Attenders at “The Plight of the Bali Dog,” during the Bali Vegan Festival – including a puppy up for adoption.
In trying to answer the question about rabies now in Bali, I had first to look back several years.
Until the outbreak of rabies in 2008, Bali had been rabies free for over 10 years.
In her 2010 column, “What You Need to Know About the Rabies Epidemic in Bali” at www.baliadvertiser.biz/articles/greenspeak/2010, Ibu Kat writes:
“The epidemic began in late 2008 in Uluwatu, probably introduced by pet dogs travelling with fishermen from other islands. A localized outbreak in such a remote area should have been easy to contain, but the World Health Organization (WHO) international protocols on rabies were not complied with. The virus soon spread to Denpasar and is now present in almost every regency on Bali.
Sanglah’s rabies clinic is treating about 1000 dog bites a month. Often there is no rabies vaccine (Verorab). Even more rarely available is immunoglobulin (SAR), the essential drug which must also be administered within one week into and around the wound if the bite or scratch has broken the skin. Two small boys were bitten last month and given the vaccine, but the immunoglobulin was not available. Both quickly died. Even when it is available, the cost of the drug is very high and depends on body weight — from Rp 6 million [U.S. $461] for a child to over Rp 20 million [U.S. $1,538] for a large adult. [Salaries here are about U.S. $1.00 an hour, so those life-saving drugs are not available to most local Balinese].
It’s not just Balinese being bitten. SOS International Clinic sees up to 300 dog bites a year, mostly tourists. The clinic always has a stock of the rabies vaccine but rarely has immunoglobulin. Because of this situation, travelers who don’t have the pre-exposure rabies vaccination often have to leave Bali urgently in order to obtain treatment elsewhere.”
Kim Patra, a Midwife & Nurse Practioner who has been living and working in Bali for over 30 years and now runs her own Private Practice & Mothers & Babies center at her Community Health Care office in Sanur, notes –
The first symptoms of rabies are flu-like, including fever, headache and fatigue, and then progress to involve the respiratory, gastrointestinal and/or central nervous systems. In the critical stage, signs of hyperactivity (furious rabies) or paralysis (dumb rabies) dominate. In both furious and dumb rabies, some paralysis eventually progresses to complete paralysis, followed by coma and death in all cases, usually due to breathing failure. Without intensive care, death occurs during the first seven days of illness.. .
In another column, Ibu Kat gave more information rabies situation in 2010. Much is still true today:
There is very little public information about the rabies epidemic on Bali. Although there’s now plenty of high quality dog vaccine on Bali and the government has received a million dollars from Australia to aggressively fight the epidemic, the human death toll continues to rise. The latest count is 40 deaths from rabies, 32 of them at Sanglah Hospital. The real number is probably higher, given the remoteness and poverty of many villages and the practice of burying or cremating bodies on the day of death without an autopsy.
BAWA [Bali Animal Welfare Association] staff member Dayu says, “We know that recently two families and a young Australian had to fly out. At least one American has been seriously bitten and did not receive immunoglobulin. We estimate three tourists a week report dog bites to us.”
This is not good for tourism.
Back in January , seven international rabies specialists visited Bali at BAWA’s invitation and spent three days sharing WHO experiences and protocols with their Indonesian colleagues. Their advice was simple and clear. “Culling dogs has never been effective in controlling rabies or managing dog populations. Bali should immediately stop culling dogs and focus all its human and material resources on vaccinating all the dogs it can and ensuring vaccine is available to people who are bitten”[my emphasis].
Dr Darryn Knobel, who has a PhD in rabies control and works with the World Society for the Protection of Animals (WSPA), gave a presentation on the ineffectiveness of culling (killing) dogs. In the past, governments in the developing world tried to control rabies in this way, but it has never been effective in either stopping the virus or reducing dog populations for long. At one point Sri Lanka and Ecuador killed a large percentage of their dogs (Ecuador 24%) without stopping rabies epidemics. When rabies arrived in Flores over a decade ago (again, with fishermen’s dogs from another island), up to 48% of the dogs were culled in some regencies. But there is still rabies in Flores; rabies can exist at dog densities as low as 5 dogs per square kilometre. Bangkok killed half a million dogs between 1997 and 2000, but there was no change in the number of human deaths and no effect on dog population growth.
