Wednesday, March 26, 2008

Rabies reminiscing

March 19, 2008

The ferocious barking of furious animals crashed through my senses and broke the rhythm of my serene morning jog around the soccer field. I turned to see 3 weimeraners charging at full bore towards me. I stopped running and stood still, hoping they would stop if they didn’t have something to chase after. They didn’t, and suddenly three snarling dogs were apon me with their teeth bared and bodies tensed to pounce. Well this would turn any dog lover a bit off.

“Nice doggie”, I said in a soothing tone. One dog paused, but continued to bark with back arched, hair bristleing, and lips curled back over teeth. The second dog, a bony nursing female with eight teats swinging from her chest paid no heed and lunged at me. Both paws landed on my chest and I grabbed her front legs to hold her chopping mouth away from me. She then proceeded to whip her head around and clamp her teeth onto my right arm. I let go of her legs and she dropped to the ground. She backed up a few paces and crouched low. She looked ready to jump again and I wondered if she would go for the jugular. Should I cover my neck or my head? What would my book on avoiding catastrophes say? Would I look under “D” for dogs, or “R” for rabid dogs, or “F” for ferocious attacking dogs? At any rate I could see the whites of this dog’s eyes, the way every canine glinted beneath the curled lips, and the tension of every muscle under the grey flashing hide, and man’s best friend was not a picture that came to mind.

I still could not believe they were actually attacking me. These were the three Weimeraners that jogged lazily around the grounds of “Rumipamba de las Rosas”, the hotel I was staying at. I’ve heard these dogs are actually called “The Velcro dog’s “ for their affinity to their owners and desire to be by their side. So where was the hook to this Velcro? I obviously had the teeth.

I was debating whether or not to throw the cell phone I was carrying at the dog’s bared teeth. But then what if I broke the cell phone? It wasn’t actually mine, and I didn’t want to have to pay for a new one. But then that was silly, wasn’t it? Certainly the cell phone wasn’t worth a jugular. I decided to adjust my position and angle the throw so the cell phone would land on grass and not on rock. Both the cell phone and jugular were saved when the dogs suddenly spun around and darted out of sight. They must have found their Velcro.

The dog hadn’t torn my long sleeved shirt and it was more pressure I felt at the area of the bite. I could see one small puncture wound, a red mark on my wrist and a few teeth shaped bruises, but that was all. I picked up a rock and kept on running.

Later I told the host that one of their dogs had bitten me. “They gave me a nice little smile and said,”I’m sorry”. Then they gave me the bill. I didn’t know how to ask if the dogs had been vaccinated against rabies and left with my bite mark. When someone else in our party mentioned to one of the staff that I had been bitten while running, their comment was,” She shouldn’t have been running”. As if it was my fault that I had been bitten by one of their dogs while running around a game field.

I haven’t developed any frothing of the mouth yet, but I have done some googleing on rabies, and it’s not a pleasant disease. Becky, a newly arrived Doctor at Hospital Vozandes del Oriente, nurtured every conceivable fear as she happily told me every morbid detail of contracting rabies.

“I seriously doubt the dog that bit you had rabies, BUT, rabies is fatal and there is no cure.” She said as we jogged along our route past the smoking volcanoes toward the town of Madre Tierra.

“But surely there are symptoms, you must know something is wrong,” I said.

“Nope, she countered. There can be no symptoms.”

“You must have some redness, or inflammation around the wound. You must have something.”

“Not necessarily, she said. It can take 10 days to develop symptoms and by then it’s too late. You always die. And here’s the kicker, you can be perfectly fine for two years, then all of sudden it hit’s you with certain death to follow.” (Notice the emphasis on death, fatal, and dying.)

“Well, I don’t think I have rabies.”

“I’m pretty certain you don’t either, but as a Doctor I’d advise you to get the vaccination. Why take the chance.”

I didn’t think not liking really big needles was probably a very good excuse.

While I was deciding whether or not to get the series of rabies shots, I looked into the history of rabies. It’s actually a pretty interesting fatal disease. All sorts of little known factoids of interest here. The following is what turned up on a google search.

