A Framework of ethical decision making Dean Joyce Sackey A Framework of ethical decision making

Table Of Contents Question Objectives Findings Conclusion Follow up questions Sources

Question How does the natural history,  transmission of rabies infection and cultural aspects of Haiti influence our assessment of the situation and plan of action ?

Objective To understand that the passage of time changes the community action and evaluation of the severity of the boys situation. The pathology of rabies and how a physician in foreign cultures can implement their plan of action.

Transmission Rabies is a disease that is transmitted from animals to humans through the saliva or tissues from the nervous system of an infected animal. Once the virus reaches the spinal cord, it rapidly ascends to reach the brain. When it reaches the brain it is fatal.

Symptoms The first signs of rabies can be a very non-specific flu like illness which lasts several days. Then the classic signs of rabies appear.. Muscle weakness Insomnia Anxiety Excess salivation Hallucinations Problems swallowing Fear of water Ultimately, the patient lapses into a coma and dies of respiratory failure and shock.

Natural History Rabies is a zoonotic disease. Zoonotic diseases can pass between species. The rabies virus attacks the central nervous system causing severely distressing neurological symptoms before causing the victim to die. Rabies is the deadliest disease on earth with a 99.9% fatality rate.

Diagnostic There is no test that can detect rabies in humans at the time they are bitten. By the time symptoms develop, it is too late for treatment and there is no cure. Therefore, even though rabies may not be at the top of the disease list, it’s imperative not to dismiss the possibility.

Vaccines Unlike most vaccines given to prevent disease, the rabies vaccine is given after exposure. The post exposure vaccine consist of 5 injections, given on day,  0-3-7-14-28, immune globulin is also given with the first shot as a safety net, until the vaccine kicks in.

The history of Haiti Haiti is one of the five remaining small island countries in the Americas where canine rabies is still a major problem and has the highest rate of human rabies deaths in the western hemisphere with an estimated 2 deaths each week. Worldwide, rabies has caused about 17,500 deaths in 2015.

Haiti-Medicine and Health Care Malaria, typhoid, tuberculosis, intestinal parasites, and sexually transmitted diseases take a toll on the population. There is less than one doctor per eight-thousand people. Medical facilities are poorly funded and understaffed, and most health care workers are incompetent. Life expectancy in 2000 was under fifty-one years.

The Big Question Rabies Vaccine or medical center? Although the cost varies, a course of rabies immune globulin and four doses of vaccine given over a two-week period typically ranges from $5,000-15,000, depending on the nature of the exposure and the probability of rabies in a region. 15,000 dollars could get the low funded medical center a lot of supplies.

The Rabies vaccine would take a while to be transported to Haiti. The boy most likely has the virus because of how common it is in Haiti. If we wait for the vaccine, the virus will be moving far up along his body.

Follow up question What happens if there is an outbreak of rabies in a certain community, what's the protocol for that ?

Conclusion As physicians in Haiti, we have decided to give the money towards the medical center. Rabies is a very serious and dangerous disease. It has a 99% fatality rate. The child was bit on the leg which gives him more time compared to if he had been bitten on the arm. The rabies vaccine is very expensive, would take a couple of days to arrive to Haiti, and might not even work if the virus has already moved far up along the body. The money saved can be used in the low funded medical centers.

Resources https://rabiesalliance.org/rabies/what-is-rabies-and-frequently- asked-questions/what-is-rabies#What is rabies? http://blogs.worldbank.org/voices/taking-bite-out-haiti-s-rabies- problem

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