December 4, 2012
BUNDA, Tanzania — Tucked in a quiet corner of the bustling area occupied by this town's bus station and central market, the setup doesn't look like much: a few of the country's ubiquitous four-wheel-drive vehicles, some men in dress shirts, and a red bucket and a couple of picnic coolers that are at least as beat-up as the trucks.
Atop the bucket, though, is a gleaming array of hypodermic needles, starkly clinical amid the dust and scattered garbage of the market. On the far side of the vehicles is an even more extraordinary sight in Tanzania: dogs on leashes.
Some of the makeshift tethers are rope and some are chain, sudden restraints on a free-range life. As the dogs stand with their mostly boy handlers in an irregular line, they bark and whimper periodically. One dog occasionally challenges another, and the men keep a wary eye on the few animals that seem especially aggressive. When a black-and-tan dog twists and slips its chain collar, there is a sudden surge of vigilance until the boy gets it back on the leash.
But for animals that spend their days roaming and foraging, protecting livestock and helping as hunters, they seem surprisingly patient, the scene, on this October morning, surprisingly routine.
The dogs are waiting to take their medicine, the annual vaccinations that have virtually eliminated rabies, in humans and in animals, in the towns and villages surrounding the country's iconic Serengeti National Park and in the park itself, one of the world's great wildlife preserves.
It's a program directed and mostly paid for by a small not-for-profit organization half a world away, Chicago's Lincoln Park Zoo. ”Part of our mission at Lincoln Park Zoo is conserving wildlife where the wildlife is,” says Lisa Faust, the zoo's conservation and science vice president, who watches the proceedings keenly. She is spending two weeks touring the Tanzanian operation to try to figure out how best to run it going forward.
The calculations include finding the money to keep paying for it and the ultimate but challenging goal of passing its control into Tanzanian hands.
For the past five years the zoo's Serengeti Health Initiative has been injecting domestic dogs here. Begun in 2003 by another group of scientists, the program delivered its millionth vaccine in the spring. Along the way, it has nipped disease outbreaks in the park that were killing lions and other predators, and it has saved 50 to 150 human lives a year in the villages.
"The program is working,” says Julius Keyyu, research and coordination director of the Tanzania Wildlife Research Institute, a government agency headquartered in the city of Arusha. “They are doing a good job, especially the vaccination effort in the Serengeti area. Even human bites are down.”
The Serengeti Health Initiative is one of several projects that have proved domestic dog vaccination can effectively control or eliminate rabies in the developing world, just as it has in wealthier nations. The work has helped push a worldwide effort to fight rabies that has gained special vigor in the past seven years, since the founding of the Global Alliance for Rabies Control.
With a toll conservatively estimated at 70,000 deaths a year — almost all in Africa and Asia, close to half of the victims children — this long-known and almost entirely preventable disease is one of the deadliest zoonotics, even as the bulk of the attention in recent years has gone to the likes of swine flu, avian flu and SARS.
The Serengeti program, says Keyyu, “is being used as a model in different parts of the world to control rabies.”
Like many public health initiatives, the anti-rabies effort seeks to put itself out of business by eliminating its targeted disease. But in the meantime, the zoo's initial funding commitment is running out at the end of the year. When Faust returns from the trip, one of her first big agenda items will be a meeting in Chicago to figure out how the zoo can keep the program going.
Part of daily life
In the days leading up to a vaccination effort, program workers visit local primary schools to talk about rabies, taking the message to the dogs’ primary caretakers.
Then, the day before the vaccination, a vehicle mounted with a loudspeaker rolls through a town or village, telling people when and where to take their dogs.
Posters are put up explaining, in words and images, the danger of rabies and what to do in case of an animal bite. Written on them is the time and place where the shots will be given and a key message: The treatment is free. In a country where rural households earned 121,000 Tanzanian shillings, or about $76, per month, according to a 2007 government survey, few people in these towns have money to spare for dogs.