Rabies (Latin: rabies, "madness, rage, fury") is a viral zoonotic neuroinvasive disease that causes acute encephalitis (inflammation of the brain) in mammals. In non-vaccinated humans, rabies is almost invariably fatal after neurological symptoms have developed, but prompt post-exposure vaccination may prevent the virus from progressing. There are only six known cases of a person surviving symptomatic rabies, and only one known case of survival in which the patient received no rabies-specific treatment either before or after illness onset. Rabies has been recognized for over 4,000 years. Yet, despite great advances in diagnosing and preventing it, today rabies is almost always deadly in humans who contract it and do not receive treatment.

Rabies-free jurisdictions, as of January 2006:
Australia, New Zealand, Fiji, Guam, Hawaii, the United Kingdom, Republic of Ireland, Norway, Sweden, Finland, Iceland, Japan and Taiwan/ROC.

Cats, dogs, and cattle account for nearly 90 percent of rabies cases in domestic animals, with horses, mules, sheep, goats and ferrets making up the remaining cases.

Among wild animals, the disease is most often reported in skunks and raccoons. Other wild species in this country in which rabies is commonly found include bats, foxes, and rodents.

The rabies virus, present in the saliva of an infected animal, is usually spread by a bite or scratch that punctures the victim's skin. The virus has a strong affinity for cells of the nervous system. It enters nerve cells at the site of the wound, travels to the brain, and then follows other nerve pathways to the muscles and organs. It also invades and damages the muscles involved in drinking and swallowing.

There are at least two other ways in which humans have been known to have contracted rabies, both extremely rare. Two people were exposed by breathing the air in caves inhabited by rabid bats, and six people contracted rabies following implants of corneas from donors who had undiagnosed rabies.

Most human victims, and apparently lower animals as well, suffer excruciating pain on swallowing liquids. Though they suffer from thirst, animal and human rabies victims are terrified by the sight of water. Another name for the rabies disease is hydrophobia.

Rabies can be totally prevented. You must recognize the exposure and promptly get appropriate medical care before you develop the symptoms of rabies.
• Where rabies is found: Human rabies is quite rare in the United States. Only 27 cases have been reported in people in the United States since 1990. Yet in some areas of the world (for example, Southeast Asia, Africa, and Latin America), human rabies is much more common. The incidence of rabies in people parallels the incidence in the animal kingdom. The great strides that have been made in controlling the disease in animals in the United States and in other developed countries is directly responsible for this decline in human rabies.

◦ Although rabies in humans is very rare in the United States, between 16,000 and 39,000 people receive preventive medical treatment each year after being exposed to a potentially rabid animal.

◦ Rabies in wildlife accounts for greater than 85% of animal rabies in the United States.

• Animals that carry rabies: Raccoons are the most common wild animals infected with rabies in the United States. Skunks, foxes, bats, and coyotes are the other most frequently affected.

◦ Bats are the most common animals responsible for the transmission of human rabies in the United States, accounting for more than half of human cases since 1980, and 74% since 1990. Rabid bats have been reported in all states except Hawaii.

◦ Cats are the most common domestic animals with rabies in the United States. Dogs are the most common domestic rabid animals worldwide.

◦ Almost any wild or domestic animal can potentially get rabies, but it is very rare in small rodents (rats, squirrels, chipmunks) and lagomorphs (rabbits and hares). Large rodents (beavers, woodchucks/groundhogs) have been found to have rabies in some areas of the United States.

◦ Fish, reptiles, and birds are not known to carry the rabies virus.

Normally between three weeks and three months can pass between infection and the onset of symptoms (incubation period). But in individual instances, it may be as much as several years.

In spite of being bitten by an animal with rabies, it is not certain that you have been infected. Only one out of six people who have been bitten develop symptoms - even if they have not been treated.

If you get rabies and do not manage to be treated in time, the disease evolves in two phases:


The prodomal phase (prelude)

In this phase, the patient may have a fever, vomiting and loss of appetite, headache and pain at the site of the original bite.

The autonomic nervous system is affected. This manifests itself as copious salivation and weeping.


The neurological phase

Paralysis may occur in this phase. In particular, there are spasms in the throat, making swallowing difficult.

The person affected becomes terrified of water (which is why it's also called 'hydrophobia') and becomes anxious and hyperactive.

It is in this phase that animals become mad and bite. Symptoms such as those seen in encephalitis are also present, along with increasingly uncontrolled movement, confusion and delirium.


Prospects

Once visible symptoms have developed, the mortality rate is almost 100 per cent. Very few people are known to have survived a rabies infection.

