Maybe Rabies — By Jennifer Shipp
Asia Nepal South Asia Tips

Maybe Rabies — By Jennifer Shipp

Not everyone gets fevers and nausea and achiness with pre-exposure rabies vaccines, but John and I did. Luckily, Lydian was symptom free.
Not everyone gets fevers and nausea and achiness with pre-exposure rabies vaccines, but John and I did. Luckily, Lydian was symptom free.

I’d like to begin by talking about our bed. In photos of our vacation rental, our bed looked comfortable, but in real life, I’m sure that it’s just a piece of wood covered with a thin roll of cotton and some sheets. If I tripped and fell onto the bed by accident, I would hurt myself. It was that hard.

Normally, I pride myself on being able to adapt to things like hard beds, but last night, we all broke down and put some soft comforters over the mattresses to make things just slightly softer. It was lucky that we did this because by 1:00 AM, both John and I had high fevers, nausea, and hell-on-earth-achiness.

By some stroke of luck, when we were in Costa Rica, a client commissioned me to write about medical evacuations in foreign countries. I knew about medical evacuations because I’d considered one when John was sick in Morocco with Cyclosporiasis, but at the time, I’d had no idea how to initiate one or how much it would cost if one was necessary.  John recovered well enough to travel by land back to Spain. The next year, after our trip to Costa Rica, I had learned all about the business of medical evacuations through my client which gave me a boost of confidence in the realm of travel.

A medical evacuation is decidedly expensive running between $50,000 and $100,000 per person. If you don’t have travel insurance that specifically covers a medical evacuation and you need one, you will be asked to front this sum of cash before they airlift you to a country that can adequately handle your health care needs.

Travelers to India, for example, are at a relatively high risk of being bitten or scratched by a monkey. I knew this because of all the research I’d done about medical evacuations. Because Indian hospitals and clinics don’t stock the Rabies immunoglobulin that’s needed to prevent the development of the disease in humans should they be licked, bitten, or scratched by a rabid animal, such an encounter requires a swift medical evacuation to a country that does stock the immunoglobulin. I learned through my research that bites and scratches in countries like India or Indonesia are one of the major reasons why people have to be medically evacuated.

Before I’d feel comfortable going to a place like the Monkey Temple where petulant monkeys will steal food right out of your bag and crawl all over your, I wanted us to have the rabies vaccination. Though we carry travel insurance (UPDATE 2017: Not anymore–we do medical tourism now), I don’t tend to put much faith in such things and I’d rather cover all my bases. Thus, one of the main reasons we came to Nepal was to visit the CIWEC Travel Medicine clinic to get the rabies pre-exposure series that would exempt us from needing rabies immunoglobulin and a medical evacuation should we be scratched or bitten by an animal in India. In the United States, it would cost us around $3600 to get the pre-exposure series, but here in Nepal, it is only $360. The CIWEC clinic is highly recommended. It’s the place where US Embassy workers in Nepal go when they get sick. We figured it would be no-big-deal to get the pre-exposure vaccination series while we were here for four weeks.

On our first full day here in Kathmandu, we took a taxi to the CIWEC clinic to get our shots. Lydian was terrified of the shot, having recently endured two painful Japanese Encephalitis shots at the Travel Medicine Clinic in Boulder, CO. The rabies shots themselves, however, were quick and painless. When they were over we all smiled at each other and joked about how easy the process had been. We walked out of the clinic and got in our taxi to go back to our apartment, all of us relieved to have accomplished one-third of our goal.

When we arrived back at our apartment, we decided to go exploring to find groceries. We walked uphill for some distance in the hot, stinging sun past tiny, garage-sized businesses with funny names like “Unique Meat Store” and “Try Again Food Center” until we found a grocery store. Even now, I can’t tell you what we bought because my stomach turns over just thinking about it. It was in the store that I first noticed that my eyes were having trouble focusing on the food labels. I didn’t mention it to John or Lydian, but instead chalked it up to jetlag.