Dr Knobel cited Mexico, Tanzania and Channai, India (with one of the highest rabies rates in the world) as locations that brought rabies under control with mass dog vaccinations and good medical services for humans. No culling was done in these locations.
In developing countries, between 25 – 50% of the general dog population dies every year. So if you eliminate that many, you are only replacing one type of mortality with another. The population loss is quickly offset by the rapid growth rate in the remaining population. Dr Knobel mentions that even in areas with the highest recorded rates of culling, populations swiftly recovered.
When culling takes place, the survivors no longer have to compete so hard for food or territory. Better nourished dogs have bigger litters, and more of these puppies survive. Very soon you have at least as many dogs (all unvaccinated) as you started with. And, until the dog population recovers, lots more rats. Frederick Knowlton reported in 1972 that coyotes bear an average of 4.3 pups at high population densities, but 6.9 pups when hunted down to low densities, making more food available. This proved to be the key to understanding why hunting or poisoning almost any canine is futile in controlling population.
Culling also encourages a couple of dangerous human behaviours. When a banjar’s [village] dogs are eliminated, Balinese families soon feel they want another dog. They quickly replace the culled dogs with unvaccinated puppies brought in from [possibly] infected areas. Or when culling starts, people move their dogs to a rabies-free area to prevent them being killed. Of course if these dogs are already infected, they transmit rabies to the new area. This could be why the epidemic is so widespread in Bali. (Infected dogs may not show symptoms for up to a year.)
Dogs are very territorial. Eliminating dogs from a banjar means that outside dogs can move in. A population of vaccinated dogs is the banjar’s best protection against infiltration by unvaccinated, possibly rabid dogs. Ironically, the maligned Bali street dog has an important role to play in preventing strange, unvaccinated dogs from entering their territory (providing, of course, that they have been vaccinated).
Sixteen villages in Gianyar have had confirmed rabies-positive dogs including, in the Ubud area, Peliatan, Sayan, Jukit Paku, Andong, Mas, Tegallalang, Abanagan and Gentong. Almost all of the infected dogs were owned; they were not street dogs except in the sense that most dogs in Bali wander the streets during the day and return to their compounds at night. The rabies epidemic in Bali is not being spread by packs of wild dogs. It is being carried by owned dogs. And only urgent mass vaccination can control it.
Vaccinating dogs against rabies is hard work. The four BAWA teams, in cooperation with the Dinas Perternakan, leave before six every morning in vans equipped with large catching nets and high quality vaccine. In the hot sun and the pouring rain they capture, vaccinate and mark every dog they can find in complying banjars, keeping careful records as they go. These days, they are vaccinating about 500 dogs a day in Gianyar Regency. But BAWA can only use the WSPA-provided vaccine in banjars which sign an MOU committing not to kill their dogs. Sometimes the BAWA team has to return five times to a banjar to obtain the signatures it needs. With about 50,000 dogs in the Regency, this is a daunting project.
If a dog is acting suspicious, it should be collected for observation by BAWA. Trying to kill a dog without proper training and equipment is a good way to get bitten. Even burying an infected dog without protection is dangerous. A man in Mengwi who killed his dog recently died because some of the infected dog’s saliva entered his eye. Dogs suspected of rabies should be reported to BAWA at 0811389004 and they will collect and quarantine the animal. Currently there are no other rabies quarantine facilities on the island. If a dog is still alive 10 days after it shows suspected symptoms, then it is considered rabies-free. A rabid dog (or human) will die 5 – 10 days after the first symptoms appear.
Vaccinating your dogs and keeping them off the street is the safest option these days. Since an early March directive from the Bali government ordering 10,000 dogs a month to be culled, pets have become a soft target.
Chaining dogs also creates difficulties. A dog chained in a compound can’t protect its territory, and can’t even defend itself if a rabid dog attacks it. . .
If bitten, BAWA recommends, “Cleaning the wound immediately — right then and there, not waiting until you get home or to a clinic — is very important in preventing the virus from entering the body and reaching the central nervous system. Wash the wound for at least 10 full minutes with running water and detergent. (Detergent breaks down the wall of the virus.) Then apply iodine or alcohol to the wound and get the patient to Sanglah Hospital quickly. The contact person for the Rabies Team there is Dr. Ken Wirasandhi at 081 2395 8111. Pray that they have VARS rabies vaccine and immunoglobulin when you need it. Dog bites should not be stitched.”
