Rabies trumps Covid: four months hunkered down in Laos


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Asia » Laos » South » Tat Lo
July 16th 2020
Published: July 16th 2020
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I had said that the next blog would not be from Tad Lo, surely we’d be on the move and somewhere else within internally-open Laos. I’d also stated that the virus we really fear is Dengue, not Covid. However, I had overlooked the unequivocal bad boy: rabies. The chances of Dengue or Covid killing a fit and healthy individual are slim, rabies doesn’t mess: once you have symptoms an unpleasant demise is as near a certainty as death itself – only 14 people ever, worldwide, are recorded as having survived it and some 59,000-odd per year don’t.

If you are travelling extensively within a rabies endemic country you are strongly advised to have a series of shots prior to departure. These are not cheap. And we have never done so. Why? Because my belief was that the pre-shots only broadened your desperation-window (the period within which you need to initiate jabs or get your first booster) from 24 to 48 hours whilst all high-risk destinations have the vaccine, even in tiny remote rural clinics. Let’s just say I was embarrassingly, dangerously wrong; I’d simply never really thought it through.

You guessed it, Ali got bitten… by our pup here
at Sipasert. Obviously we have known the pup for half its short life and it wasn’t being aggressive, merely mouthing (although with needle-like young teeth) in that attention-seeking, experimental, pup behaving manner. Yet it was at the stage of wandering freely and had itself been bitten by something large in recent days. He appeared to be fine and the chance of him having rabies was slight indeed, but you can’t tarry and you definitely cannot run the risk. Ali immediately washed the wounds for a solid fifteen minutes with soapy running water (she used a whole bar), this is highly effective at reducing any potential viral load present, and then applied an Inadine dressing (it sucks iodine into the wound and zaps the – bizarrely for such a killer – rather fragile virus). That said, with hindsight, the recommendation is not to apply a dressing and merely use a liquid sterilizer such as iodine to drench the wounds (not that we had any such fluids). Anyway, within the hour Pon, amidst many apologies, was running Ali to the nearest clinic to initiate shots (required on days 0, 3, 7, 14… and, seemingly here, day 28).

If my prior beliefs had been accurate then all was already well. The trouble is, as I said, they weren’t… Of course a vaccine takes time to initiate antibody production (to a significant extent, some 7 days or so) and until you have sufficient antibodies you are defenseless. Once symptoms become apparent you are assuredly going to die. But, in the case of rabies in humans, these typically take 1-3 months to manifest (in pups who knows?); there again they may also present within as little as five days. The vaccine shots alone, even if started immediately, are no guarantee of survival. What you need is, additionally, a shot of human rabies immunoglobulin directly into and around the wound: essentially, in the manner of Blue Peter, some antibodies we made earlier. And that’s why you get your pre-shots: if you have had them you don’t require the immunoglobulin, you already have a degree of protection and now all you need is two additional boosters to further stimulate your immune system.

Our local clinic doesn’t stock the immunoglobulin, not surprising as its shelf- (fridge) life is tiny and its price, accordingly, is exorbitant (you need 20 units per kilogram of body weight and even
Ali’s feather light 51kg would cost something in excess of $500 for the single injection). The locals merely hope that they won’t be unlucky and trust to the (not cheap themselves) vaccine shots.

So… there was the need for some rapid research and quick decisions. If you have contracted rabies it will start to spread immediately via your nervous system towards the brain where it multiplies (causing an onset of neurological symptoms – the point of no return) before passing to the salivary glands (from which you can transmit it onwards in your saliva). Can you obtain the immunoglobulin anywhere in Laos (there was no running to Thailand)? This is of (potentially life-saving) value at any point up to the seven day mark (whence your vaccine-primed immune system should have you covered), but the longer you wait the more progressed the potential spread. We contacted our mate Chris Cantrell at the British Embassy (Christ he’s a savior) and within a day he’d informed us that there was a stock in Pakse hospital, three hours away. Equally we had learnt that the hiatus from becoming infective to death is, indicatively (thankfully), narrow indeed. Thus, as the pup that bit Ali
was showing no symptoms he was either uninfected, newly infected and not yet able to transmit or would, very rapidly, display obvious symptoms and drop down dead. Again, by inference, if we could monitor his health for the next few days and he remained well then surely the situation didn’t require an immunoglobulin shot (nor vaccinations for that matter). We chose observation, with the option of running to Pakse if he so much as hiccupped (spasms are a sign). Oh, and we’d be playfully splashing him with water (hydrophobia is a sign) and running him ragged (so is ataxia). Sorted.