The next day, I felt restless. I tried doing yoga. I tried laying very still. I ate a banana. I drank some Yogi Tea, steeping a little tea bag that proclaimed that Bliss is a constant state of mind, undisturbed by gain or loss….“But perhaps affected by ambient temperature and general discomfort…” a voice inside my head added sagely.

The minutes plodded along. It was 89 degrees in our apartment with no fan and no air conditioning. We all complained and whined about jetlag, the heat, the fact that all we had to eat for meals were lentils, mung beans, and garbanzo flour. Slowly, the afternoon turned to night and the apartment began to cool down.

When night came around 6:30 PM, John announced that he was exhausted. He was going to take

John is sleeping mid-day, evidence that he is, in fact, very sick...
John is sleeping mid-day, evidence that he is, in fact, very sick…

a “nap” at this late hour. Lydian also lay down in her room to “rest”. I lay on the couch with my Kindle reading a book about Buddha, but I couldn’t get into it. Around 7:00 PM John got up and said that he was going to bed for the night. Lydian wasn’t quite ready to sleep, but I’d been dropping off as I read my book and we all agreed that we could all use some extra sleep to try to kick the jetlag. The sky was still a baby blue color in the west, but we shut all the curtains and laid down on our hard beds. I was head-to-foot exhausted and I fell asleep right away.

At 1:00 AM or thereabouts, I awoke suddenly from a disturbing dream that I can’t remember and felt an intense pang of homesickness. Staring out into the darkness, I thought about my comfy chair at home, our cats, and our soft king sized memory foam mattress. As I reminisced about I home, I also started feeling intense pangs of pain in my tummy. I sat up on the edge of the bed and scrutinized the feeling more closely. It wasn’t just my stomach. I felt sick all over. I was achy and feverish, nauseated, and uncomfortable in a way that I’ve never ever felt before.

Sick. Sick. Sick.

I went to the kitchen to get some chamomile tea and then came back, slowly and carefully, step-by-step and propped myself up in bed to try to cope with the nausea. John sat up on the edge of the bed. I saw his dark shadow hunched over, unmoving and I whispered:

“How are you?”

“Not very good.” He said.

He recited a list of symptoms and I gave him the list of mine. I said, “Maybe it’s from the rabies vaccine.”

John nodded, but knowing that the vaccines were probably the source of our woes didn’t help matters any. I lay back on my pillows, stacked carefully, breathing in and out, in and out, trying not to puke. I was hot. My skin hurt. I thought of Lydian and wondered if she was okay. Our door was open and I listened for her, but I didn’t want to wake her since all of us had been kept up by the dog the night before.

Hours later, after the sun came up, while I was still feverish and feeling awful, I went in and checked on Lydian. She was fine. Totally fine, but she swore that I’d awakened her in the middle of the night (I hadn’t). She said she’d gotten up and stood in her doorway expectantly for quite some time with her flip flops on because I’d awakened her and then told her to “wait here”. I was pretty sure she’d been dreaming since she’d also thought that the door leading out of her bedroom opened into a long tunnel culminating in a big cave. Eventually, she’d opened her door and realized there was no tunnel, just the living room. At this time, she came in and checked on John and me, but she did so quietly and I never heard her.

In the morning, after I told her that John and I were sick, she expertly got out our medical bag and started looking for “diaphoretics” and ibuprophen to break our fevers. She got us tea and took care of us sweetly.

“Do you think this is going to happen on the second and third shots?” John asked me as he drug himself from the bedroom to the couch.

“I don’t know.” I slurred. John sat down on the couch, his face swollen and his eyes squinted.

“I think we should brace ourselves.” He said heaving a big sigh and putting his head back on a pillow.

“Can you imagine actually getting sick with rabies?” I said.

“No…”

Then we talked about Robin William’s suicide, Tuberculosis and Cholera, and how glad we were that it was at least cool today.

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