Rabies: A 5 Point Primer for Expats and Travelers in SE Asia.

Rabies Immunization Clinic Photo

Creative Commons. Photo by C Newlin de Rojas

1. Fatal.

If you are exposed and don’t get treatment, it is 100% fatal. Receive treatment within first 24 hours of contact with a rabies carrier for best chances of survival.

2. Saliva.

That’s how it is transferred. It isn’t about the bite, though deeper bites are more dangerous. If you are licked by a stray animal in a country with a high rate of rabid animals, i.e. SE Asia and India, you should get yourself to an emergency room. You could take a chance but it’s a game of Russian Roulette. Once you develop symptoms, you can start planning your funeral.

3. Painful

On the up side, they no longer inject you in your abdomen. Yay! But if you haven’t been pre-vaccinated, you must have an injection of RIG or Rabies Immune Globuline in addition to the vaccine shots. RIG jump starts your immune system and this part of the treatment is *painful*. They need to inject as much of this stuff as possible under the surface of your skin where the bite/lick occurred. The balance goes in your bum.

To give you a sense of this part of the treatment, imagine slipping a deflated balloon under your skin and then inflating it as much as possible. My daughter’s hand looked like the hunchback…except on her hand. Many ‘brave’ candies and biscuits were doled out by the nurses. Oh and my daughter got some too!

If you haven’t had a Tetanus shot in the last 10 years you need one of these too. And if you have a deep puncture wound, you actually need shots every 5 years. (Without treatment or vaccinations 1/4 people infected will die of Tetanus. The rate is higher for infants)

4. Ka-Ching.$$$

It’s expensive. Well, the RIG is expensive. Prices will vary. At our local (Bangkok) Catholic non-profit hospital, for an adult, you are looking at THB20,000 or $200. Of course everything is relative. If you are an expat on a juicy contract, this is likely peanuts for you and you are probably already at the more expensive snazzy hospitals. If you are in the US, you’d shell out about $1500 for a RIG dose Which brings me to #5, and this will make you Mambo.

5. It’s un-necessary

Well the balloon injection pain and loss of cash is un-necessary. If you get the pre-exposure vaccination consisting of three shots over a month, you do not need the RIG treatment, saving you money, tears, and time.

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If you work for a government agency, chances are they will have obligated you to get this done. You should thank them. If you are negotiating an expat package as we speak, you could consider asking them to organize and cover the country’s recommended vaccines prior to moving.

If you are like the rest of us, moving or traveling by choice (or working for one of those shoddy companies who are increasingly cutting corners) I’d wait until you get to Asia to get it done. It costs a fraction of the price: In the US, the three shots will cost you about $600 total pp while in Bangkok, at the local travel clinic, we paid about $15 total pp. You also have the option to choose the intra-dermal instead of the intra-muscular jabs. They are cheaper, less painful, and just as effective.

Check in later this week for our amazing story: Horses, Humans, and Rabies Oh My!, where I recount how two of us were bitten in one week, by different animals, and ended up at a snake farm for our shots. For real folks. Welcome to Thailand.

 

Readers please note: This is a short and basic overview. There are many things to consider. For example: RIG shots must be given within the first 6 days. By day 7, it can impede your own body’s response. Depending on risk factors e.g. animal and exposure types, some doctors will recommend a ‘wait and see’ approach, given the cost and availability of RIG. But then all of this is avoided if you simply get pre-vaccinated.

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How Halloween Saved The Christmas Countdown

I have a tendency to beat myself up over things. Right now, as I type this, a little voice is berating me because every time I check a published post, I find a typo but by the time I log into WordPress, I can no longer remember where it was.

Halloween 2012 was great fun but after an excruciating few weeks where little C never managed to earn a piece of Halloween candy after dinner, leaving her sister sweet P to work her way through both bountiful stashes of candy booty, I decided to jump on the candy fairy wagon for 2013.

It’s actually genius. You get the kids to pick out 10 (or whatever you deem reasonable) pieces of candy and the rest gets packed up to be collected by the candy fairy for less fortunate kids. In exchange, the fairy leaves a gift for the kids. For our inaugural year, I chose a small box of lego. I was so impressed with how willing they were to let go of the booty, I even stuck two lollipops on the box and a little fairy dust –aka sparkles that never actually make it into anything crafty.

The extra candy was hidden away to be disposed of when the kids were out. So of course, six weeks later, it’s sitting exactly where I left it. Every time I look at this one shelf of books, the candy bag says:

tsk tsk tsk, here I am still waiting to be given away. What’s wrong with you? You need only walk to the security gate and hand me over. Surely that’s not too difficult? Even for you?!

I could go on. Luckily, Thai Halloween candy is so unbelievably lame, I wasn’t tempted to consume it myself. Had there been decent candy, well I don’t even want to go there.

Thai Halloween Candy

Chocolate Flavored Skim Milk Tablets. Yum.

Before I know it, it’s November 31st, and I haven’t bought anything to put in the advent calendar! Crikey, what sort of SAHM am I? And then I remember the Halloween stash. Saved by my incompetence. Determined not to stuff them with sweets, I pick out a lone pack of candy for day one and vow to buy stickers and things for the next 23 days.

Day two rolls around and I have to distract the kids, while briefing Jefe where the candy is and tell him to put some treats the next box.

Later that day, I run off and buy a collection of erasers and small safari animals. I was rather pleased with myself, until I realized only the gorilla and brown bear fit in the boxes. Oh and strangely the camels. Every other creature will have to be a stocking stuffer.

This time I take it as a sign that the rest should be filled with the Halloween candy, reducing the pressure on my budget and my conscience as the voice from the book shelf is much softer now, with only half a bag left waiting for a home.

Don’t Touch My Child! Lessons from Asia

The American psyche is still reeling 33 years after the disappearance of little Etan Patz on his neighborhood corner. Kids have never been more coddled and cooped up. Activities like biking to school, which were once commonplace, now risk getting parents reported to social services, publicly ostracized, thrown in jail and on occasion nearly punched out by well-meaning grannies.

Is Our Fear Founded? 

Every successive generation of technology along with the widespread adoption of social media means we are now, more than ever, aware of potential dangers. Couple this with competing media outlets battling it out for viewers, and we have a very distorted view of the threats facing our children today.

This article was written for  In Culture Parent. To continue reading please click here.