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Working to educate slum-dwellers about rabies

by
01 July 2014, at 1:00am

Pete Wedderburn continues the report of his trip to Delhi with ASHA where he found a high level of ignorance about rabies with many not knowing what to do if bitten by a dog.

LAST month, I discussed the global problem of rabies. I explained that India is the worst affected country in the world, with over 20,000 human deaths, mostly children, and nearly all human cases being caused by dog bites.

The “street dog” culture means that dogs live close to humans, although they are rarely kept as house pets in the way that we keep them in the UK.

I also explained that the answer to India’s rabies crisis is well-known but difficult to implement: vaccination of 70% of street dogs against rabies, combined where possible with sterilisation of dogs to prevent breeding.

This has happened successfully in some parts of the world, virtually eliminating human cases of rabies, and this is the approach taken by Mission Rabies, the UK-based charity that is aiming to vaccinate over two million dogs in India against rabies over the next three years.

The biggest challenge is to find a way to make rabies vaccination an integral part of a society that has no tradition of veterinary care of street dogs.

To find out more about dealing with rabies on the ground, I travelled to Delhi earlier this year. I was part of a group from my local church visiting a busy, chaotic slum, with other team members working in areas such as human paediatric health, education and building renovation.

The charity that we were helping, ASHA, is primarily focused on these issues, dealing effectively with many welfare issues in the slums. There’s no doubt that the charity’s work has transformed the lives of the slum dwellers but, to date, rabies had not been on their list of priorities.

My aim was to carry out a survey to try to determine the status of rabies in the slum: what did people know about it and what needed to be done to help?

Difficult research

The first thing I discovered was how difficult it is to do social research in a foreign country. I had thought I might gather several hundred questionnaires over three days, but the process took longer than I had expected: up to 15 minutes for each interview via an interpreter, then time spent seeking out the next candidate.

I ended up with just 40 completed questionnaires: not as many as I’d have liked, not enough to be significant in a formal sense, but still enough to gather useful feedback about the subject.

What did I learn? First, I discovered some interesting socioeconomic facts: 75% of households live in just one room, shared between an average of four people, with no kitchen, no bathroom, no hot water; 95% of slum dwellers own a mobile phone; 90% own a television; 65% own a bicycle.

Second, I discovered that street dogs are a significant part of the slum community, with an average estimate of one dog per 17 humans (the range was one per five to one per 20 people). The only way to get a more accurate figure would be to do a detailed dog census, which would be a major logistical challenge in itself, but the estimates are enough to make the point that there is a substantial population of dogs. While only 15% of people said that they “owned” a dog, 57.5% said that they feed local dogs at least once a week.

Third, I found a low level of awareness of the rabies: 80% of respondents had not heard of the disease, and only half of the 20% who said that they had heard of rabies were able to explain the disease to someone else. Some people thought that rabies would make them “bark like a dog”. 

Furthermore, only 45% of people thought a dog bite could be fatal, with 55% of people disbelieving this. There’s clearly a need for community education about rabies in order to prevent future cases. 

More positively, despite the lack of knowledge about rabies, 90% of people would go to hospital if bitten by a dog (where they would be given the post-exposure rabies vaccination).

As well as doing this, some people would take other action, including putting red chilli powder on the wound, and resorting to “witchcraft”. The 10% who “did not know what to do” if they were bitten by a dog are worrying: they would be very vulnerable to developing clinical rabies if bitten.

What can be done?

After gathering this information, the next stage was to work out what can be done to help in Mayapuri and in the other slums of Delhi. The charity that was hosting me, ASHA, has an effective network of community health volunteers on the ground, keeping an eye on the health of inhabitants in their local area, and passing on information to them about health and disease using handouts and ash cards.

I gave a presentation to a group of these volunteers, discussing the results of my survey with them and handing out several hundred picture-based information leaflets about “Getting along with dogs” (designed by Mission Rabies).

These volunteers will go back to their own areas and will talk to local parents and children, stressing the importance of avoiding dog bites by interacting appropriately with dogs. They’ll also mention rabies, the importance of wound cleaning and the need for a visit to a medical centre if a dog bite does happen.

But this was just one slum. What about the other 58 slum areas (housing 400,000 people) under ASHA’s care? And what about the other 500-plus slums in Delhi (with millions of inhabitants) that ASHA has not yet reached? 

There is a massive population in Delhi that’s still unaware of the ongoing threat of rabies. What can be done to reach them?

This is where Alliance of Animals and People (AAP) may come in: I visited this charity, too, while in Delhi. The concept is simple: AAP sends a volunteer on monthly visits to nominated slums to teach groups of children about awareness of the risk of dog bites and the importance of rabies prevention and treatment.

AAP also works with local communities to lobby municipal authorities to provide rabies vaccination and population control of street dogs.

An AAP staff member could visit slums like Mayapuri to give regular classes to children, raising awareness of these issues and helping to prevent future cases of rabies.

Educating the next generation 

If this generation of young people are educated now about the subject, they will soon grow into a well-informed generation of adults and the entire slum community will then become rabies-aware.

This suggestion may sound sensible, but it isn’t always so easy on the ground. In particular, funding is a challenge. AAP staff members are already over-stretched: if extra work was scheduled (such as visiting new slums), extra staff members would need to be recruited, costing at least £2,500 per year per head.

Since returning from Delhi, I have continued to liaise with the local charities, but it always comes back to funding. Can you help? Visit www. allianceofanimalsandpeople.org/ to find out more.

  • Dogs Trust is currently in talks to award a grant to Alliance of Animals and People (AAP) for support in the expansion of a rabies and dog welfare education campaign, and a sterilisation and vaccination programme in Delhi. It is already a keen supporter of Mission Rabies and its work in India.