Pet dogs being vaccinated in Serian, Sarawak.

DECLARED rabies free in 2012, the recent deaths of three children in Sarawak from the disease is a cause for concern. A fourth victim is on the critical list. All of them are from villages close to one another. Naturally, all is being done by the federal and state authorities to stem the spread of the infection, believed to have crossed the border from Kalimantan, Indonesia. Dogs and cats from Sarawak, for example, are banned from the peninsula. The state’s pets are being vaccinated and possible infections are being traced.

Rabies is described by the World Health Organisation as a “disease of poor and vulnerable populations whose deaths are rarely reported and where human vaccines and immunoglobulin are not readily available or accessible”. If this description is true in this instance, then it is an indictment on the provision of health services in the country, which is not uniform. According to the Health Ministry, there have been no deaths from rabies in the country for two decades. Why is it occurring now? Are the affected villages too remote? But, that should not be a problem given the country’s claims that there are many rural health clinics. Indeed, Serian, where the deaths occurred, borders Kalimantan and is, therefore, remote. Nevertheless, if Malaysia is indeed escaping the middle-income trap as claimed, gaps in public healthcare are inexcusable.

Or are pockets of poverty still a reality, a fact often missed as the nation sprints towards 2020 and the prospect of a high-income economy? That the children were treated in district hospitals suggests that connectivity exists and healthcare is accessible. Could ignorance of modern hygiene be the problem? Is there a need for more effective public health education. It is regrettable that lives are being lost for the simple want of acceptable standards of hygiene. This should not to be tolerated when the country is expected to be fully developed in a mere three years.

When tuberculosis (TB) and other infectious diseases common to the Third World reemerged, it is blamed on migrant workers, who are then meticulously screened before they are allowed to work in Malaysia. With this rabies outbreak, infected dogs crossing over from Kalimantan are blamed. Agreed, long borders have a tendency to be porous and animals enter without need of travel documents. They, in turn, infect Malaysian animals, both wild and domestic, with the latter endangering humans who come into contact with them. The onus of prevention then lies squarely on the shoulders of the authorities, whose duty it is to ensure that standards of personal household hygiene are kept at a level that inhibit the spread of diseases. Rural clinics must be made more proactive. A register of the members of the community they serve will help them extend the healthcare service. In short, better interaction between the community and healthcare givers should be made man-datory.

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