New Post at a site we watch, pazonehealth.org.


Learn about parasitic disease! Fun Fun Fun!hydatid-being-removed-from-brain-e1506534933194.jpg

http://www.pazonehealth.org/single-post/2017/09/27/Hydatid-Disease-Part-IV

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Rabies: 9 years and things are not getting better


 rabid dog
For about nine years now, I have been traveling to Baltimore on a semi-annual basis. I go to the Johns Hopkins Bloomberg School of Public Health and deliver, more or less, the same talk, year after year,  about rabies.
9 years, and more deaths.
It’s part of the vector-borne section of the course. While not a vector-borne disease (unless we wish to think of dogs as a vector between us and bats–a bit of a stretch, if you ask me), rabies is considered one of the Neglected Tropical Diseases (NTDs), and because it’s a preventable cause of horrific and needless suffering it needs to be somewhere.
Opening Salvo
I always preface my talk with two informal survey questions:
  1. Does anyone know what the OIE is?
  2. Does anyone know what One Health is?
Answers:
  1. OIE stands for Office International des Epizooties, or World Organisation for Animal Health (yes, they use the British spelling of “organization, which I think is a political statement, but that’s another post). It’s kind of like the WHO for animals, and it is based in Paris.
  2. One Health is a concept advanced by the American Veterinary Medical Association, the CDC, and other organizations. The CDC states “One Health recognizes that the health of people is connected to the health of animals and the environment. The goal of One Health is to encourage the collaborative efforts of multiple disciplines-working locally, nationally, and globally-to achieve the best health for people, animals, and our environment.”
I think that over the years, I’ve had maybe three ‘yes’ answers to these questions, combined. The conclusions are obvious:
  1. The OIE is failing in its mission to educate the other health professions, as well as the general public, on the importance of animal health, both as it relates to animals alone and to human health as well.
  2. The One Health concept is a failed attempt by the veterinary profession to assert its presence into discussions of public health. It represents the profession’s inability to move itself from the general world of agriculture (where it is also clearly important) and place itself among the disciplines of other health sciences.
(As a veterinarian, we are used to being the red headed stepchild of the medical professions, so this doesn’t really surprise or irk me. Sometimes, we even create brilliant concepts, like One Health, so we can pretend that it’s really a thing for those outside of our bubble.)
So, what’s the problem here, specifically regarding rabies?
Let me preface this by saying that , I don’t really trust rabies statistics. The latest updates I’m reading estimate the annual number of rabies deaths at 59,000.  Given that most of these deaths come from rural areas in Africa and Asia with poor access to treatment and prevention, I’m not sure how they come up with that number. (On my to-do list: contact a rabies epidemiologist.) What I do know is that when I first started giving the talk, the number was 25,000 – 50,000. The range itself, varying by 100% of the low number, inspires doubt in and of itself.
That noted, the trend over the past nine years is at best level, and at worst shows an increase of 18%. Rabies does not get a lot of attention. Most diseases of the poor—Chagas’ disease, cysticercosis, leishmaniasis, hydatid disease, and others—get little attention. AIDS/HIV, tuberculosis, and malaria are the exceptions, but two of those are not restricted to poor areas overseas. Rabies kills “only” 59,000 people a year, a number that pales in comparison to the other diseases listed here. But working on one disease does not preclude working on another.  Rabies is low hanging fruit. The numbers of rabies deaths are skewed towards children.  Rabies is not a medical mystery. The bottom line is that no one should die the horrible death that comes with rabies infection.

 

Stoopid Kat!


IMG_0036Or stupid Homo sapiens.

(I’d write a post of import to someone other than me, but as I mentioned yesterday, the world is beginning to overwhelm me. Today I searched “Sunniest places in New Zealand.” I am sure that NZ has its own problems, but starting a war with North Korea and dealing with the daily antics of Tangerine Jesus aren’t among them. )

So you get this story instead:

I’m in the process of demolishing the downstairs bath. (I’ve got some really hideous pale yellow tile if you need some replacements.) Getting rid of the garbage is part of the challenge. I was shoveling out some of the plaster and tile through the bathroom window. I left the window open to get some fresh air in there. I closed the door to keep the animals out. Zoot and Dingo, my indoor cats, have occasionally gone walkabout, and it’s not fun.