And a case history of a 23 yr old English woman for those interested in morbid details:

"On June 17, 1981 she was bitten on the ankle by a dog in New Delhi. On August 18, about two months later, she experienced the first prodromal symptoms. She became anxious and depressed, and it became impossible for her to drink more than small sips of liquid. While sleeping, she frequently sat up in bed suddenly, terrified. On August 19, she became confused, hallucinated, and was incontinent of urine. On August 20, she was unable to eat or drink and was taken to the hospital where she hallucinated and screamed in terror. Misdiagnosed as a psychiatric case, she was injected with a tranquilizer and sent home, however she repeatedly woke up screaming in fear and became so wild and agitated that her husband felt he could not deal with her by himself and took her to her mother's house. She remained terrified, hallucinating and screaming in horror throughout the night. She had no water for almost three days. She fell into a coma the next morning, and died on August 23."

That being said, I got the rabies vaccination.

Fast Fausto

March 22,2008

Fausto was driving in crazy Ecuadorian fashion. Yellow lines meant nothing and double yellow lines didn’t exist. He was weaving all over the road dodging dogs and people and passing cars like he was racing the Indi 500. This car was meant for speed.

I had hitched a ride from Shell to Quito with Jesse Saint, the aforementioned grandson of Nate Saint, who was murdered by the Auca Indians in the 50’s. Jesse, a resident of Florida, made the trip to Ecuador about 4 times a year to manage his airplane business. Fausto was the father of his business partner and the driver of our speed machine. We also had David, the nephew of Fausto in the car, who was going to Quito to meet for the first time the parents of an American girl he was dating.

The police were out in force today. It was a holiday weekend and they actually placed cones on the center lines around curves to prevent drivers from passing on the blind corners. They knew their drivers well, and knew it didn’t matter if the line was a double yellow, you had to put an actual obstacle in the path to encourage decent driving. These were a challeng for Fasuto. He drove straight at the cones as if he was aiming for a strike in bowling and then dodged back into the traffic at the last second.

We carried on in this fashion for about an hour and had just left Banos behind us. Then I saw it. The first time I had ever seen a cop pull over a driver, and the driver happened to be Fausto. The 20 year old police man pulled along side us in his truck with the “Policia” logo and angrily thrust his chin and eyes toward the side of the road. He was sporting a very serious frown and his eyes were squinting darkly beneath the furrowed eyebrows.

We pulled over, he got out and checked Fausto’s driver’s liscense, and then told us to follow him. Fausto was being cited for passing a car on a bridge. After about 15 minutes we passed two cops on motorcycles. The cop we were following waved to them and they made a U-turn and fell in line behind us. Finally we came to a stop in front of the police station in Pelileo. Fausto got out of the car and walked up to the gate of the station. There were now 4 policemen present.

Jesse turned around in the passenger seat and questioned me, “How strong are you?”

“Not strong enough, but I can run fast”, I replied.

“That’ll do”, he chuckled.

Then Fausto was forcibly pushed into the police truck by the four cops and and the truck left. Our driver had just been arrested and taken to jail for up to 30 days for passing on a bridge. The 3 of us sat in the car dumb-founded.

David was unable to drive because his license had been stolen and he didn’t have his papers. Jesse was unable to drive because he didn’t have his visa stamp indicating how long he had been in the country. Me driving was out of the question and I didn’t mind one bit on that account.

Then David sprang into action. With his blackberry in hand he began to access every latino’s extensive network of family, and made a call to arms. An uncle and his son were called from Banos, other family up the road in Ambato were contacted, and most importantly the cousin who was an official of something or other was notified. He left the car to research our options and disappeared up the road. Now we were down to two gringos in an Ecuadorian car without a driver 2 ½ hours from our destination.

Jesse explored the car’s provision’s. We found five taffy’s and consumed them immediately. Then we sat. And sat. And sat.
The warmth turned to cold, the daylight turned to darkness, and the full moon rose and cast it’s light on the broken and upended sidewalks of Pelileo.

Then David’s troops began coming in. The uncle and his son from Banos turned up. An elected official of Pelileo, who had been contacted by the family official, appeared in his business suit looking very official.

The official official came up to the car and indicated for Jesse to get into the driver’s seat and begin driving. We drove downtown and stopped to pick up another official wearing a nicer business suit. “Passing on a bridge very bad”, he said. This, of course, he said as he indicated for Jesse to cross over a double yellow line to go the direction needed. Then we drove back to the police station. The two officals got out with Jesse and David and the uncle and the uncle’s son and a deal began to be made. I saw some money exchange hands and slip into the pocket of Mr. nice coat.

