The Financial Passage Maker: The Wonders of Eleuthera ... and Rabies

Earlier this year, I spent some time in Eleuthera, one of the Family group of islands in the Bahamas. You can read a thumbnail description here: https://en.wikipedia.org/wiki/Eleuthera

It is a sublime place: uncrowded, replete with miles of pristine beaches (take your pick - the waves of the Atlantic on one side or the warmth of the Caribbean on the other). It is largely undeveloped for tourism with the exception of some high end residential areas in Governor's Harbour. Although we stayed at a friend's house, there is a wide offering of rental houses at reasonable rates.
http://www.discover-eleuthera-bahamas.com/eleuthera.html

The best approach to visiting this wonderful place is to slooowww down, rent a 4-wheel drive vehicle to negotiate back roads, and visit the various small settlements and beaches strung out along the Queen's Highway. Remember to drive on the LEFT and keep pace with the 45 mph speed limit. Due to very high import charges, your vehicle is likely to be a clapped out Jeep w/o air conditioning and with engine lights and the like in alert mode. The daily rental cost is about US $60.

This said, the main attraction is the friendly residents. Everywhere we went, we encountered open, smiling people with a wonderful sense of humour. They were genuinely glad to have tourists around. And forget about the crime rates that are present on other islands in the Caribbean: no one locks their cars or houses. There is a real sense of community in Eleuthera.

While simple, the food was fresh, tasty and very satisfying. We were especially fond of the food at Billy and Brenda's BBQ in Jame's Cistern: the ribs and boiled mutton were to die for; also the pumpkin and rice (a first for me); and never have I had macaroni as good. If you visit, get there between 11:00 AM and 2:00 PM every Friday and Saturday .... any later, and they will likely be sold out of everything. For those with a sweet tooth and a distain for waist watching, Brenda's deserts are very tempting.

Now to my adventure with rabies.

We stayed at a small beach house. Weather, especially the hurricanes, is hard on buildings. The house was a bit porous to things such as insects, the occasional mouse (intruders were dispatched promptly by trapping), and surprisingly, a brown racer (snake) which I initially thought was a twig by the fridge. I gently herded the 3' creature out the door with a broom. We were not at all put out by this circumstance as we've learned to take things in stride as they are part of the environment of places we visit.

However, one night, I awoke from my sleep to find something working on my ankle. I awoke quickly from a stupor and kicked the thing off. When the lights were turned on, there was no sign of the critter ... only two small puncture wounds about .5 inches apart.

I went on the Internet to check out possible culprits. The bite was consistent with that of a brown racer (they are only very slightly venomous and have been known to be aggressive in biting people). I hoped that this was the instigator. However, there was another, more sinister possibility ... a bat ... an animal which produces a similar wound.

I was very alert to this possibility as I was, for 10 years, manager of Wildlife Research for Ontario. We ran a large-scale rabies control program which was successful in eliminating terrestrial rabies from the Province. (At one time, Ontario was the "rabies capital" of North America due to the prevalence of human and domestic animal exposures to rabies in foxes and skunks.) And although I had received pre-exposure treatment decades ago, there was no assurance that my antibody levels were adequate to overcome a challenge from bat-borne rabies, strains which are especially aggressive in human beings.

I looked for signs of bats, and sure enough there were potential signs, including a sighting one evening while we were outside admiring an exquisite sunset. I checked wildlife reports for the island and sure enough, there were some roosts. Further, there was evidence that the incidence of bat rabies was in the range of 1 to 3 percent of the sampled populations.

I consulted with a local doctor, Dr. Bacchus, a wonderful, cultured gentleman, esteemed greatly by island residents. He checked with the local vet, and was informed that no cases of rabies had been reported in people and domestic animals since 1972 - also that the "scene" was quiet. He thought that I might want to get post-exposure treatment on my return to Ontario in a week's time. (Eleuthera and the Bahamas do not have the resources for rabies treatment, so the only options were to go to the U.S. or return home.) Dr. Bacchus was not willing to take any payment, so I reached into my pack and gave him a book: The Brain That Changes Itself: Stories of Personal Triumph from the Frontiers of Brain Science by Dr. Norman Doidge. He was delighted as it is one of his professional interests (he operates a pain clinic in Spanish Wells).

I weight the odds. Dr. Louis Pasteur had studied rabies mortality in humans and discovered that the odds of dying increased as the site of the bite got closer to the brain. The reason for this is that the rabies virus replicates along the nerves. The body has more time to produce antibodies for bites on legs than, for example, on the neck or face before the virus reaches the brain. You can read more about Louis Pasteur here - a giant in the scientific world whose legacy has benefitted everyone:
http://www.britannica.com/biography/Louis-Pasteur

Using this logic, I should be OK as my antibody response system is excellent.

However low the odds of contracting rabies, I was mindful that bat rabies is very aggressive in humans ... and that the overwhelming majority of cases of rabies in people in North America (with very few exceptions) can be attributed to exposure to bites by bats.

I decided to return home for treatment. I Skype'd my local health unit and discussed my situation. It was agreed that post-exposure treatment was appropriate and they went about preparing the medication for my arrival.

A hint: I tried to contact the health unit by cell phone and land line to no avail - the circuits were overloaded and unreliable. The owner of the nearby Rainbow Inn (a fellow Canuck) advised that Skype is a more reliable option. It worked flawlessly from a WiFi access point.

For convenience, I received my first injections at our local hospital. While in a sick bay at the emergency department, I overheard the nurse at the nursing station mention something like ... "poor guy". Although it was her first experience, she did a wonderful job. There was only minor discomfort when 10 cc's of rabies immune globulin was injected at the site of the wound and a shot of vaccine was administered in my deltoid. I experienced no adverse reaction to this and three other follow-up injections. There is nothing to fear from the sometimes painful stomach injections and allergic reactions which sometimes resulted from treatments in years past.

Bottom line:

Elethera is a wonderful place. We will return very soon. We left with the sense that we had only begun to turn the first few pages of a very engaging book.
Be very careful of bats. In wild populations, the incidence of rabies can be in the vicinity of 1 to 3 percent. In one study in Colorado, it was ascertained that 50 percent of the bats recovered that had bitten people were infected with rabies. (Rabid bats are more prone to bite.)
Do not handle bats. Dispose of dead bats with a shovel and bury them.
If you think that you have been exposed (sometimes bites are missed/ignored) go immediately to your local health unit. Read more about it here: http://www1.toronto.ca/wps/portal/contentonly?vgnextoid=6daa548c35432410VgnVCM10000071d60f89RCRD
It is useful to keep things in perspective. For many years, I was exposed to bats during spelunking expeditions. Those were early days and we took a cavalier attitude to life. However, it seems that society is becoming more risk averse (to its detriment) and the age of helicopter parents and those afraid of risk are occupying a larger measure of our public discourse. "Prudence" is fast-becoming an artifact of the past. The fear mongering of politicians, those with a self-focussed "agenda" and a sensationalist public media should be dismissed out of hand. Live life large, prepare for contingencies and be flexible in responding to unanticipated events. And make sure that you don't become a candidate for a Darwin Award: http://www.darwinawards.com/