Published August 02, 2010
BALI, Indonesia - Putu Valentino Rosiadi should have started third grade this month. But instead of buying a new school uniform and notebooks, his father mournfully cradles a black-and-white photo.
The 8-year-old was next door when a stray dog jumped him in May, ripping its teeth into the boy's right calf. He was stitched up at a local hospital and sent home. His family was told no cases of rabies had been reported in their area.
Earlier this month, a high fever hit him. Valentino died two days later.
"He was delirious. There was foam coming out of his mouth," said the boy's father, Komang Suda, 32. "Every time we tried to give him water, it was like he went into shock. He was shaking and very agitated."
A rabies epidemic has gripped Bali, an island of 3 million people and one of Asia's top tourist destinations. Seventy-eight deaths have officially been logged in the past two years, including that of a 40-year-old woman a week ago, and many other deaths have likely gone unreported.
The Indonesian government says it's overwhelmed, with more than 30,000 dog bites reported in just the first half of this year across Bali. In a highly criticized move, officials killed about 200,000 dogs, instead of initially conducting mass vaccinations as recommended by the World Health Organization.
"We have a serious problem with the anti-rabies vaccine for humans ... we are very short of treatment across the island," said Nyoman Sutedja, chief of Bali's provincial health ministry, who expects all stocks to run out by next month. "We need help."
Hospitals across Bali have faced periodic shortages of free post-exposure vaccines since the outbreak began, leaving poor residents with few options. The shots remain available at pharmacies, but many Balinese cannot afford them.
"The sad part is they get to the hospital and they get turned away because they don't have any vaccines," said Janice Girardi, an American who runs the nonprofit Bali Animal Welfare Association, which has vaccinated 45,000 dogs and recently received funding to conduct an islandwide campaign. "Then they go home and die."
Several countries, including the United States and Australia, have issued travel warnings advising vacationers to consider getting pre-exposure rabies vaccinations before arriving and to avoid contact with dogs while in Bali. A handful of foreign tourists have reported dog bites, but none have been fatal.
Shots given immediately after contact with saliva from a rabid animal can easily prevent death. But once symptoms appear, treatment is useless.
Rabies kills some 55,000 people annually - mostly children - with nearly 60 percent of those deaths from dog bites in Asia, according to the WHO. The disease still exists in the U.S., but human deaths are extremely rare. Nearly all bites occur from wild animals, such as raccoons or bats.
The rabies incubation period can last from a few weeks to months or even beyond a year. Flulike symptoms, such as headache, fatigue and fever, are the first signs of infection, followed by agitation, breathing problems, fear of water, paralysis and coma.
Bali dogs, often covered in a scaly mange, are a common sight across the island. They roam beaches and hang out in packs, lounging around temples and markets. Many are kept as guard dogs, but as part of the island's Hindu tradition, most are typically allowed to run and breed freely. They forage for food from restaurants and garbage heaps, and have largely coexisted peacefully with locals and tourists. The entire island remained free of rabies until the first case was reported in November 2008.
Some believe rabid dogs from the neighboring island of Flores may have carried the virus with them into Bali aboard boats. Many Indonesian sailors refuse to leave port without their dogs, convinced canines are a source of good luck at sea.
"Culturally, it is difficult to convince people that dogs can carry disease," Sutedja said. "In the traditional Balinese faith people believe that dogs will take them to heaven."
Once rabies arrived, the virus spread quickly because a mass vaccination campaign was slow to start. Government officials opted to kill dogs in areas where human rabies cases occurred, using strychnine-filled meatballs and blow darts.
A third of the island's estimated 600,000 dogs have been killed since the outbreak began, Sutedja said. But he admitted the problem has only worsened with more puppies being born along with a spike in dog bites. Only about a quarter of Bali's dogs are kept as pets.
"The government doesn't want to do what everybody tells them from the WHO on down," said Dr. Henry Wilde, a rabies expert at Chulalongkorn University in Thailand, which serves as a WHO collaborating center on the disease. "It's a virtually hopeless situation."
Because dogs are territorial, vaccinating an entire village creates a natural barrier to keep rabid strays out, Wilde said. He added that in some cases, vaccinated dogs were being killed. About 70 percent of the dog population must be vaccinated to control the spread of the virus, but so far only about 20 percent of Bali's dogs have been reached.
Sutedja said the government has responded seriously to the threat, fearing dog attacks could damage its lucrative tourism industry, which so far has remained strong.
The island, known for its sun, surf and shopping, has slowly rebounded from two suicide bombings in 2002 and 2005 that killed more than 220 people. Many hope next month's release of the movie "Eat Pray Love," filmed on location in Bali with Julia Roberts, will attract hordes of new visitors.
But Valentino's father is a world away. He sits quietly outside his tiny two-room brick house nestled among lush banana trees near the western border with Java, about 100 kilometers from the five-star beach resorts and exquisite restaurants bustling with tourists.
Since the dog that attacked his son was killed and never tested for rabies, no one can say for sure whether his boy was infected with the deadly virus. Doctors maintain a rare autoimmune disease was to blame. Sutedja, however, said rabies is the suspected cause because dogs in the village had tested positive for the disease.
"I'm definitely upset, but there's not much I can do," said the boy's father, as a warm summer rain poured down. "My kid is dead and nothing can bring him back."