Jesse poked his head into the car and said, “Fausto’s getting out.”

About five minutes later the police car returned and Fausto got out. There were slaps on the back, shaking of hands, and thank you’s abounded. Jesse, David, and Fausto got back into the car and we were four once more. Four hours after arriving in Pelileo and $120.00 lighter, fast Fausto was back on the road.

Tuesday, March 11, 2008

Hacienda Releche



La Ascencion del Altar

March 10, 2008

“The Bishop”, is the name given to the 17,451 ft peak of El Altar volcano. The Spaniards thought the pointed crown of the volcano looked like a huge cathedral and named it El Altar. “The Bishop” is the highest, but El Altar actually has nine separate summits surrounding it’s 3km crater with equally pious names. “The Big and Little Nuns”, “The Tabernacle”, “The Eastern Friar”, “The Devout Friar”, “The Central Friar”, “The Great Friar”, and “The Cannon” all share court around the Laguna Amarilla at the crater’s center. Incas called this massive collapsed volcano "Capac Urcu," meaning "Almighty Mountain." A full fledged ascent of this magnificent volcano, thought by many to be Ecuador’s finest climb, takes 7 days.

Well, I didn’t have a week, or a crampon, or an ice axe, so I opted for the lazy gringo route. Let the horse do the work and then hike the final 1000 ft to the crater rim. This works out well if you think the ride will be the local fair ground pony amble with cotton candy at the end. In reality, however, it is a hard core cowboy ride up and down the steepest terrain I have ever encountered, on a mule. Throw in 3 feet deep mud, land slides, and rain storms, and it is surprising I have lived to tell the tale.

My partner in crime was the young, gullible Swede, Johanna. We had stayed the night as the only guests, and only occupants of the rustic Hostal Releche. Unless, of course, you count the enourmous mountain beatle that flew circles around us sounding in no small way like a helicopter chopper. At 7:30am Saturday morning we were waiting patiently as our guide, Sergio, worked silently in his blood red poncho and leather chaps, readying the mule train for the trek.

Just before Johanna was catapulted onto her mule she decided to tell me that the last time she was on a horse she fell off when it was standing still and broke her arm. Seeing as I still thought this was a fairground pony trek that didn’t seem to be a problem. Then we set off and Johanna and her mule set off in a different direction. “What do I do?”, she yelped, as her mule disappeared down an alternate path and her reins flopped about unfettered on the mules neck. “Hold the reins”, I yelled after her as we dashed off in pursuit and tried to corral her wayward mule. Once we had all our mules in a row, we continued on towards the legendary mountain.

From the beginning I could see that this was to be a ride like no other. The horses sloshed about in knee deep mud and the guide kept whipping his reins at Johanna’s mule’s rear yelling “mula!” to get him to pick up what already seemed like a fairly good pace. Johanna was bouncing around in the saddle, threatening to bounce off at any moment, and I was weaving back and forth on the trail trying to hem Johanna’s mule in and prevent him from charging off to lands unknown. Then the going got steeper and the horses were grunting with the effort of the slippery mud and we all just settled down to business.

We went on for a couple hours in this fashion until I noticed that the guide had stopped bellowing “mula” and seemed to be peering intently into the gorge below. “No hay via”, he muttered and raised a hand for us to stop. I could now see rushing water and a brown sludge indicating a recent mud slide through the area we were traveling. We dismounted and after a cursory check the guide beckoned for us to continue on foot. Johanna and I slogged through the thick mud in our newly purchased rain boots. I tried to remember escape maneuvers for quicksand from my “how to survive any catastrophe book” as the mud sucked me down and threatened to seep over the boot rim at my knee caps. There was no way to avoid the mud and soon we had both hands plunged into the oily black goo in order to pull our foot free for each step with out leaving the boot behind. We managed the crossing and then the horses were sent across riderless. The weight of their bodies plunged them deeper into the mirey mud until the black earth rose up to their bellies and threatened to envelope them whole. They didn’t seem fussed, however, and emerged once again on the other side dripping and shaking the mud off like a dog wrestles out of the water.

