda and Mukujju health center 1Vs in Tororo, Masafu general hospital in Busia and Buyinja health sub –district in Namayingo district among others.
But when our reporter visited the facilities, it was discovered all of them had almost nothing in stock.
For instance, records available at Masafu general hospital in Busia district indicate that the facility receives 20 doses of rabies vaccines for humans quarterly, too little to meet the swelling demand.
Facts about rabies
Every year, many people in Uganda die from rabies after being bitten by suspected rabid wild animals, majorly a dog or fox.
Rabies is a vaccine-preventable viral disease spread mostly by contact with saliva from any rabies-infected wild or domestic animal, via a bite, scratch, and lick to an open wound or with the eyes, mouth or nose (mucous membranes).Bats can also carry rabies.
In humans, rabies is almost always fatal, once symptoms develop. Rabies can be prevented by avoiding animals and seeking prompt medical attention if in contact with saliva from a rabies-infected wild or domestic animal, including pets.
The victim bitten by an infected animal usually shows signs of the disease after 1-3 months, becomes paralyzed and dies within 7-10 days after showing the signs.
The wild carnivores (such as foxes, jackals and wild dogs) are reservoirs for the disease and can transmit the disease to domestic dogs.
Airborne transmission is also possible under special circumstances such as in laboratories and caves with an extremely high bat density.
The signs in humans include; Headache, Fear of water, wind and exposure to sunlight, difficulty in swallowing and breathing, seeing and hearing strange things that are non-existent and anxiety.
The signs of an animal with rabies include; aggressiveness, chewing strange things (rocks, dirt or wood), excessive salivation, fear of exposure to light and difficulty in swallowing and breathing. Rabies is a big threat to the lives of Ugandans but it is unfortunate that some dog owners do not know the risks of keeping a dog that has not been vaccinated.
Victims of dog bites don’t know how to manage dog wounds that lead to the development of the virus in the brain killing over 160,000 people every year, the majority of deaths being reported in Africa and Asia.
In Uganda, a rabies vaccine for all is too expensive for the Ministry of health. It can only be available to high risk groups like game rangers.
A dose of rabies vaccine goes for between 40,000-100,000 in private clinics, something that has left several victims to die without options.
Rabies is endemic in Tororo and the district is one of the hot spots for rabies in the Country.
Data obtained from the District Veterinary office indicates over five people are bitten by suspected rabies dogs monthly.
According to the report, over 40 cases have been registered between the month of March to- date with 37% mostly children ages 15 years and below.
Recently, there has been a public outcry at the border of Uganda and Kenya mainly in Malaba town council and Mella Sub County on the influx of wild and stray dogs and foxes from Kenya terrorizing the population and domestic animals.
Reports also reveal stray dogs have invaded and turned Tororo general hospital into their homes terrorizing patients, patient attendants, and medical staffs and above all, they mess up operations at the facility especially in the nights.
In May this year, a suspected wild fox caused a lot of panic in the entire Tororo Municipality forcing residents to return to their homes as early as 6PM.
Victims’ voices:
Maya Collins, a 34 year old father of five was beaten and infected with rabies in May this year at his home in Namayuge, Buswale Sub County, Namayingo district.
Maya, a farmer and an operator of a grinding mill narrated how he painfully parted with 180,000 shillings to get treated only to receive one dose.
He says he paid someone to get him the vaccine outside the district because he was told at his district health facility of Buyinja in Namayingo had run out of stock.
Maya says he is currently stuck at home caught between life and death, not certain of the future with the one dose he got.
He narrates how he was ignorantly forced to apply DHARMA spray on his wound DHARMA spray, an antibiotic used in animal wounds because he lacked knowledge of using clean water and soap and first line treatment.
Stephen Mangeni, another victim and a resident of Sikuda sub County in Busia says a rabid dog bit his 20 year old brother on his way back from a nearby trading center leading to his death.
He explained that his brother only opened up about the dog bite when his condition deteriorated. This is after he went to Masafu general hospital in Busia and failed to get a rabies vaccine to save his life.
Akello Hellen, a resident of the Eastern division in Tororo Municipality was also beaten by a suspected rabid dog in June this year. Her test turned positive for rabies.
She painfully narrates how she spent 345,000 shillings at Divine Mercy private hospital in Tororo town to treat the rabies. A dose at the facility costs 69,000 shillings.
Owor Timothy, a resident of Kidera in Rubongi Sub County in Tororo District is the latest victim bitten by the suspected rabid dog on the buttocks on the night of 2nd July 2024 at his residence.
