The world's most infectious disease is 100 percent fatal - but also 100 percent preventable. In the Philippines, where, every year, 300,000 bite victims are treated for rabies and around 300 people - mostly children - die from the disease, a battle is under way. The government has set itself a target to eradicate rabies by 2020. Lifelines travelled to Manila to find out just what it will take to achieve this. And, in the busy waiting rooms of 'bite centres' and the isolation room at the Research Institute for Tropical Medicine, director Brian Tilley discovers that what for some is the stuff of childhood horror stories, is for many others an all-too-frightening reality.
Most people do not usually know much about a disease until someone they know gets it. My first film for the Al Jazeera series Lifelines: The Quest for Global Health was on rabies. Growing up in South Africa, rabies was definitely a disease you didn’t want to get. Your parents would warn you that if you were bitten by anything wild you would need an injection - and if you didn’t get it, you could look forward to a nasty death. But fireside tales of rabid meerkat and mongoose were usually devoid of fact. My trip to the Philippines, however, put that right.
Our first morning of shooting in Metro Manila was at the bite clinic at the Research Institute for Tropical Medicine, where hundreds of post-weekend patients had arrived for treatment. In the Philippines, up to 300,000 people are treated annually at bite clinics like this, mostly for dog bites.
We had been told that these centres were busy, but the burden of rabies is much starker when you see the mothers with their children and the old people waiting, patiently fanning away the pressing Manila heat.
We met nine-year-old Bibo and his mother Rowena in the queue. Bibo already had his arm bandaged but he needed the rabies treatment. At bite clinics in the Philippines this first crucial post-exposure treatment is free, but thereafter patients need to find the money for a further three treatments. Bibo’s family was from the Pamplona Compound on the edge of Metro Manila and Rowena was already worried about how they were going to afford the treatment. Bibo’s arm had had a chunk taken out of it by the next-door neighbour’s dog, which, for obvious reasons, was named One Eye. The first and most important post-bite injection has to be given directly into the bite. This wasn’t easy to watch and Bibo, perhaps because of the cameras, must have been the only kid at the clinic that day who did not wail the house down.
On the top floor of the Research Institute, at the end of a long corridor, are two heavily barred rooms. Dr Betsy Miranda from the Global Alliance for Rabies Control (GARC) showed us the rabies containment ward. It was empty except for a single metal bed and barred windows and reminded me of the cells on Robben Island where Nelson Mandela and his fellow inmates spent years of their lives. But here, if you are unlucky enough to go through these doors, there is no release. Once rabies has entered the central nervous system it cannot be cured. When a patient is admitted with full-blown rabies they die within 48 hours. The stories about rabies might have sounded exaggerated to 11-year-old boys in the South African bush, but nothing can prepare you for witnessing the hell of a rabies death.
We had already filmed mass dog vaccination campaigns, vet training and gotten a sense of where Bibo lived and what happened on the day he was bitten when a call came through to say that a patient had been admitted to the rabies ward. We had asked the head of the Research Institute if it might be possible to film when a patient was admitted. Dr Beatrice Quiambao had said this would depend on the family.
Back in the corridors outside the rabies unit the mood had changed completely. Young staff moved about with serious efficiency. Gathered around the barred door at the end of the corridor was the family of Mario Evangelista, a 53-year-old man who had been bitten by a dog at work. He had not been to a bite clinic, instead trying the traditional methods still popular in the countryside and small towns – bleeding the wound and rubbing it with garlic. His family was devastated. His oldest son, Marlon, tried to explain to us what it felt like to hear that there was no hope and that your father would die, soon.
GARC is working with the Philippines Department of Health to eliminate rabies. They hope to achieve this by 2020 with a campaign that is rolling out island-by-island, province-by-province.
Dr Charles Rupprecht of GARC says: “One of the biggest challenges with rabies is the basic concept of neglect - why are we a neglected disease? We have eradicated smallpox and even a disease like rinderpest, so why do we still have human rabies in children? We have tens of thousands of individuals, usually children, that die. Why?”
Working together, the departments of health and agriculture and the GARC have already got rid of rabies on one island in the Philippines. They are now moving the focus of the campaign to the northern province of Ilocois Norte.
Here the landscapes feel familiar. They fit the clichés of the Far East, probably because so many American movies have been shot here – Apocalypse Now, Platoon, The Year OF Living Dangerously - films about devastation and war. Right now in 2013 the war is on rabies. As Miranda says: “We bring together many sectors to achieve one goal of eliminating human and animal rabies. We will do it by 2020, region-by-region, island-by-island.”
On the last day of our shoot, we went to visit Bibo. His family had borrowed money from neighbours and relatives and he had completed his course of post-exposure injections. He was playing football under coconut palms.
Lifelines: The Quest for Global Health will air on Al Jazeera in 2014.