We woke the next to morning to find the pup absent. Maybe he’d wandered off? And yet we didn’t see him all day. I questioned everyone as to his whereabouts. Eventually it became apparent that Pon had relocated him to a distant farm in the village. Relocated? Was that a euphemism for ‘had him put down’? I emphasized our need to see that he was healthy and was assured that she’d bring him back for a visit. We were not assured. Twenty four hours later we’d still not seen him and I was beginning to get tetchy. The clock
was ticking. We had not asked for Sipasert to pay for the shots, but we did owe a week’s money and threatening to deduct the 750,000 kip from this was an imminent hand-forcing possibility, much to Ali’s distaste. If the dog was sick we needed to get to Pakse pronto; if it had been put to sleep, similarly. Again I implored: we just need proof that the dog is healthy.

The next day he was back, not just for a visit but actually reclaimed. The pup himself was evidently delighted to have returned and his mum positively delirious as she set about licking him from head to paw and nibbling out his newly acquired fleas. As to his health, he was as fit as a fiddle: a very apt phrase as its original meaning was ‘suitable for purpose’ and, as happy as we were to know that we hadn’t been instrumental in his death, his vitality was certainly that. We would not be chasing immunoglobulin. As if the pup had some preternatural insight into the reason for his extrication from banishment he spent the entire evening trailing us and later, as would now become his norm, slept outside our
door.

So, a great resolution all round – apart from the $90 the vaccine shots would cost. Ali had had the first two and might as well continue for the whole course, at least she would henceforth be rabies inoculated…

And, typically, to this joyful Yin there was a painful Yang. Chilo (my grizzly best friend and the alpha male of the pack) promptly bit two locals within the course of a fortnight. The first instance was an individual on a bike (he hates bikers) and Pon duly paid the man off; the unforgivable second was a toddler. No doubt the child had seriously provoked him (we’ve witnessed Namphun, Mario and Camcum pull his tail, prod and poke him, whilst if in the way he’ll receive a swipe with a broom or a foot to the bum – all of which he stoically tolerates). Nevertheless this behavior simply couldn’t be over looked and off to the farm he was sent. As bereft as we are at least he wasn’t, as would almost certainly happen in the West, sent forthwith to that kennel in the sky.

The current most likely contagion is, thankfully, not life threatening. It is a common observance here and elsewhere in Asia to see parents/friends picking lice from heads. Namphun, constantly in our presence and often climbing all over Ali, is crawling with them. We need to source a suitable shampoo.

Virally… I pray that the next blog doesn’t have Ebola in the title.

Anyway, on a lighter bucolic note: water buffalo. These are truly a strange beast. If the cows are grazing below us they will actually gaze up imploringly if they see a corn cob, melon skin or apple core in the offering; the buffalo ignore such freebies with disdain. They are wonderfully placid but fussy as hell. Oh, and they have the most bizarre, pitifully weak call, very much like your average cat's meow.

Yesterday Fabrice proffered us what looked like a hunk of minty smelling bark, from a rather expensive looking packet. What was it? He had no idea, but did say that on the back of chewing three such pieces he felt rather stoned. And so it transpired. It rather reminded us of Fijian Yangona, with the added bonus of subsequently great breath.

An extremely common sight in almost every yard are teepee-resembling vertical stacks of woody shoots; they’ve been cut, bundled and are awaiting a further purpose. It materializes that they are cassava (manioc/yuka), the edible (on cooking) tuber has been harvested and the trimmed stems are subsequently replanted… everywhere, regardless of incline, soil quality or irrigational suitability. Peculiarly cassava is a food stuff that we’ve yet to be offered. We are not unhappy with that as it was a Fijian staple that was only marginally more palatable than the dense cloggy dalo, another tuberous root that I will be grateful never to cross forks with again.

Two, thirty year old, references to Fiji in two short paragraphs is an ominous sign as that’s where we caught dengue.

Meanwhile, we continue to make our monthly jaunts to Salavan for the purpose of renewing our visas. To date Pon or another family member/friend has always (very kindly) taken us and whilst there she’ll stock up with items that are unavailable here. Often an assemblage of children will accompany us and on these occasions we’ll all ride in the back of the pick-up, squatting or lounging on a giant reed mat. It’s a journey that is far more pleasurable from this lofty, wind-blown vantage
where you can appreciate the tiny hamlets, spot the muddy fish ponds and now, in July, gaze across the green vibrance of the recently planted rice fields. On the return we all suck on straws emerging from plastic bags that may contain iced coffee or other rather more unusual iced drinks: one variant is sweetcorn based, another like a thin rice pudding, and the third incarnation – purple in colouration – contains slithers of some gelatinous fruit. We’ll also be snacking on aromatic sausages, gammon-like hunks of bacon and rolled cones of wafer-like sweet crispy waffles (think classy ice-cream cornets).

