old yeller

I had my first case of rabies that died yesterday. It was a 16 year old
kid who had been bitten by the family dog a month before, and came in
for his rabies shots, but after the first round of injections (the first
time you come, you get 8 shots) he stopped coming. There are supposed
to be a total of 4-5 rounds of injections. The family told me that they
had had enough shots, so they didn't come back. Rabies is uniformly
fatal, even in the US, but completely preventable with the right meds
and timely treatment.
We find that despite working here for over 50 years, there is still a
fair amount of distrust of the muzungu medicine among the rural poor.
We have moms pull out their severely malnourished child's feeding tube
because there is a perception that we are choking their child, only to
have the child then die of malnutrition. We have a mass exodus from the
hospital when we have a death on the table in the OR because they think
we're trying to kill them. Every time there is a death on the ward,
since everyone is right next to each other, people get antsy and want to
leave to get away from the bad vibes/spirits etc. Of course, many
people get it and are grateful and get better, but not everyone.
I couldn't elicit from the family of the kid with rabies whether they
hadn't returned because it was too hard to get back, or they hadn't
understood the regimen of shots and thought they'd had enough, or if
they didn't like the idea of all those injections and thought we were
trying to harm them. I'm not sure which answer makes me sadder, but
seeing 16 year old kids die is always hard, especially when you were so
close to saving them -- just a few more visits for a few small injections.
It makes me worried for the future of the anti-retroviral program in
places like this, but fortunately, like I saw on my previous trip out to
the bush, it is couched in Zambian terms by Zambian workers, and
hopefully that will bridge some of those barriers, to mix metaphors.
Certainly it would be less well received by me, although I apparently am
good to hand out certificates. :)