We have now begun the second half of our community rotation. So far we have completed two weeks of community clinical in Iloilo City and surrounding area and are now in Antipolo, which is a suburb of Manila. Here we will complete our two weeks of community clinical thus finishing that requirement of our degree.
On our first day of clinical in Antipolo we visited a city health unit where we received a tour and learned more about their services. The clinic services 850,000 people and the nurse to patient ratio is 1/150,000 people. Ideally they would like to see 1/30,000 for a nurse patient ratio, but this is not possible due to their nursing shortages and funding.
One service in particular that interested us was one we are not all that familiar with in Saskatoon or even Canada. They have a section of the clinic devoted solely to rabies. The nurse informed us that they get 20-30 new diagnosed rabies cases every day. That is just for this city.
Upon observation of the city itself we have noticed the large amount of stray animals, namely cats and dogs, which wander around. There are usually no designated owners of these animals and therefore they lack the proper vaccinations we would normally see in Canada. These animals scavenge in garbage for their food and are dirty, thus carrying various diseases. They are unruly in their behaviour and from our Canadian perspective we fear them and their unknown actions. As we observe the Filipino people in their interactions with these animals it is normal for them to see stray animals and we will often see the children playing with or petting them. During other interactions we have noted people who try and avoid the animals and are cautious.
Our view of stray animals comes from our Canadian laws and treatment of animals as we have experienced growing up. The law states dogs and cats must be licensed, on a leash on city streets, and to be put down when they bite a human. If laws are violated fines are issued. Many dogs and cats are spayed or neutered thus preventing over population. As we do not see the same laws here it is foreign to us.
In Canada we do not have high incidences of rabies and this can be attributed to these laws. Perhaps if these same laws were implemented here the rabies incidence would decrease. Due to various factors we believe it would be hard for these laws to take effect.
One way they are combating this issue is through vaccination. In the clinic we visited, once an individual is diagnosed as carrying rabies they are given a free first vaccine and are required to pay for the second two dosages. If they feel an individual cannot afford the second two doses then they will be covered. These health initiatives have lowered the deaths associated with rabies and hopefully will continue to prove effective.
The chart for rabies exposure in the clinic
This is a terrifying picture of a poster hung outside the rabies clinic.