Rabies: A 5 Point Primer for Expats and Travelers in SE Asia.

Rabies Immunization Clinic Photo

Creative Commons. Photo by C Newlin de Rojas

1. Fatal.

If you are exposed and don’t get treatment, it is 100% fatal. Receive treatment within first 24 hours of contact with a rabies carrier for best chances of survival.

2. Saliva.

That’s how it is transferred. It isn’t about the bite, though deeper bites are more dangerous. If you are licked by a stray animal in a country with a high rate of rabid animals, i.e. SE Asia and India, you should get yourself to an emergency room. You could take a chance but it’s a game of Russian Roulette. Once you develop symptoms, you can start planning your funeral.

3. Painful

On the up side, they no longer inject you in your abdomen. Yay! But if you haven’t been pre-vaccinated, you must have an injection of RIG or Rabies Immune Globuline in addition to the vaccine shots. RIG jump starts your immune system and this part of the treatment is *painful*. They need to inject as much of this stuff as possible under the surface of your skin where the bite/lick occurred. The balance goes in your bum.

To give you a sense of this part of the treatment, imagine slipping a deflated balloon under your skin and then inflating it as much as possible. My daughter’s hand looked like the hunchback…except on her hand. Many ‘brave’ candies and biscuits were doled out by the nurses. Oh and my daughter got some too!

If you haven’t had a Tetanus shot in the last 10 years you need one of these too. And if you have a deep puncture wound, you actually need shots every 5 years. (Without treatment or vaccinations 1/4 people infected will die of Tetanus. The rate is higher for infants)

4. Ka-Ching.$$$

It’s expensive. Well, the RIG is expensive. Prices will vary. At our local (Bangkok) Catholic non-profit hospital, for an adult, you are looking at THB20,000 or $200. Of course everything is relative. If you are an expat on a juicy contract, this is likely peanuts for you and you are probably already at the more expensive snazzy hospitals. If you are in the US, you’d shell out about $1500 for a RIG dose Which brings me to #5, and this will make you Mambo.

5. It’s un-necessary

Well the balloon injection pain and loss of cash is un-necessary. If you get the pre-exposure vaccination consisting of three shots over a month, you do not need the RIG treatment, saving you money, tears, and time.

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If you work for a government agency, chances are they will have obligated you to get this done. You should thank them. If you are negotiating an expat package as we speak, you could consider asking them to organize and cover the country’s recommended vaccines prior to moving.

If you are like the rest of us, moving or traveling by choice (or working for one of those shoddy companies who are increasingly cutting corners) I’d wait until you get to Asia to get it done. It costs a fraction of the price: In the US, the three shots will cost you about $600 total pp while in Bangkok, at the local travel clinic, we paid about $15 total pp. You also have the option to choose the intra-dermal instead of the intra-muscular jabs. They are cheaper, less painful, and just as effective.

Check in later this week for our amazing story: Horses, Humans, and Rabies Oh My!, where I recount how two of us were bitten in one week, by different animals, and ended up at a snake farm for our shots. For real folks. Welcome to Thailand.

 

Readers please note: This is a short and basic overview. There are many things to consider. For example: RIG shots must be given within the first 6 days. By day 7, it can impede your own body’s response. Depending on risk factors e.g. animal and exposure types, some doctors will recommend a ‘wait and see’ approach, given the cost and availability of RIG. But then all of this is avoided if you simply get pre-vaccinated.

Wills, Life Insurance & Who Gets the Kids When You Live On the Other Side of the World

 

by CNdR. All Rights Reserved.

by CNdR. All Rights Reserved.

I like to think of myself as a very organized person.  Well perhaps not organized exactly. More like I get the really critical things done. I can fish out important documents in an instant even if I can’t find my sunglasses for the umpteenth time. (And yes they were on my head)

When it came to having kids, I fit the urban upper middle class cliché. I researched nipple creams and organic mattresses, to vitamin K or not, what were the best BPA-free bottles for my freshly expressed milk. I am the one trudging through international airports with car seats in tow even though I don’t own a car or a driver’s license at that. You get the picture.

If you told me then that I would find myself living halfway around the world, with two children five and under, without a will, established guardians and life insurance, I would cry “sacre-bleu! How dare you accuse me of such neglect and irresponsibility!”

Yet here I am, without any of these papers in my waterproof emergency filing briefcase.

Apart from the fact that I can’t even believe it myself, the truth is that each time I try to tackle this, I am totally overwhelmed about how to handle the situation given the life we have chosen.

Starting with life insurance: I can’t figure out where I should take this out. Do I take it out here in South East Asia? Do I take out a policy in the US? What happens when we move again? And why didn’t I take it out before that bout of postpartum? Apparently taking anti-depressant are likely to drive up your premiums. Seriously, given that we pop these in the US like breath mints, I wonder how many folks would reconsider the severity of their condition. I definitely needed mine but had I taken out the policy earlier….sigh.

What about the kids? What happens if the grim reaper comes knocking earlier than expected?

I find I have to turn down my architect husband whenever he suggests I join him for a romantic escape to some exotic location he’s currently visiting on business. With my luck something would happen to the both of us and our precious mini-banshees would find themselves alone in Bangkok with no family for thousands of miles. And when that family showed up, they likely wouldn’t even recognize anyone.

Once upon a time, we had more sisters and brothers and aunts and uncles. Chances are, we lived closer and saw them more regularly. Now, under the guise of globalization and hyper efficiency, people must follow jobs where they can find them, often on the other side of the globe. Families are smaller, more scattered and lacking the close-knit ties that proximity often engenders.

My girls have never met their Mexican uncle and his family. They’ve seen their abuelita a few times on Skype but they can’t really communicate with her because their Spanish is limited to a few phrases. We left the states before our eldest could really create memories and since then, our girls have seen my elderly parents twice in the flesh. Once in 2011 and once in 2013. Hardly serious bonding time. They likely couldn’t recognize my brothers if they tried.  The only life they’ve known or remember is life in Asia.

Without a will, the law leaves it up to the families to work out. Try as I might, I can’t imagine making the girls pack-up and move far from everyone and everything they have ever known. Taking them away from a familiar environment, culture and friends following the loss of their parents seems cruel. And even if we did subject them to that, most of our immediate relatives are ruled out due to mental illness, age, and health. The few that are left either already have large broods, don’t speak the same language as the girls, and are complete strangers to the girls. My lip starts quivering at the thought of putting the girls through such a situation.

So what to do when you are an expat with limited resources and a family that just can’t or wont travel to see you? For me, I’ve felt that we’ve developed a family of sorts with the friends we’ve made abroad. My eldest knows and loves several of my friends more than any of our family members. And I can’t help but wish that, should something come to pass, the girls could at least transition with them.

But I also can’t find the courage to ask them. It’s such a huge responsibility– albeit a hypothetical one–  to put on people. And so another day passes, and our Will is left unwritten.

Are you living far from your family? How have you handled this? I’d love to hear from all of you.