BAWA reports, “Rabies Control Now
Since 2011 the government has officially managed Bali’s rabies control and eradication program. BAWA continues to sterilize dogs as a population control measure and to immunize animals against diseases including rabies.
BAWA runs a 24/7 emergency hotline and education programs to raise awareness.
Unfortunately poisoning continues. BAWA lobbies for sterilization and vaccination to combat rabies. We advocate strengthened animal welfare laws to make inhumane killing and other cruelty illegal; we also argue for better law enforcement.
What it doesn’t say on its website is that the Indonesian government has shut down BAWA’s animal shelter.
What’s the international official word on rabies in Bali?
According to the U.S. Government travel advisory: “Rabies is endemic in Indonesia, but extensive dog vaccination has reduced cases in Bali by almost 80 percent. Other islands in East Nusa Tenggara (NTT) and Sumatra still pose risks for rabies. Rabies is a highly fatal disease and availability of treatment is very limited. If bitten, immediately seek treatment at an international clinic. The CDC recommends rabies vaccination if you will spend time in rural areas while in Indonesia.” https://travel.state.gov/content/passports/en/country/indonesia.html
The World Health Organization (WHO) says, “In recent years, a number of rabies control and elimination pilot programmes carried out in Africa, Asia and Latin America have achieved a sustained reduction in human rabies cases through mass vaccination of dogs. In a number of urban areas, particularly in India, vaccination coupled with sterilization of dogs has resulted in local elimination of rabies in both humans and animals. . .
The most complete official information I found was at the BARC, Bali Dog Adoption and Rehabilitation Centre, website:
“Rabies is prevalent in Bali. . .
WHAT IS THE CURRENT RABIES SITUATION IN BALI?
As of April 13, 2013, more than 130 people have died from rabies in Bali since the outbreak began. Human and animal rabies cases have been confirmed near popular tourist destinations throughout the island. Efforts, including vaccinating dogs for rabies, have been made to control the outbreak. These efforts appear to be helping to manage the outbreak on the island.(Source: The Global Alliance for Rabies Control).
WHAT IS RABIES?
Rabies is a rapidly progressing virus that causes death. It is almost always spread by an animal bite but can also be spread when a rabid animal’s saliva gets directly into the eyes, nose, mouth, or broken skin. The primary sources of human infection worldwide are dogs and certain wildlife species, such as foxes, raccoons, mongooses, and bats.
How can Travelers Protect themselves?
CONSIDER A RABIES VACCINE
• Immunization is recommended before you arrive in Bali, however, if intend to be here longer than 3 weeks you can obtain the immunization here at a cost of approximately $45. If you would like to do this please contact us and we can recommend a clinic for you to visit. The pre-exposure rabies vaccination is a three-shot series (days 0, 7, and 21 or 28) given before travel contact with the animals.
• Even if you receive pre-exposure vaccination, you will still need immediate medical treatment if you are bitten or scratched by an animal.
Avoid animal bites.
• Avoid touching wild animals and pets. Pet dogs in Bali are not always vaccinated against rabies.
• Resist the urge to rescue animals with the intent to bring them home to your country. Dogs and cats may be infected with rabies but not show signs until several days or weeks after you first encounter them.
• Supervise children closely, especially around dogs, cats, and wildlife such as monkeys. This is important since children are more likely to be bitten by animals, may not report the bite, and may have more severe injuries from animal bites.
Act quickly if an animal bites or scratches you.
• Wash the wound well with soap and water.
• See a doctor right away, even if you don’t feel sick or your wound is not serious. To prevent rabies, you may need to start a series of vaccinations immediately.”
What’s the on-the-street report about rabies that I’ve heard here in Bali in 2016?
A woman from Darwin, Australia, whom I met here in Ubud, has lived in Lombak, an Indonesian island east of Bali and west of Sumbawa, for 18 years. She says that rabies is a big problem especially for the poor Balinese. She has heard that one or two people die each week because of rabies. Part of the problem, she says, is that the government won’t give the very expensive anti-rabies serum unless the dog is caught and has tested positive to rabies. If the dog gets away, the bitten person will not be given the serum, and so by the time it’s obvious that rabies is the problem, it’s too late to do anything.
