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Nothing had prepared Enos Chebet (10) for a vicious dog attack as he returned from school.

The P5 pupil of Uganda Primary Education school Suam in Suam town council, Bukwo district, was returning home from school, on foot, in the evening.

As he walked on, he recalls noticing a dark dog crossing his path and stopped on the edge of the opposite dusty access road, staring back at him, feigning innocence.

The unsuspecting litte Chebet, by instinct, thought it was one of the innumerable harmless domesticated dogs around the village, walking on past it, to proceed home.

However, he had barely walked three strides affront, only to be greeted with a sudden sharp pain in the left leg tendon, sending him scampering, on time to noticed the same dog turning away to go after hurting him.

The sudden vicious attack from the dog happened when Chebet was hardly 500 metres away from his parent’s home.

The little victim had managed to limp home, blood oozing from the fresh dog bite.

James Chemsito, his father, swung into action on learning the plight of his son.

He had rushed him to the nearby Rwirwot Health Centre III, where the patient could only obtain a first aid of a tetanus injection and referred to Bukwo General Hospital.

However, as hard luck would have it, authorities at the hospital regretfully had advised them to try elsewhere as the rabies vaccine was out of stock.

“My son accessed anti rabies drug from Kitale Hospital across the border in Kenya,” the boy’s father says.

Christopher Chepsiro, 53, of Rwirwot cell in Suam town council was returning home after work in the family field at about noon, when a fox unnoticeably emerged from the nearby thicket by the access foot path and attacked him from behind, biting him in the back.

His immediate action was to hurry at the nearby Rwirwot Health Centre III to seek for medical attention.

But all he could obtain was a tetanus injection.

He can’t bear to recall the difficulty he went through to access the rabies vaccine. All rabies vaccines must be taken over 2 weeks to be effective and to prevent getting rabies. 

“I accessed the rabies vaccine from Kitale Hospital at a prohibitive cost, equivalent to not less than Uganda currency shillings 450,000,” he sadly observes.  

Agnes Chemtai, 33, a resident of Rwirwot cell, was going about her routine domestic chores when their family cat, as if possessed, suddenly rose up from where it lay, nearby, came where she was seated washing utensils and bit her thumb hard and extensive.

Accessing rabies vaccine would become her worst nightmare.

The victims are merely a fraction of between 200-250 cases of suspected rabid dog bites that Bukwo district registers annually.

The most recent wave of rabies epidemic that barely a month ago before authorities brought it under control, has registered four cases of death.

The victims died after failing to readily access the rabies vaccine.    

Yet, apart from viral epidemic outbreak haunting human victims, it too threatened lives of livestock, as 11 cattle have too died upon sustaining dog bites from rabid dogs and fox.

Why Bukwo?

Bukwo district lies in the Elgon mountain ranges catchment area in eastern Uganda.

District veterinary officer Dr Henry Chelangat says a sizeable proportion of the district borders with Mt Elgon National Park, a game animal sanctuary hosting a handful of wild animals that are principal carriers (virus host) of the viral disease (rabies).

Among the perpetual carrier (virus host) game animals are foxes, jackals, wild dogs and cats.

“Occasionally, domestic pets (dogs and cats) have been driven by pangs of hunger; inevitably going on hunting errands, in the process straying in the nearby national park where they encounter with game animal carrier of the viral disease.

How pets contract rabies virus

Chelangat observes that the encounter of domestic pets (dogs and cats) with carrier wild animals in the wilderness is fondly scary as often the parties are engaged in fights, that entail biting each other and in the process, the domestic pets get infected with rabies.

It takes an incubation period of two weeks for a domestic pet that acquired the virus (through scary encounter with carrier game animals), to succumb to visible signs of the deadly viral infection.

“There are numerous visible signs/symptoms a domestic pet dog/cat exposed to rabies exhibit, but most notable ones include unprovoked violence to human beings and livestock (sudden mental out bursts of infected animal).

Infected domestic pets assume a dazed facial appearance, as well as developing form around the mouth and dripping saliva.

Acting Bukwo district health officer Dr Godfrey Barteka defines rabies as a deadly viral infection passed on to people through dog, cat or fox bite.

He is, however, quick to observe that while rabies is dangerous, it is preventable if a victim gets a rabies vaccine shortly after exposure to the virus.

He explains that the virus majorly wrecks the brain and spinal cord organs.

The incubation period before symptoms of the viral disease manifest on the victim varies from between two and six weeks, depending on the part of the body a victim sustained dog bite.

“When the dog bite is very close to the victim’s head, for instance, shoulder line or upper part of the arm, among others, the viral incubation is so short as the dog bite spots in question are so close to the head that hosts the brain organ (the part of the body that the virus targets. The reverse is true, similarly when a victim sustains a dog bite on the feet,” he says.      

A human being exposed to rabies and is unable to access rabies vaccine within the minimal stipulated viral incubation time of two weeks is bound to face dire effects, among others inflammation of the brain and distortion of spinal cord fluid flow, high fever, dazed appearance, form around the mouth and dripping saliva.

“Once the victim develops the visible signs and symptoms no amount of medical attention would make miracles of a patient to recover apart from dying,” the health officer says.

Survivors of rabid dog bite experience

Agnes Chemtai, a house wife and mother of four who sustained a bite from her own cat, says it was a horrendous experience.