Owor, 62 and a piggery farmer was in pain feeling headache and nausea as he visited the office of Tororo District Veterinary office to register his case and seek referral to Rubongi military hospital for treatment.
According to him he was attacked in the night as he attempted to save his piglets from being eaten by the wild dog.
Owor is among the many who don’t know the first line emergency treatment of suspected rabies wounds. He shocked this reporter saying he applied engine oil on the wound as first aid.
Adong Teddy is another victim from Amagoro A North in the Eastern Division of Tororo Municipality. The 62 year old elderly woman was attacked and bitten on the leg by a wild dog on 3rd July 2024 on her way to a drug shop in Kasoli village in Eastern Division in Tororo Municipality.
She is currently undergoing a lot of pain with her wound not improving.
Experts’ Views:
Veterinary epidemiologist Sonja Hartnack is working together with Makerere University in Uganda on ways to effectively combat the deadly virus.
Around the world, someone dies from rabies every nine minutes of every day. Uganda records over 130 rabies deaths annually, but the number of unreported rabies fatalities there is presumably much higher according to Hartnack.
Hartnack reveals that dog bites are the cause of over 95% of all rabies cases. When someone is bitten by a rabid animal, a race against time begins because it’s a death sentence once the virus has reached the brain through neural pathways and the infected person presents the first symptoms.
The closer a dog bite wound is to a person’s head, the less time there is to take action he adds.
“To survive, the bite victim must receive a post-exposure prophylaxis (PEP) before the virus reaches neural pathways and the spinal cord,”.
However, that’s easier said than done in Uganda: only 20% of animal bite victims receive all five doses of the necessary PEP regimen. “Frequently, there are not enough PEP medications on hand and the bite victim gets sent to another healthcare center, which sometimes is far away,” says Hartnack, who is investigating the rabies problem onsite in Uganda together with research partners at the country’s Makerere University.
Hartnack says if dogs were vaccinated against rabies and their vaccination status were viewable in a registry, that could spare families and the healthcare system from having to undergo and administer PEP treatment.
He says that it would be much cheaper to vaccinate dogs to prevent rabies transmission than it is to treat dog bite victims. At the same time, this would mean less suffering for both dogs and people.
Since rabies is mainly a disease of poverty, not everyone can afford transportation to a healthcare center. Also, those affected sometimes don’t consult a doctor after a dog bite because they don’t know it’s necessary, or they contact a traditional healer who casts out demons. “Children are the most frequent victims of dog bites. There have been tragic isolated cases in which children kept a dog bite incident secret from parents and the entire family ended up falling ill with rabies,” Hartnack relates.
This holistic approach of thinking about and promoting the health of animals, humans, and the environment interconnected is called One Health. “It results not just in better care for people and animals, but also reduces costs,” Hartnack says.
The stated goal of the project is to largely eradicate rabies through vaccination and education campaigns, improved diagnostics, and case surveillance. The project is thus in line with the objectives of the World Health Organization (WHO), which is striving to end human deaths from rabies transmitted by dog bites by 2030.
Dr Juuko Ndawula, a consultant for herbal therapy says he knows no herbal cure for rabies.
Dr Ndawula warns victims of any animal bites against visiting traditional herbalists or witch doctors saying it’s a death sentence.
Health experts recommend that whoever sustains a dog/wild animal bite is required to wash the wound immediately with running water and soap for 15 minutes, report to the local leader and animal health practitioner to get a reference letter and should rush to the nearby health center for treatment within 24 hours.
However in order to prevent rabies and animal bites, it recommends that dog owners confine and feed their dogs, and the population should desist from throwing stones or provoking dogs, and stand still if the dog tries to attack you.
Dr. Boniface Obbo, the Uganda Veterinary Association (UVA) secretary has hailed the government for its commitment to tackle a problem that is widespread across the country, but can be resolved with vaccination of pets.
He urged Ugandans to take keen interest as well. ” We advise the general public to consider vaccinating their dogs and cats at least once a year to protect the public from the deadly Rabies.”
District leaders speak
Dr Pakasi Daniel Nalapa, the Tororo District Veterinary Officer said they are experiencing several challenges to tackle the problem such as lack of facilitation to move to homes and sub-counties to look for pets for vaccination, Vets as foot soldiers are not given Post Exposure Prophylaxis (PEP) and some of them are abused and ridiculed by the population for wasting time and money on animals instead of humans.
Dr. Pakasi narrated that pet owners are reluctant to bring them for vaccination, the laboratory in Tororo is not well equipped with RDTs as compared to Busia and communities kill the suspected wild animals that have bitten someone, burn it and delay reporting cases.