Remember that I’m not the best resource since I speak neither Indonesian nor Balinese, and I’m a tourist, staying in a Balinese tourist town. Keeping in mind that people everywhere like to complain about their government, (and this part is hear say) I’ve heard from various sources on the street that –
- The Governor of Bali just wants all the dogs killed as the easiest way to take care of all threats of rabies. [But we know that would not stop rabies].
- Government men come into villages and kill all the dogs even those that have been vaccinated.
- The villagers who resist the government men have been educated to stand up for their vaccinated dogs.
- There has been a eight-year killing spree of dogs.
- About 30,000 of the unique Bali Heritage Dogs have been culled since 2009.
- Rumor is that perhaps the government men get a bounty for each killed dog.
- Although the Balinese do not eat dog, other groups do. Some come into Bali and set up cheap restaurants selling meat from kidnapped and killed Bali dogs. 😦
- Leather products here especially if they are made of strips of leather can be from the hides of dogs and cats. 😦
- The symptoms for rabies and tetanus are very similar. Therefore, there is confusion in diagnosing rabies and even cause of death may not be accurate and so data about rabies is not reliable.
When many, many dogs were culled in 2008 after an increase in rabies, the rat population exploded and destroyed many of the rice fields. So the villagers know they need dogs, if for no other reason, to keep the rodent population down.
Because I’m in Ubud, a tourist town, I’ve seen mainly well-cared-for dogs. The saddest one is this one on Jalan Bisma.
Bali dogs, perhaps the oldest breed on Earth, are smart, hardy, short-haired, and independent, all wonderful traits in a humid, hot climate with owners who don’t have many material resources. The Bali dogs also have litters of about six puppies.
Now, however, on Bali it is popular for Western bred dogs to be imported. One myth is that if your dog is Western, it won’t get rabies! Not true, of course. Many of the imported dogs are high maintenance and expensive and have big litters. 😦
At the “Plight of Bali Dogs” talk last weekend, (Oct. 9, 2016), Ebony from BARC (Bali Animal and Rehabilitation Centre shared many facts. One is that it has been estimated that one un-sterilized dog over a seven year period could possibly have up to 67,000 offspring! So sterilization is essential in keeping the dog population at a reasonable level. BARC sterilizes 20 dogs a week.
BARC has an animal sanctuary and an adoption center; it works to educate local people, provide vaccinations, and medical care for animals, especially dogs. Started by an Australian woman, Linda, BARC relies on donations to continue its work.
Besides providing local families with dogs that have been vaccinated and sterilized, BARC does followup home visits and provides medical care for its adopted animals. Ebony also praised Elisabeth’s good work with cats at Villa Kitty.
A local Balinese man, Made, tells us that BARC comes in to his village each month to vaccinate any new dogs and check on the health of the animals.
My non-expert conclusion about rabies in Bali in 2016:
From the many healthy dogs I’ve seen and the fact that the news I can read in Bali now is not mentioning rabies and that the U.S. State Department Travel Advisory (that usually gives the most conservative recommendations) says rabies is mainly contained, and that the great animal rescue organizations here continue to do good work of vaccinating dogs and educating people, I think the rabies situation is better; rabies is not gone – but at least here on Bali in the tourist areas, there is less rabies than before.
But, if you are in Bali, the best way to prevent getting rabies is to
- Get a vaccination
- Check that the dog where you are staying and the neighbors’ dogs are vaccinated
- If you are bitten, follow WHO recommendations. Wound cleansing and immunizations, done as soon as possible after suspect contact with an animal and following WHO recommendations, can prevent the onset of rabies in virtually 100% of exposures.
- Stay at a place with a Bali Dog to ward off any dog that might have rabies. 🙂
Also, BARC recommends, “Before your trip, find out if your health insurance covers health care overseas and medical evacuation.”
When you come to Bali, consider bringing in items (towels, medicines . . . ) that can help the rescue organizations. BARC’s Ebony has been able to bring in expired, but still good, animal medicine that’s much needed – donated by Australian veterinarians. See if vets in your country will do the same. But a word of caution. Indonesia has draconian laws about drug dealers, so contact the rescue organizations for specifics so you don’t get in trouble by doing a good deed.
BARC -Bali Animal Rehabilitation Centre – https://barc4balidogs.org.au/
BAWA – Bali Animal Welfare Association – http://bawabali.com/
Villa Kitty – http://www.villakitty.com/
Be aware, be safe – and help Bali organizations that are working to help animals – and to stop rabies.