The cycle is repeated from March to December in a 6-mile-wide zone, a cordon-sanitaire (sanitary cordon), around the park. Last year, the zoo’s staff of five Tanzanians delivered 40,000 vaccine doses in 154 vaccination days and passed on approximately another 80,000 doses to local veterinary officials in areas just beyond the zone.
Lines are shorter than usual on this day in Bunda. Rain kept the workers from putting up posters, and the town’s size of about 40,000 inhabitants renders the loudspeaker method less effective than in villages. Still, by midmorning about 200 dogs (and a handful of cats) have been inoculated.
A vaccination begins with the dog owner approaching the Land Rover where workers sit, taking information through a window in a kind of makeshift medical office.
Clutching one of the brown vaccination certificates the workers say has become a valued keepsake among dog owners in the vaccination zone, the owner waits to get called over to the coolers. (The vaccine must be kept cold, a challenge in a country with limited electricity and refrigeration.)
From there, it happens quickly. The owner tries to hold the dog steady. Dr. Imam Mzimbri, the Serengeti Health Initiative's veterinarian and project coordinator, or Chunde Bigambo, the assistant project manager, delivers the shots, which also contain parvovirus and canine distemper vaccines. The dog is protected for the next year.
"One stick, it is done,” says Mzimbri, 51, who has been with the project for four years. “We also have spray for the (dog’s) wounds and a balm for mange.”
"It's easy,” says farmer John Magesa, 30, who has brought the dog he uses for home and livestock security.
And the logic is clear: “If my dog got rabies, it would endanger my family, and all the community.”
Another of the few adults who have brought a dog is John Nyamkuro, 58, a farmer. “By vaccinating the dogs,” he says, “I can prevent (rabies) from going to humans, especially the kids.”
Although the program's founders worried about whether people would allow strangers to inject their dogs, acceptance has been easy and rapid, they say, by now even becoming an expected part of life.
“People, they like it,” says Kaneja Mangaru, 30, a worker wearing a Lincoln Park Zoo T-shirt that would appear ordinary in the zoo’s gift shop but here seems almost ironic: Along with the logo, it says “Lion Country.” “In some areas last year, we couldn't go at the usual time because a bridge was out. They kept on calling us, ‘Come to the village!’”
In a shirt, tie and dress slacks, Joseph Ogwa, the acting district livestock official for the Bunda District, observes. He and his peers could be the ones to run the vaccination program if it were to pass into Tanzanian hands.
Ogwa says he is an admirer of the program. “It's very, very effective,” he says. ”We don't have cases now. I remember 10 years ago it wasn't good because there were so many cases of rabies.”
His daughter was 12 then, he says. She was sitting on the back of his motorcycle while he stopped to talk with a friend. “The dog was hidden somewhere, and it came and bit her on the leg,” he says.
It was such unusual behavior, Ogwa immediately suspected rabies and paid “a lot of money” to get her the standard post-bite treatment, a series of shots that fight off the virus.
But few Tanzanians have Ogwa’s money or, as an animal-care worker, the knowledge to immediately fear rabies and seek proper care. A girl in a more rural area, back then, might not have been treated after such a bite. (One study in Tanzania last decade estimated that 15 to 24 percent of people bitten by suspected rabid animals did not seek medical attention.)
The way rabies works, creeping slowly through the nervous system, into the brain, its symptoms often don't show for weeks. By then it is too late to do anything but try to manage what is, by all accounts, one of the most horrific deaths humans can experience.
Planning the future
Lisa Faust did a portion of her own doctoral research in Tanzania, studying elephant demography in Tarangire National Park, to the east of the Serengeti. This is her first time back as a manager.
The Serengeti Health Initiative costs the zoo more than $110,000 a year, she says, for everything from salaries to vehicle maintenance, fuel and permits. A “substantial” portion of that tab was picked up by a private donor, Dr. Susan Sherman, a North Shore veterinarian and zoo board member.