“For a week before I accessed the rabies vaccine from Kitale Hospital in Kenya, I endured painful sleepless nights. The pain around the festering cat bite was throbbing. It was as if somebody was repeatedly pricking me with niddles,” she recalls.

Julius chemsito, another survivor, attests that apart from needle-like flashing pain, he endured high fever before he accessed the vaccine.

“My wife constantly wiped my body with a wet cloth to calm the temperature,” he remembers.

Accute vaccine stock out at public health utilities in Bukwo 

Barteka says rabies epidemic outbreak in Bukwo district is as old as the community owing the district being nearer the Elgon national park.

In the past, the district health authorities managed to bring the sporadic epidemic outbreak under control until the 2021/2022 health ministry restructuring exercise.

Bukwo district, like Kween, were curved from the great Kapchorwa district in the recent past.

When Bukwo attained a district status, the then biggest health public health utility (previously Bukwo health centre IV) was elevated to Bukwo General Hospital.

However, in the 2021/ 2022 periodic grading exercise of public health utilities across the country by the health ministry had seen Bukwo General Hospital pitifully degraded to health centre IV.

“Nobody knows why Bukwo General Hospital was degraded from a hospital to a health centre IV, although we’ve formally and repeatedly expressed this concern,” Barteka says.

He adds that degrading Bukwo Hospital had serious financial implication.

“Before it was degraded in the 2021/2022 financial year we would be allotted shillings 300 million that has since drastically dropped to as paltry sh60m,” Barteka says.

He explains that before the 2021/2022 restructuring, the district would use part of the sh300m allocations to adequately stock among others the rabies vaccine for the perennial rabies outbreak.

Fred Kibet, the assistant district health officer in charge maternal health, regrettably says the last drug dispatch to the district through National Medical Store (NMS) was only rabies vaccine for six patients against the enormity of rabies epidemic patient challenge that stagger between 200-250 patients perennially.

“Rabies vaccine is critical when we are making drug orders with NMS, however, a drastic reduction of the resource envelop to sh60m means that the little resources at hand equally caters for buying other essential drugs,” he observes.

Shortage of ant rabies vaccine in public health utilities has resonated deplorably to victims.

Christopher Chepsiro, a survivor, contends sustaining a rabid dog bite entails weaving a lot intricacies with largely shortage of ant-rabies vaccine in public health utilities.

Effect of rabies epidemic to livestock

District veterinary officer Dr Chelangat says livestock, like human beings, have not been immune to the challenge of rabies infection.

“Because livestock move out in the wilderness to graze, many have encountered rabid infected animals and in the process sustaining lethal bites, although cases livestock being attacked by rabid predators are many in the community,” he says.

Intervention by Agriculture ministry

He observes that at the height of the epidemic in the month of October to December last year (2023) the ministry swung into action.

“We’ve since received 5,000 doses of animal rabies vaccine. And as mitigation measure by the district veterinary office we’ve vaccinated 4,964 domestic dogs and cats,” he says.

Intervention by the district health office 

Barteka says there has been joint intensive community awareness through reach visits and local FM radio station by both the district human and animal health curative team.

“The message has implored the community to rush to the nearest health utility in the event of sustaining a suspected rabid infected animal bite. On the other hand, the district animal health curative team has always emphasized mobilisation of the community to bring their domestic pets for vaccination,” he says.

Chelangat, emphasizes the importance of awareness campaign by his office.

The veterinary office has among others emphasized the dangers of consuming carcasses of animals suspected to have died of the viral infection.

In the local FM radio station the district veterinary office has constantly spelt out signs and symptoms of animals suspected to have died of the viral infection.

Efforts

In an effort to control public health outbreak, the Government, through the health ministry and community public health department, has opened a regional public health emergency operation centre, now hosted at Mbale Regional Referral Hospital.

According to the overall in charge of the emergency centre, Dr William Okiror, the primary objective of the emergency operation centre is to respond to any epidemic outbreak that escalate in Elgon region.

“Among the activities the regional operation emergency centre is mobilising and co-ordinating the relevant human resource on the ground and at the ministry in the event of an epidemic outbreak in the region,” he observes.

Chelangat says the agriculture ministry has ably played its role for they’ve since received 500 doses of animal rabies vaccine.

Challenges

Barteka calls authorities in the ministry to re-instate Bukwo district its previous status (district with the biggest public health utility holding the status of general hospital.

“Downgrading the only district public health referral facility meant missing out innumerable privileges in terms of support from the Government,” he says.

Chalangat observes that there is need for the Uganda Wildlife Authority (UWA) to emulate from their counter parts across the border.

Mount Elgon National Park is a natural resource shared by both Uganda and Kenya.

According to Chelangat, while the local community in the Uganda side continue to grapple with rabies outbreak, the case is different with local community across the border in Kenya, that registers minimal cases of rabies outbreak.

Numerous bench marking trips in Kenya by veterinary team from Uganda, reveal that the government of Kenya through the Kenya Wildlife Authority have committed resources to fence the section of the game park that is in vicinity of the local community.

“The physical barrier of a chain link fence has stopped wild animals communities from straying in the communities, and equally the community cant wander in the national park. Our brothers and sisters across neighbouring Kenya used to suffer challenge of sporadic rabies outbreak, but not any more when a chain link fence was erected around the section of the national park nearer to the community. Its our prayer is if only UWA could do the same it could substantive measure in guarding against sporadic out rabies outbreak that constantly threaten lives of people and their livestock,” Chelangat says.