The Three R’s: Rabies, Rambo & Raging Hypochondria – Ko Samui, Thailand

The Three R’s: Rabies, Rambo & Raging Hypochondria
Ko Samui, Thailand

“It’s my bladder,” said the old man next to me, “it hurts when I pee.” Why do pensioners feel the need to discuss their medical problems with complete strangers? Is it an attribute of old age that arrives with the pension? This man was a total stranger, yet there we were, sitting in a doctor’s waiting room discussing the delicate nature of his plumbing.

“What you here for?” He eventually asked.
“Rabies,” I answered. I couldn’t blame him for looking surprised.

The trouble began two weeks earlier. My girlfriend, Caroline, and I had just arrived in Ko Samui, a small tourist island in the Gulf of Thailand. The journey had been 14 hours of back breaking tedium and we arrived tired and hungry, prompting us to take the first hotel offered by a gang of persistent touts. The room was clean, the bed was large and the shower was a hosepipe. What more could you ask for?

After a quick wash and a change of clothes we wandered over to the resort’s beachside restaurant. Candles flickered, cicadas sung and waves broke – it was perfect. A smiling waitress shuttled back and forth with an endless supply of noodles and beer, while a shaggy beach dog sat at our feet begging for scraps.

Returning to our room after dinner, we stumbled across the same dog curled up by a bungalow. Crouching down, I stuck out my hand to give him a goodnight pat. In an instant, he changed from a cute bundle of fluff to a snarling mass of teeth, lunging forward and biting my hand. To think, an hour earlier I was sharing my chicken Pad Thai with the ungrateful little bastard. Stumbling backwards, I surveyed my bloody wound as the snarling dog retreated into the darkness.

We never hear about rabies in the UK, probably because there hasn’t been an indigenous case since 1902, but in developing countries it’s still a massive problem, killing 35,000 to 40,000 people every year. In Thailand alone, 50 people died from the virus the previous year, all but ten contracting the disease through dog bites.

Following the instructions in my pocket first aid kit, I cleaned the cut with soap and water and swabbed it with an Alcowipe. I’d never been immunised against rabies and Caroline urged me to go to hospital, but I was tired and drunk. All I wanted to do was sleep. Big mistake.

Since 1947, twenty-two people have died from rabies in the UK, all of them contracting the disease abroad. In May 2001, 55-year old Hilario Laya died after returning from the Philippines, where a stray dog bit him. His life might have been saved if he’d received immediate medical attention, but he ignored the bite and died six weeks later in a London hospital.

The next morning we were up early to catch a ferry to the neighbouring island of Ko Tao, but before we left, I wanted to find the dog that bit me and discover if he’d been vaccinated.

“What dog look like?” asked the waitress in broken English.
“Small, brown, four legs, sharp teeth,” was the best I could do, but it seemed to do the trick.
“Ahhh, Rambo,” the waitress said with a grin.

Of all the dogs in the world, I had to stroke one named after a trained killer, just my luck. She called out and little Rambo appeared from beneath a bungalow with a dead bird in its mouth.

“This dog?” said the waitress, looking confused.

I nodded.
“Rambo good dog,” she said, “not bite anyone.”

Rambo sat looking up at us, a picture of innocence. Mentioning rabies produced an angry reaction.

“No! Rambo clean dog,” she spat, “him not labid!” Before storming off, leaving me alone with the dog, whose Mutley expression said ‘better luck next time, sucker.’

As we waited for the ferry, Caroline nagged me to go to the hospital, but I was trapped in my own stubborn denial. Deep down though, I was worried. I needn’t have been. Ko Samui hasn’t had a reported case of Rabies since 1985. In an effort to attract more tourists, the local authority vaccinated all the island’s dogs, prompting them to declare Samui a rabies free zone – one of only two areas in the whole of Thailand (the other being Ko Samet). Why nobody bothered to tell me is still a complete mystery.

When we eventually reached Ko Tao I had a headache and a sore back. It was probably dehydration and the results of a 3-hour boat ride, but I was beginning to think the worst. Like a raving hypochondriac, I analysed every twinge and niggle, visualizing the infection as it crept up my spine to attack the brain. It was all too much for Caroline, who frog-marched me down to the medical centre.

“Big man, big baby,” said the nurse, as she plunged the needle into my arm. It was the first of five post-exposure injections, with the rest due 3, 7, 14 and 30 days later. The immunisation has an almost 100% success rate when administered immediately, but my 12-hour delay was enough to plant the seed of doubt in my mind.

A couple of days passed, the back pain and headache continued, convincing me I had the virus. I crossed off symptoms from a mental checklist and anticipated the moment I would turn into a slathering lunatic. Caroline thought it was great fun to play on my paranoia – suggesting dog food for dinner and waving bottled water under my nose (hydrophobia is another common symptom).

It usually takes between 9 and 90 days for rabies symptoms to emerge, and when they do it’s not pretty. Fever, anxiety, nausea and headaches for starters, followed by spasms of the swallowing muscles, hallucinations, maniacal behaviour, paralysis, coma and finally death, usually by respiratory or heart failure. All doctors can do is sedate the victim, and in some hospitals, patients are tied down until they die.

We returned to the UK the day before my forth injection was due and an emergency appointment was arranged with my GP. Dr Tim was impressed; it was the first time he’d ever had to give a rabies vaccination.

“Lets hope it works,” he said jabbing the needle into my skin, “because if it doesn’t, the only thing I can do is sign your death certificate.”

A couple more visits to “Dr Tim’s house of happiness” seemed to do the trick. Ninety days passed without incident and the threat of a madman’s death disappeared. Life was looking good until I recently read that some cases can take 2 years to appear. The headache returned with a vengeance and a dull pain appeared in my back.

“Oh well,” I thought, “only 21 months until the all clear.”