And the overall cost is made much cheaper than it could be because Merck, the pharmaceutical company, has donated the vaccine since the program’s inception. Faust estimates the value of that contribution at more than $300,000 annually. Meanwhile, one salary disappeared from the budget when the Paul G. Allen School for Global Animal Health at Washington State University hired Felix Lankester, a British researcher living in Tanzania who had been Lincoln Park Zoo’s project manager.
But losing him, at least on paper, has been a boon to the zoo, because Washington State pays Lankester's salary while he has continued to help guide the project.
Faust and Lankester meet in the Serengeti at the house the project rents on park grounds in a community of scientific outposts all named for their specialties: There are Lion House, Cheetah House and, in the zoo's case, Disease House, named with affection and irony after the first name the vaccination effort had, the Carnivore Disease Project.
In between sunrise and sunset game drives through the park, Lankester and Faust go over budgets, planning the program’s future. And they make group dinners that also include Bigambo and Anna Czupryna,
Faust's graduate student from Chicago who is doing research on domestic dog demographics in four villages southwest of the park.
It is a kind of preamble to a meeting in Chicago three weeks later. Faust, Lankester and Dr. Guy Palmer, founding director of the Allen School, are among those who spend two days in a conference room on zoo grounds.
The Serengeti Health Initiative’s future is on the table, but, the participants explain, there was never profound concern that the zoo and the university wouldn't continue the project.
The commitment the two institutions make is for five more years, but in a more equal partnership.
“Washington State's agenda is more of a livestock, public health one,” Lankester explains. “Lincoln Park Zoo's is more of a conservation outcome. This is unique. There's something for both organizations here.” There’ll be an increased focus on doing scientific research associated with the program, says Faust. One idea is to seek funding to turn over some of the work in the vaccination zone to local authorities and assess the results.
That feeds into another goal, to make more concrete plans for an exit strategy.
“We’re not ready to give it up. We’re going to stay involved,” says zoo CEO Kevin Bell. “But eventually we’re going to turn it over to the Tanzanians.”
This is why the zoo brought some of its Serengeti staff to Chicago for a month of training in the spring of 2010. And why it has expanded the reach of the anti-rabies program by supplying vaccine doses to district veterinary officers in areas beyond the sanitary cordon and training them to administer the vaccines.
But there are many complications to making a complete handoff, say those involved, from researchers to Tanzanian officials.
To help replace Lankester, the zoo decides to hire Czupryna, who has three years of experience in Tanzania and intimate knowledge of the project, as a sort of assistant manager (though her title will be research coordinator).
The money will be welcome, Czupryna says in an email from Tanzania, “but I'm actually just really, really happy that we (the zoo) have signed on for another 5 years to keep this project going. We've all been on edge the past few months.
“After really seeing the impact that rabies can have, I am ecstatic that this is going to continue and give us time to really get this transition going and going well.”
The decisions made in Chicago mean there’ll be many more such scenes as the one on vaccination day in Bunda.
There, in addition to the inoculation site at the market, a second one is set up out front of two cotton warehouses just beyond a local primary school. Puffs of the area’s primary crop are still on the ground as people show up with their dogs and, in one case, a cat carried in an empty cement bag. Agnes Justine, a local businesswoman, brings her dog for the third year in a row.
“The guys on the team are so invested in the project,” Czupryna says. “They really believe in this, and they really encourage people not only to come but to come back.”
Paulo Charles Tango, the research assistant delivering the injections, pulls a boy aside to tell him not to grab his dog by the ears, a practice many boys adopt from handling livestock.
Another boy, wearing a bright orange polo shirt, has brought three dogs on three different types of leashes – rope, chain-link and rubber – along with the vaccination certificates that detail the injections they’ve received.
He seems more attentive to his dogs than most as the animals get their shots.
And then, still quiet, the boy walks them away, toward a path through a field. He tucks the brown cards into a pocket of his cargo pants and buttons it shut for protection.
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