Working to educate slum-dwellers about rabies - Veterinary Practice
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InFocus

Working to educate slum-dwellers about rabies

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.

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