She Went Out Through The Bathroom Window

Like most things in my house, the bathroom doorknob doesn’t work so well. (You should see what I have to go through sometimes to make sure that the boiler works. Another story, another time.)

Enter, or exit,  Genius Mutt, who was not on a leash, as I let him out into the backyard. The bathroom door was not latched, it turns out, and when I came home–after dark, mind you–there was Dingo, coming to the back stairs to come in the house. (For a long while I couldn’t tell the difference between my cats, so Dingo wears a collar with a bell attached to it). I can hear her usually before I see her. He sees the cat, which means time for terrorizing. When the cats are cornered, they’ll smack Kaleb on the nose, and he’s such a big chicken that he’ll back off, but when there’s open space, the cats prefer to retreat and the chase is on. Dingo runs and hides somewhere in the backyard. I bring the dog inside, screaming at him for chasing the cat (yes, useless at best, counterproductive at worst).

I set out to get the cat. I do not want my cats outside, not during daylight hours, and certainly not at night. We have a lot of coyotes here in suburban Boston. I hear them at night, especially when a chorus of pups starts on yipping fit. I’ve lost cats to coyotes, and it’s not pleasant, especially when you find the remains. I’d rather not be living among top predators in this kind of space–they can be packed much more densely here than in the wild–but I don’ think that that is about to change.

Missing animals upset me. They make me worry. My mind starts to wander to the worst-case scenario.

I go back outside to get Dingo, but she is still frightened from having the dog chase her all over the yard, and she bolts into the darkness. Shit. Back inside, get the flashlight, get a bowl of food.

I spend the next hour trying to find the cat.  I call her. I shine my flashlight into hidden places, including the neighbor’s shed. I wait for the police to show up and ask me what I am doing slinking around other peoples’ yards at night. I look under bushes, cars, along fence lines, up trees.  No cat. Not even the sound of her bell. I know that she probably hasn’t gone that far–cats rarely travel great distances under these circumstances.  It’s getting late, but  I don’t want to go to sleep. I want to stay outside and stay vigilant for coyotes and run them off if they come on my side of the street (they live across the street, in the woods by the river.

But eventually, inevitably,  I can’t do it anymore. I’m too tired, too worried, too frustrated. A lot of my worry is just about the cat, but it gets confounded and conflated with other things. I’m worried about having to tell my son and daughter that Dingo has disappeared, and may or may not come back. I worry that in the turmoil of the post-divorce period that the children are still feeling a loss, and I don’t want to add another loss. I think of my life here, how there is only one thing keeping me here–my children–and that I’m not ready for more loss, either. My life isn’t that bad. I’m safe, I have a roof over my head and food in my refrigerator. A family, who although not here, is behind me every step of the way. A woman who looks after my soul and my well-being. But a lot of things have disappeared in the last while, and I’m not looking to add yet another animal companion to the mix.

She came back. I woke up at 3:30 AM, went outside, and she wasn’t there. I woke up again an hour later, and as soon as I opened the door, she meowed, and ran inside, heading straight down to the basement where the food is. As I write this, she is sitting on the desk next to the computer, and when I rub her head she starts to purr.

I imagine that at some point she will again escape, and I will think, Oh no, not again. But for now I’m going to just enjoy the purring sound, and try not to think about everything else that’s going on in the world.

Polaroid of the Day


Pinhole again. 7 seconds. My cat, Zoot, under a light. She’s almost all washed out. I did some manipulation with Mac Photos. See below for the cell phone picture. polaroid of the day, april 6, 2017IMG_0319.jpg

Polaroid of the Day, and The Story of My Writing Career, zikhrono livrakha


How to open a cat’s mouth

This is one from the archives, it never made it into a journal. I’m guessing I took this picture (in truth, someone else must have taken it, because those are my hands–I think) when I was still doing some veterinary journalism, and that it was for an article.

Opening a cat's mouth

Writing used to be a great gig. I would write a number of articles per year. I’d do research, interviews, and then an editor would go over them with a fine tooth comb. Sources would be checked. Interviews would be transcribed. I would rewrite them to the editors’ specs, and then we’d go over the final product. For all of this work, I’d get paid enough to make it worth my while, and in my best year freelancing made up about a third of my income.

Then came the internet.