Rat trace

The past Monday was gloomy. Plagued with thoughts about the transfer of unused PhilHealth funds to the national treasury, my eyes met a dark-gray-colored sky. Was the weather a sign of more ominous things to come? Driving along the Elliptical Road, I chanced upon a group bearing placards warning us of the effects of climate change. I honked my horn to show support. On Tuesday, we were invited to join a summit wherein there was a call to action to help increase immunization coverage rates. Current statistics show that though progress has been made, we are still off-target, evident from the reported pocket outbreaks of measles and pertussis. Wednesday brought on a heavy downpour as if the heavens were commiserating and giving us a stern warning of how we all have played a role in bringing us to where we are. Gloomy became gloomier.

“Ang Pinoy nga naman talaga!” This was the caption attached by a friend to a video of four men indulging in their version of whitewater rafting, cruising through a main street that resembled a river. In several shared posts, children and adults were seen swimming and frolicking in murky floodwaters, unaware of the consequences such reckless behavior posed. While it is laudable to have a mindset to try to make the best out of a situation one is in, this was definitely the wrong time to adopt such an attitude. With the onset of the rainy season, aside from waterborne diseases, a cause of concern is leptospirosis, a known zoonotic disease.

Transmission. One may become ill from direct or indirect exposure to the urine of infected animals like dogs, cattle, sheep, cows, goats, swine, cats, and rats. Rats are the most common culprits and once infected shed the bacteria in the environment. Humans may acquire the disease through several ports of entry: via mucous membranes, cuts or skin abrasions, and ingestion of urine-contaminated soil or water. Writing this piece inevitably brought on a memory that never fails to make me smile. It was of a Grade 5 student who asked me why rats like to urinate on rooftops after I delivered a lecture on leptospirosis. Caught off-balance, I did my best to probe and found out that her mom would always forbid her from standing under the spout which drains the water from the rooftop every time she is allowed to play in the rain.

Infection. It can either be asymptomatic or symptomatic with an incubation period ranging from two to 30 days but usually from five to 14 days after exposure. With the sad scenario the whole country and the world witnessed last Wednesday, we are counting the days from Supertyphoon “Carina” with dread, preparing for the likely possibility of an upsurge of cases and admissions.

Clinical manifestations. These are very nonspecific and may be similar to other diseases such as dengue, typhoid, or viral hepatitis, so obtaining a history of significant exposure provides a high index of suspicion. The latter coupled with the following signs and symptoms such as fever, body malaise, vomiting, diarrhea, headache, abdominal pain, neck stiffness, conjunctival suffusion manifested as red eyes, calf pain, and in more severe cases jaundice and/or decreased or total loss of urine output warrant immediate medical consultation. It is also advised that those who were exposed or are continually exposed seek a health professional’s advice for assessment and possible prophylaxis. While the general course may be mild, it may also be potentially severe enough to cause death.

Prevention. The best is still to avoid contact with possible sources of infection. If this is unavoidable, it is always prudent not only to be armed with protective clothing but to always ensure that water and food are safe for consumption. While these pointers are easy enough to understand, in reality, are hard to adhere to, most especially for those who live in areas prone to flooding, who are dependent on public transport, or whose occupation involves constant exposure. Available vaccines are mostly employed in veterinary medicine and, from current data, those commercially licensed for human use are given to targeted populations in a handful of countries.

On the first morning back to work, many employees and outsourced personnel came to the hospital clinic for evaluation. The family physician could only shake her head in response to the numerous stories told. One that got imprinted from our meeting was of an individual who had chosen to swim to save essential household items that he had worked hard for.

It was 5:30 p.m. and the rain had started to fall. Driving home and seeing the long queue of people hoping for a ride and garbage lining the streets, I wondered what the next days would bring. Join me in wishing and praying for that much-needed rainbow.

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