Srinagar, Mar 26: In a typical case of adding salt to injury, the government-run hospitals across the Kashmir Valley don’t have the Rabies Immunoglobulins (RIG) for the victims of dog bites falling in Class III category, forcing them to purchase the costly drugs from the market. This is notwithstanding the rising cases of dog bites across the Valley, with half of them falling under Class III—where the victim has one or further bites, scratches, licks on broken skin, or extra contact that breaks the skin.
According to medicos, those handling or feeding suspect animals but whose skin is intact fall in Class I category of dog bites while the victims with slight scratches without bleeding from contact or licks on broken skin fall in Class II category.

NO RIGs
The Class-III patients, the sources said, require Rabies Immunoglobulins, with each equine-RIG vial costing around Rs 400 to 500 in the market. The hospitals across the Valley, they said, don’t have the drug available, which is forcing the patients to purchase it from the market.
“Poor people cannot afford to purchase RIG from the market. One vial of RIG has 1500 units and the dose is 40 units per-kg of body weight. For example, if a person is 60 kg, he needs 2400 units, which means around two vials of RIG. But he can’t afford it, so he gets only one vial, which provides insufficient amount of passive immunity through RIG,” said a medico at the Anti-Rabies Clinic (ARC) at SMHS Hospital here.
The medico, wishing anonymity, said more than half of the victims have class-III bites who need the RIG. “Mostly Equine (horse) RIG (ERIG) is used while the Human RIG (HRIG) is thrice costly, beyond affordability of all the victims of dog bites. Every year nearly half of dog-bite victims receive incomplete treatment due to non-availability of expensive RIG, and even when they procure a vial, they never receive full required dose,” the medico said.
Sources said the Class III cases are on rise in the Valley, with the ARC—run by the Social and Preventive Medicine Department of the Government Medical College Srinagar—registering 5 to 10 cases of dog bites in Class III category every day.

ARC RECORDS 2968 DOG BITE CASES IN 2010:
In 2010, the ARC has registered 2968 cases of dog bites, with nearly half of them in Category III. Of late, the officials there said the number of cases have increased under the Category. “We have asked the GMC Principal to take up the issue of RIGs availability with the state government,” said an ARC official, insisting not to be named. “Since it is a costly drug, it should be available in all the hospitals so that a patient gets the adequate dose. The state government should earmark the funds for the RIGs separately so that poor patients are not made to suffer.”
“Incidentally, previously the patients were provided one dose of anti-rabies vaccine and had to procure four additional doses from the market. However, due to shifting from intra-muscular to intra-dermal route of vaccination as recommended by the World Health Organization, Director General of Health Services and Drug Controller General of India, over last two years, the patients at ARC at SMHS Hospital are provided all the doses of anti-rabies vaccines free of cost. However, the patients need to be provided RIG free also, otherwise it jeopardizes the whole management and puts the patient at risk of succumbing to deadliest rabies,” asserted a consultant there.

‘NEED FINANCES’
When contacted, the GMC Principal, Dr Shahida Mir said they have taken up the matter with the state government. “The rising cases of dog bites is indeed a matter of concern. We have asked the government to enhance our budgetary allocation so that we are able to procure RIGs as well. Class III bites are on increase. 50 to 60 percent bites fall in Class III. On an average we get 4000 patients with dog bites a year. The number we receive at SMHS Hospital, is now a bit less because the Directorate of Health Services is also taking care of the issue,” she told Greater Kashmir. “Unless we have the budget, we can’t procure the RIGs.”

‘WILL PURCHASE’
The head of the SPM Department and Medical Superintendent of SMHS Hospital, Dr Muneer Masoodi, who is also the member-secretary of the purchase committee of GMC Srinagar, said they are in the process of purchasing the RIGs. “We will soon put it to tenders and we are in the process of looking into our requirement of RIGs. Hopefully we should be able to purchase it sufficiently this year,” he said.

DHS CAN’T PROCURE IT?
The Director Health Services Kashmir, Dr Muhammad Amin Wani said the Health Department cannot procure it. “We are only concentrating on anti-rabies vaccine. A vaccine vial costs Rs 1000 for five doses. We have 5000 doses available in our provincial stores right now,” he said. “We are in primary care. This (RIG) is a tertiary care intervention, when the patient has already developed neurological manifestation.”
But the medicos disagree. “The RIG is simply to be procured. It has nothing to do with primary or secondary health-care. It is simply required in any hospital or a health centre for Class III dog bites,” said a medico, asserting that the Health Department must procure it and keep it available in the hospitals round the clock as just giving Anti-rabies vaccines without injecting RIG leads to incomplete management of Class-III animal bites.
Sources said it would require an amount of Rs 50 lakh annually to procure RIGs for Kashmir Valley.

Lastupdate on : Sat, 26 Mar 2011 21:30:00 Makkah time
Lastupdate on : Sat, 26 Mar 2011 18:30:00 GMT
Lastupdate on : Sun, 27 Mar 2011 00:00:00 IST