Disease Prevention - Rabies
By: Erin Vidler Romanuk, LMSW, ACSW
Appeared in The Spirit AWCS magazine in April 2009.
Erin Vidler Romanuk, LMSW, ACSW is a licensed clinical social worker from Michigan. She is a member of the Shanghai International Mental Health Association (SIMHA). SIMHA is a multidisciplinary professional association of therapists who provide mental health services to the international communities in Shanghai. For more information about SIMHA please visit www.s-imha.org.
Bali, Indonesia was supposed to be a memorable trip for me. My husband and I had been looking forward to spending time relaxing by the beach and exploring the island’s rich history and culture. Little did I know that the trip would meet and exceed my expectations.
Some of our friends who had been to Bali before suggested that we visit the Sacred Monkey Forest Sanctuary in Ubud. My husband and I thought that the Monkey Forest sounded like a great idea. We did a little research and found out that we would be able to feed bananas to the monkeys and get close enough to them to take some spectacular pictures.
Immediately as we walked into the entrance of the forest, we were bombarded by monkeys. They were approaching us from all sides and demanded that I give them the bananas that I had just bought at the entrance. Within one minute I had monkeys climbing on me taking the bananas right out of my hand. My husband and I along with several other visitors were laughing and taking pictures aw we fed the monkeys.
After all of the bananas were eaten by the monkeys we continued walking though the forest. As we were making our way back towards the entrance a monkey decided to climb up my right leg and hang on to my arm. What happened next not only shocked me but taught me a valuable lesson in health care and safety. The little muddy monkey that climbed onto me decided to mistake me for a banana. He tried to take a bite out of my right forearm.
The monkey did not break the skin on my forearm, but he tried. I had a bite mark in the shape of a mouth with some immediate bruising and red, raised skin. I cleaned the area with antibacterial wash and I decided to head back to the hotel to ask the staff for advice on medical care. My biggest concern at this point was to determine if I was at risk for rabies. All I knew about rabies was that it was fatal if left untreated.
Once back at the hotel we decided to go to the International Security OverSeas (SOS) Clinic on the island. I was quickly evaluated and the doctor and she determined that I needed to begin post-exposure treatment for rabies, even though there had been no documented cases of rabies in monkeys on the island.
For those of you who do not know much about rabies or the rabies vaccinations consider yourself lucky. Rabies pre and post exposure vaccinations are difficult to find many places in the world, including the United States and China. Not to mention, the cost associated with these vaccinations can be very expensive. Pre-exposure rabies vaccinations are recommended if you are traveling in areas where there are documented cases in animals. Moving to Shanghai, China did not qualify us for the pre-exposure vaccinations. If we would have moved to a more rural location in China then we would have received the pre-exposure vaccinations.
There are five post-Exposure vaccinations in all. They must occur on days 0 (the day you get bit), 3, 7, 14, and 28. I was able to get the day 0 post-exposure vaccination at the SOS clinic in Bali. After talking with medical staff at SOS and our health insurance company we found out that the only hospital in the Shanghai area that carries imported post-exposure rabies vaccinations is Shanghai United Family Hospital. While still in Bali, SOS made appointments for me at Shanghai United for the rest of my vaccinations. Unlike Bali, where the SOS clinic was a 20 minute drive from our hotel, the only SOS clinic in China is in Beijing.
I returned to work the week we got back from our trip to Bali and resumed life as usual. However, on what would have been day 7 for my post-exposure treatment, SOS contacted me to let me know they had been reviewing my case. The doctor reviewing my case made the determination that in addition to the five post-exposure vaccinations, I should have received an initial rabies immune globulin at the beginning on my treatment. Typically the rabies immune globulin is administered when there is broken skin as a result of an animal bite. Since my bite had no broken skin , the doctor at the SOS clinic in Bali decided that I did not need the rabies immune globulin.
The doctor that reviewed my case said she consulted with the World Health Organization guidelines, which said that in any animal bite case, regardless of the severity, the rabies immune globulin should be administered. The only location in China that has the imported rabies immune globulin is the SOS clinic in Beijing. SOS made arrangements and paid for my flight to Beijing, my hotel for the night, and arranged for a driver to take us to and from the airport in Shanghai and drive us around Beijing as well. They also waived all fees at the SOS clinic. The only payment we were responsible for was the rabies immune globulin, which ended up being four additional shots at the sight of the monkey bite.
In total I have had nine shots over the course of a month. I have completed the required course of treatment for rabies exposure. I tell people that my immunization card looks like a passport because I have stamps from three different hospitals and clinics where I received treatment. Even though I have had to travel near and far for these shots, I can rest easier now knowing that I am protected against rabies. In the future I will avoid any type of animal sanctuaries, regardless of how interesting or unique they are supposed to be.