The veterinary officer decried rabies vaccine stock out in government facilities in the district forcing most victims to seek treatment in private health facilities who recommend for 5 doses as compared to three in government just to exploit the population.
He however recommended for massive sensitization of the community through radios on the effects of rabies, first aid and how its controlled, people should keep dogs that they can manage, encourage them to control dogs population through castration and removing the uterus (spaying) and government should undertake a deliberate move to vaccinate animals, health practitioners and health workers who deal directly with the rabies victims.
Dr. Pakasi called for an improved disease reporting system from the village to the district, mass mobilization of pet owners to avail their animals for vaccination against rabies, enforcing our laws on pet owners who don’t present their animals for mass vaccination if we are to achieve the 70% target.
Omitta Patrick, the Tororo District Health Inspector confirmed that they have deployed surveillance officers in health facilities in the district and they are prepared to respond to incase of any distress call.
Omitta said the ‘One health’ district task force headed by the Resident District Commissioner is sitting this week to map out strategies to tackle the problem following reports from neighboring districts.
He said all village health teams have been notified on the free toll number of 82006767 to respond or send messages to the anonymous number on detection of any case in the communities.
He confirmed inadequate availability of the rabies vaccines in all facilities in the district yet the demand by victims from Busia and Kenya is high.
Omitta recommended for rabies vaccines to come under affirmative action and shouldn’t be credited under primary health care.
Dr Okoth Obbo, the Tororo District health officer recommended visiting schools sensitizing the children on the dangers of getting exposed to wild animals especially dogs and telling them how dangerous rabies is as a disease.
Mary Evelyn Aool, the Natural Officer Tororo said as ‘One health’ team, they have alerted the technical planning committee on the outbreak in the neighboring districts and parish chiefs to report any wild animal noticed in their area for appropriate action.
Aool also attributed the destruction of swamps especially in Malawa and Malaba rivers, caves in Tororo rock and Osukuru hills and forest letting out the wild animals to communities.
She warns the public against destruction of the environment especially areas that act as habitats for wild animals and also encourages them to plant more trees to conserve our environment.
Mulimba James, the Busia District Health Inspector who doubles as the Surveillance focal person confirmed shortage of rabies vaccines, a situation that has given a window to business men to exploit, including dealing in fake vaccines.
He appealed to the government to urgently send vaccines to these hospitals to save the situation and also called upon the population to vaccinate their pets to curb the vice.
Dr Patrick Baraza, the District veterinary Officer Busia and his Namayingo District counterpart Dr Godfrey Kiyimba have confirmed that the two districts have procured 7000 and 3000 doses respectively of anti rabies vaccines for free and mass vaccination of pets as part of the interventions.
He says at least three cases involving animal bites are reported on a daily basis in Busia district, the majority of which are children and women.
Dr Baraza adds that whereas they have been recording dog and cat bites, bites involving foxes, Jackals, Civet cats and mongoose are on the rise.
He confirmed that they registered ten cases of animal bites in the last one week but two turned out positive for rabies.
Impact of Degradation on environment.
Land degradation affects nearly 2 billion hectares of land worldwide and is therefore a priority issue across the globe as manifest in the Action Plan for the United Nations Decade on Ecosystem Restoration (2021-2030).
The World Environment Day, inaugurated by the UN in 1972 and first celebrated on June 5th 1973, serves as a global vehicle for raising awareness and promoting action for the protection of the Environment.
As the World commemorated the World Environment Day 2024, the clarion call to action sounded louder than ever under the theme “Our Land, Our Future. We are # Generation Restoration.
This year, rather timely focus on land restoration, desertification and drought resilience underscores some of the most critical environmental challenges of our day and is imperative for concrete collective action.
Uganda on the other hand marked the day that was celebrated in Sironko district, Bugisu sub-region in Eastern Uganda under the National theme” Land Restoration for Climate Resilience”.
Environmental degradation is an increasingly pressing issue that affects us all. It is caused by a variety of factors, ranging from human activities to natural disasters, and its effects can be devastating. Many of these effects can cause further degradation, which means that this impact works as a downward cycle.
In many rural areas, people rely on the environment for their livelihood. Right now, 8 in 10 people living in poverty are rural, reflecting the severity of our environmental crisis.
Environmental degradation is a major contributor to poverty. Deforestation, overgrazing, pollution, and climate change all contribute to environmental degradation and can lead to decreased crop yields and water shortages. These factors can all contribute to poverty, as people are unable to produce enough food to feed their families.
However, encroachment and destruction of the environment such as wetlands, forests and river banks among others have forced most of these wild animals to seek refuge in the communities hence terrorizing the population.