And talking of gelatinous fruit… It is lychee season and a tree out front is full of them, some small cherry-sized species. Our washing line is daily readorned with hanging bunches – that is until Namphun comes calling and demolishes the day’s stock.

As rainy days became more prevalent so the odd mosquito appeared and, fearing an imminent assault, we finally invested in a net. We sunk nails into beams and with precision length quick release ties in place had a dry-run hang. Shit, the roof of said net bore a (not unattractive) yogi bear motif whose weave is so tight as to negate the effect of the ceiling fan that is still desperately required. Fortunately mosquito numbers have yet to necessitate nocturnal envelopment and three weeks on the net remains bagged. But we are prepared.

Nevertheless, so we’re informed, during rainy season bed nets serve a further purpose: preventing scorpions and snakes – also keen to find a dry haven - from joining you during your somnambulance. We have started to see squashed scorpions on our little roads which, given the lack of traffic, causes some concern as to their abundance… and where they were heading.

As we wander, with the pup almost invariably in tow, we no longer receive the universal greeting of “sabai dee” but rather the extended “sabai dee teachers”. The pup himself, officially named Pak Dam (black mouth), is more widely known as “Teachers’ dog”.

Finally there was a party worthy of Savanah and Windy boy displaying their fire-twirling skills. The massed ranks of kids were both enthralled and terrified; the men folk definitely the former during Savanah’s scantily clad flaming hula-hooping. Incredibly reserved for us we cried off before midnight – it was a school day tomorrow after all
- whilst others were there until dawn.

Going back several blogs you may remember that Fa, the owner of Honey Bee restaurant, had invited us to accompany her when she returned to her home village in Champasak province some five hours away. Given the potential extended imposition we had declined her offer and as it materialized she didn’t actually leave as planned. Now, however, she was going for a shorter visit over the celebratory period of small Buddha day (her term not mine). In fact it seems that this is Boun Khao Phansa:the onset of Buddhist Lent or the annual three-month rains retreat known in Laos as "Phansa". Khao Phansa means to remain in one place during the rainy season. And what do the devout do during this enforced stasis? They sit and reflect, contemplate and meditate. So, unless things miraculously change, it appears that our lives are very monkish.

Unlike Christian Lent there is no abstinence involved and Fa informed that she wanted to take her western friends (seven of us) and a select bunch of locals from Tad Lo to join her family (she’s one of an astounding fifteen siblings) in feasting and partying. How could we refuse?

And what trouble she had gone to. Into the back of the truck with us, under an elevated tarp (essential protection from the early morning downpour and the inevitable midday scorch), were mountains of supplies and coolboxes, not to mention five cases of Beer Lao. Within minutes of departure we pulled up alongside a line of roadside stalls selling durian and pineapples and a great mound of these, primarily for gifts, joined us in the back. Then at Pakse we paused at a modern supermarket where Fa purchased all manner of western desirables that she knew to be breakfast favourites of her guests: slabs of bacon (Yaan, French, is very partial), porridge oats (Spanish Juan has them every morning at Honey Bee), a monstrous number of eggs, loaves of sliced bread for toast, real butter (Ali’s eyes lit up), as well as a miscellany of tins, tubs and jars whose contents might just be required. She’d not let us contribute a kip. This we had predicted and thus had already enforced an agreement whereby she’d allow us to buy a great stock of the mysterious bark, leaves and accoutrements that are assembled into
paan-like (also red-goo generating) parcels chewed incessantly by the elder ladies in the village; apparently her mum would be delighted. These we could acquire at a market closer to home. We had, at the supermarket – for our return to Tad Lo – managed to procure some tins of pate and tuna (oh, the anticipation), mayo for the latter, and several jars of rather promising-looking imported jam (we’d pick-up some butter on our return journey). Pushed, Fa did also allow us to buy several boxes of mini packaged cakes, a purported favourite of the extended family’s children.

Just shy of Fa’s village we stopped at a little rural market and were greeted by some remarkably familiar looking faces: two of her (many) sisters run a vegetable stall. And it was here that we gathered the necessary veg and matriarchal goodies. Fa’s attention had been distracted by some beautiful traditional embroidered skirt material and she was struggling to choose between two such lengths. Magda (Polish) had the inspired idea of requesting one for herself and off they tootled to the nearby tailors. Of course she had the second sample made up for Fa as well. The finished skirts would be
delivered later that evening. This diversion had the additional benefit of allowing us, in Fa’s absence, to pay for all the fresh green produce.