An hour later, Johanna miraculously still in the saddle, we reached the refugio on the Collanes plain and the mules were let loose to graze and rest. Johanna and I continued on foot the final leg to the crater rim. The peaks of El Altar were shrouded in fog, but the Bishop revealed himself enough to show the grandeur of his lofty position. As we made our way across the boggy plain cattle mooed in the distance and small herds of horses and new foals meandered across the pasture lands. The valley walls echoed with the play of water and I counted over 20 streams cascading into falls as they flowed over cliffs and rushed to the valley floor.

Another two hours later and we made the pass of the caldera and high rock wall enclosing Laguna Amarilla. The view was breathtaking and worth every gasp and muddy boot it took to get there. We spent only 10 minutes beneath the altar before we had to return to catch Sergio and the mules before they left with out us. As we stood up to leave The Altar awoke to give a mighty groan of breaking ice and then lay silent once again. It was as if our visit and toil had been acknowledged by the ancient mountain and he had roused himself briefly before falling asleep again.

Our return trip was no less exciting. We were enveloped in a thick fog within minutes of departing and then the heavens let loose. The wind fought us and the rain soaked us and still the mules labored on. We came to the mud slide and Sergio hacked a new route and shoveled heaps of mud over the trial edge to clear a path. We set off again, Johanna by now an expert rider. Two hours more and we were back at the hacienda, almost 10 hours after we left.

I was frozen to the core and covered in dirt, mud, horse hair, and filth, but I would gladly return to the Bishop and his altar to record the majesty of such seldom seen beauty once more.

Sergio and the mud



The Bishop and the fertile plain



I'm on top of the world!!!!



Sunday, March 2, 2008

clinic patrons



Patient, Tungurahua, and Kirsten



Children and homes



Banos region evacuee's community



bus shennanigans



caravans and communities

March 2, 2008

The soft woosh coming from the left rear of the bus could only mean one thing. The bus had a flat. Luckily, or one might say, by providence, we had just passed a volcanizadora 200 meters back. No, it’s not some star trek gadget, but the local tire repair gang. Around these parts with the rocky pot-holed roads, and the tendency of buses to catapult over speed bumps, they ran a steady business. The bus turned around and limped back with a now audable thump for every tire revolution. We pulled up to the road side business and the show began.

The bus was jacked up and then two men scurried over with nut removal thingy’s and blasted off the bolts holding the wheel onto the axel. The wheel was maneuvered off and rolled away to another man wielding an anvil. He went at it with a fair few mighty swings and some how got the tire off the rim. I’m not certain how they do it in the US, but I’m pretty sure it’s not done with axe blows. The bus tire tube was pulled out and I am told they fuse the hole by melting the rubber back together.

This particular volcanizadora was also in the business of fighting cocks. While the road show continued you could have a look at his selection of four battle ready roosters. They were on display under four separate wire traps and scratching and pecking the dirt in a vain. One of them had completely lost his tail feathers, presumably in the last fight. I have never seen a cock fight, nor do I want to, but I am quite sure GOD was showing them mercy when he made them with a very small brain.

A half hour later and we were once again on our way.

This particular trip was organized by The Iglesia Esperanza Eterna. We were part of a medical caravan on our way to assist indigenous farmers displaced by the eruptions of Volcan Tungurahua. Sixty families living under the rim of the volcano had been rehoused by the government into one room dwellings without water or electricity. The Esperanza church was bringing clothes, blankets, food, and three doctors to provide free medical care. HCJB was providing a doctor, a nurse, free medicine, and three helpers to disperse and organize it all. We were provided a covered hallway between residences to set up shop. Four consultario rooms were set up and divided with blankets down the length of the hall. The Swedish nurse Kirsten and I took information and vitals before sending them to the blanket rooms. After the doctor visit they stopped by the table pharmacy and picked up some meds from Johanna and another nurse. We saw 60 people in 1 ½ hours. Most of the women my age were missing half their teeth. The most common ailment was “bichos del estomago”. Literal translation, “bugs of the stomach”, actual diagnosis, “worms”.

I felt sad for these people who lived such a difficult life with no hope of anything better. They lived a meager existance to begin with, farming and carrying back breaking loads down precipitous slopes. They spent their lives carrying enormous weights, and when they were too old to carry loads anymore, they spent the rest of their lives doubled over carrying the weight of a spine that would no longer straighten. How could I who lived a life of comparable luxury, not give more?