The village itself, I have no idea as to its name, is stunning. Situated along a currently very dry stretch of the Mekong (from our bank it was a sandy half kilometer to reach the central flow) it is a sleepy maze of narrow flora-enshrouded orange mud lanes with the wat, a few basic shops and, by Laos standards, really rather affluent houses and homesteads (most builds incorporate at least some brick and concrete whilst the roofs are typically tiled rather than a patchwork of corrugated iron). Ducks, geese, chickens and dogs are, highly vocally, everywhere, whilst Mynah birds hop around puddles and masses of butterflies flutter between hibiscus.

We immediately met mum and what an adorable hardy (she has pushed out fifteen weens) little old lady she is. Sleeping wise Fa gave us the tour of options: three family-owned homes including hers were currently empty but, prior to our arrival, had been aired, curtains rehung and beds made. Personally Fa would be crashing with her ma. With an inevitable late lunch consumed Fa
announced that she was off to pick up the fish, some sixteen kilos worth: there were plenty expected for dinner that night.

And as the sun set and beers cracked the numbers on the raised sitting/eating platforms outside our (Fa’s) house swelled.

I fell in love with another of her sisters, a large bubbly, beer-guzzling delight. Meanwhile Yaan was running scared: one of Fa’s close friends, not a shy lady, had already made less than subtle indications as to her amorous feelings towards him.

A constant succession of salted, lemongrass-stuffed crucible-grilled and spicy steamed fish joined the heaped piles of white string noodles, salad and aromatic leaves, from which succulent parcels adorned with fiery jeow were constructed. There was music, animated talking, laughing, dancing, all amidst the constant chinking of toasted glasses. What a welcome.

Rising, slowly, the next morning we were presented with wondrous platters of eggs, bacon and mountains of buttery toast (and it is true that even Ali and I blanch at cold spicy fish and sticky rice as a hungover breakfast). Replete, recaffinated, and with focus almost restored we needed to make haste and find a boat: we were heading out for a day on/in the Mekong. With water-play inflatables already blown we ambled across the river’s peripherally dry beach-like bed. On board we chugged up river beneath threatening skies to a series of sand (mud) banks where we duly decamped and, removed from the main push, were able to wallow and float in the safer shallow currents (schistosomiasis be damned). I wished I’d brought my bottles (rods).

The centre piece of the evening’s meal was lovingly crafted – she really does have the hots’ for Yaan – by Fa’s demonstrative friend: a sumptuous Tom Yam, although the protein component to this, catfish heads, was only moderately well received by most of the westerners. Nevertheless, once again it was a beautiful, chilled, atmospherically thunderstorm-punctuated, squishy night.

Roused early the girls were kitted out in Laos skirts, blouses and sashes; the men with only sashes but required to cover their knees (I borrowed Ali’s combats): we were headed to the wat. Along with half a dozen other groups we sat (with feet tucked respectfully behind us) in the main hall before the abbot and monks on the raised dais. Ceremony complete (there was much pressing of heads to the floor, the
occasional sonorous echo of a giant gong, whilst the abbot managed to answer his mobile phone between leading chants) a breakfast meal, prepared by various families of the village, was presented to us all. It’s never too early for a spicy pork laab salad and the belly pork was divine.

The Tad Lo Laos contingent would be heading back later that morning and, from the outset, we’d stated our need to leave with them: another visa run was imminent as was a further rabies jab for Ali. Fa had intended to stay on for some additional time with her family, particularly her mum, but was equally desperate for some of her guests to remain with her. And that’s the problem with such hospitable hosts: unable to contribute meaningfully you feel compelled not to outstay your welcome, not to overly stretch their generosity. Thus the others, likewise, felt the need to return and ultimately Fa also decided to join us. There were tearful farewells and a succession of wrist amulets to be tied. My favourite sister and a gaggle of other relatives and friends met us on the village outskirts; she climbed into the back of the truck, with bottles
of beer and a single glass: there’s always time for a last shared drink.

Fa was already close to all of us westerners, but now the bonds are something else entirely; plus, personally, we’d made a whole bunch of new chums.

Midway back we were pulled over at a police checkpoint, Fa rolled her eyes. Slumbering in the back we westerners were invisible, but such random extortions of baksheesh are not uncommon in Laos, even to tatty old pick-ups.

Huge pale yellow melons, marrow-like cucumbers and ugly nobly green pumpkins are the latest crops to be harvested and as we turned into the side road to Tad Lo it was dotted with vendors behind mounds of such produce.

On our arrival at Sipasert Savanah beckoned us look to our balcony: the pup and ma were asleep outside our door where apparently they’d been encamped since our departure.

As much as we are hankering after a change of scene there is so much we are going to miss about this place. And then just to ensure we didn’t hastily run off there was another party, one at which Ali (really quite sober) misjudged a treacherously high
tree stump step, slipped off sideways and duly buggered her knee which swelled horribly. The next day Pon was on the case and she materialized on our balcony with a large strip of Wan Son, a fleshy two foot-long leaf that she’d scorched over coals. Thus prepared the leaf exudes a sap from its blisters and it was duly applied to Ali’s knee. She screeched. And then gasped through gritted teeth: “It’s not the knee, that’s........ scolding”. Nevertheless, within two days of repeated applications… and with it rested, elevated and pampered there was a marked improvement. Physio Juan took a look, had a manipulation, and diagnosed the worst: a torn ACL. The same affliction has seen me endure four operations on my left knee over the last fifteen years. On the up-side we did go trekking in the Andes soon after my initial injury and prior to any operation so we know that it isn’t totally debilitating. Indeed, few over the age of fifty ever have such an injury operated on, you simply can no longer do any sports involving lateral movement.

Oh, we discovered why we’ve never been served cassava: it is all immediately exported to China, who pushed the switch from coffee to manioc in the first place. It is more profitable and hopefully – who knows – not as environmentally destructive as, say, palm oil cultivation in Indonesia.

So… Another month passes.

At the turn of the year I was in Nepal, alone, and stated Nepal and the lonesome Yeti that in thirty years of travel we have never been static for much longer than a month. We’ve now been in Tad Lo for four. Yes, it may be one of the safest places – Corona-wise – in the world right now and we are suffering no hardships, but that is a long time.

In five days there is a French-chartered plane heading, ultimately, to Paris and there will be something like 300, predominantly French (95 percent of all Laos backpackers are), on it. Tad Lo and Sipasert has seen many such individuals passing through in recent days, on their way north to catch it; indeed Savanah and Windy (who’ve been painting a mural along the recently constructed flood wall) will be among that number and consequently there’s yet another party occurring tonight in their honour. Ali is to be monitored, escorted and mollycoddled in
all endeavors.

Just how many of us will remain? This question is only of real import if Laos suddenly behaves as Thailand have stated they will do and not renew any more visas (fines and even imprisonment are threatened). Yes, those stuck in Thailand were lucky in that visa renewals were automatic and free until July 31st, but the word is that you must be out by then. This eviction – they want all those on tourist visas gone – may well have been exacerbated by two recent minor outbreaks there; but, both clusters were due to returnees, repatriations from Sudan and Egypt. Those foreign nationals who have been encamped for multiple months are no threat and, surely, if financially sound they are, given the crazy circumstance, purely a small boon to the struggling economy. There are still a few flights leaving Thailand, but if a similar policy were to be adopted here… well, we would be truly buggered and Chris Cantrell would will really have to earn his stripes…

I refuse to make any predictions as to the location from which we’ll next blog: it could be here or somewhere else in Laos, possibly in
Vietnam, China, quarantined in France, or even back in England.

We love unstructured, unplanned travel, but…

And, on a final note, our thoughts go out to those in a far less fortunate position than ourselves: to those whose countries really cannot, given their means, cope and to those in countries whose leaders really should have known and performed better who have simply let their inhabitants down. To the latter, particularly cadet bone spur: shame on you.


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16th July 2020

Another month...
...and a bit of a scare. Glad all worked out for Ali. Her background in health a virtue. Most people would not think rabies or tetanus until it was too late. Glad to hear you both are chiving on, lice and all, lovely pictures of the day to day goings on in Laos. Let’s try not to get entangled in any more viruses while abroad! So where will the Yetis be next month? I will tune in to see.
17th July 2020

Rabies...
I had a similar incident as Ali. Back in 1967 in Thailand I was playing with a friend's German Shepard and fell on its open mouth. A tooth grazed my ankle. Less than 10 days later the dog died. The U.S. Army vet (American troops had just arrived in Thailand) cut the dogs head off and took it to the lab in Bangkok for rabies testing. Yep, it had it, so I got the full series of shots, alternating between arms for 19 days. I'm glad to hear that Ali survived!
17th July 2020

Rabies...
Wow, you had a very close escape. Thank heavens for that vet, he really did save your life.
11th August 2020

I can’t believe I’ve only just noticed your blog.
I love reading blogs from travelers of a certain - ahem - demographic who still travel the rustic way. All the best for wherever you go next. Whatever you’re doing sure beats sitting here helplessly in the States while Cadet Bone Spurs leads us down the dark path towards becoming a Failed State.

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