Mission Rabies Sri Lanka 2017 11th to 26th September 2017

Background

Rabies is one of the deadliest viruses in the world, with an estimated 59,000 human deaths each year 1. Despite this it is 100% preventable through vaccination. As over 98% of human rabies cases are a result of exposure through dog bites 2 vaccinating dogs against rabies will significantly reduce the number of human rabies deaths. Vaccinating at least 70% of the canine population creates herd immunity against rabies and effectively eliminates it from the canine population 3; this has a knock on effect improving the welfare of both dogs and people.

Mission Rabies was set up in 2012 to help eliminate canine rabies from the world. With support from the Dogs Trust and Worldwide Veterinary Services it is hoped that this goal can be achieved by 2030. After the success and great results from working in India since 2013 Mission Rabies has expanded its work to other parts of Asia and Africa. Mission Rabies conducts year long vaccination campaigns in Goa, India; Ranchi, India; and Blantyre, Malawi. There are smaller campaigns in Zomba and Chiradzulu, Malawi and annual vaccination campaigns in Tanzania, Uganda and Sri Lanka.

In January 2015 the first Mission Rabies outside India– Dogstar Foundation (Dogstar) partnered vaccination drive was conducted in Negombo, Sri Lanka. Prior to the mass canine mobile vaccination program in Negombo in 2016, Dogstar partnered with the Negombo Municipal Council (NMC) to hold 137 static point vaccination sites throughout Negombo. These were held between June and September 2016. Prior to and during the mobile vaccination drive Dogstar undertook a period of community sensitisations. Dogstar run year round humane canine population control programs and have sterilised over 5,500 dogs in Negombo since March 2015. During 2017 Dogstar will be discussing introducing Canine rabies surveillance with the NMC and was opened up to International Guests (volunteers).

In 2017 the NMC advised they would take on full responsibility for Rabies vaccinations in Negombo moving forward. Katana Pradeshiya Sabha ( Katana ) the administration area that borders NMC to the east has had a confirmed and a number of suspected Rabies cases in 2016/2017 and it was agreed to provide a proof of concept program in the north of Katana which would act as a buffer zone for Negombo.

Partnerships and Staffing

Mission Rabies has partnered with Dogstar to work in Negombo, Sri Lanka, where Dogstar are based. Dogstar was established by Mark and Samantha Green in 2006, initially providing animal adoption, veterinary care and preventive care to animals in the Kegalle region. Since 2014 the main focus of Dogstar’s work moved to Negombo Municipal Area and since December 2016 Katana Pradeshiya Sabha ( Katana ).

Dogstar primarily runs a combination of outreach sterilisation campaigns and community animal welfare education in situ. Dogstar also works towards canine rabies elimination through surveillance and vaccination, under the guidance of Mission Rabies.

Location

Vaccinations took place in Katana ( purple ), a peri-rural division of the Gampaha district in the Western Province of Sri Lanka. This location was chosen because it is the neighbouring district to Negombo ( blue ), which has been the location of Mission Rabies and Dogstar mass vaccination drives in 2015 and 2016. Rabies control programs in Negombo district has now been taken over by the Municipal council lead by the Municipal council veterinarian.

Katana has an approximate area of 105km² and Katana Municipal council comprises of 22 wards² A 2012 census p laces the human popu la t ion a t approximately 235,291³.

Since March 2017 the Dogstar mobile sterilisation clinic has been mainly based in Katana and to date had sterilised 2692 dogs, predominantly in the northern region.

Katana is divided into 67 working Dogstar zones which are approx. 83% larger than working zones in Negombo.

In 2016 there was a confirmed rabid puppy in Katana district in Dogstar zone 217, and a further 2 suspected but unconfirmed canine cases in Dogstar zones 203/204.

Weekly Epidemiological Report 4th -10th March 2017 , published by Ministry of Health Nutrition & Indigenous Medicine reported a human case of Rabies in Gampaha District. The Victim a 71 year old woman lived on the southern border of Katana with J’ela. A stray puppy is suspected but not confirmed to be the cause of her exposure.

1.http://www.lgpc.gov.lk/downloads/Ward%20Maps/WP/Gampaha/09_G5Katana.pdf

2.http://www.statistics.gov.lk/PopHouSat/CPH2012Visualization/htdocs/index.php?usecase=indicator&action=DSMap&indId=10&district=Gampaha&Legend=3#

3 http://www.epid.gov.lk/web/images/pdf/wer/2017/vol_44_no_10-english.pdf

Accessed on 25/09/2017

Program

The 2017 program delivered vaccinations by a combination of simultaneous static points and door to door teams . The program ran from Monday 11th September to Tuesday 26th September and IGs were present between 11th-15th and 18th-22nd September. Data was collected using both the Mission Rabies App and WVS App.

4 vaccinating teams operated daily , 3 teams went door to door comprising of 2 IG’s to vaccinate and data collect , 1-2 Dogstar staff who carried out animal handling roles , issued vaccination cards , leaflets and a dedicated driver and vehicle.

The 4th team ( Flying Squad ) consisted of 2 IGS to vaccinate and data collect and 2 Dogstar dog catchers and a driver all highly experienced in dog catching. The flying squad focused on roaming dogs but also attended locations where owners were unable to handle dogs or capture their dogs.

A new addition to this years program was the Dogstar mobile spay neuter program operating alongside the vaccination teams offering canine and feline sterilisations for both male and female animals. All animals undergoing surgery were also vaccinated unless a valid vaccination card was presented by the owner or guardian.

All cats presented for surgery were owned , dogs were a mixture owner presented , owner handover to the catching teams & unaccompanied dogs caught and transported to the clinic in Bali style nets.

A pop up static point was also offered at the sterilisation clinics for already sterilised dogs or for owned dogs whose owners did not want surgery. This was advertised by the Dogstar community team via face to face interactions with the community and via public address recordings played on the Dogstar Tuk Tuk the night before and the morning of a clinic , bilingual posters at the clinic also advertised that Mission Rabies vaccinations where available on site.

A number of different team deployment options were trailed during the 10 days from single teams in separate zones to all teams including in the mobile clinic working together in one zone which proved the optimum use of resources.

Some static points where also held in areas the door to door teams were not working to test public response.

Data

A total of 4523 dogs were vaccinated during the program . 2366 vaccinations where delivered by the door to door teams , 736 by flying squad, 914 were vaccinated at the pop at static points and a further 427 were sterilised and vaccinated at the mobile spay neuter clinics.

40 cats who were sterilised were also vaccinated

Blue marker - single vaccination via door to door / flying squad

Red marker - Mobile spay neuter program / pop up static point

Sterilisations

427 dogs were sterilised and vaccinated at the mobile Dogstar spay neuter program , 283 of those were brought to the clinic location via the dedicated dog catching van or the flying squad with the remaining 184 being brought by their owners. Additionally 40 cats were sterilised and vaccinated

Static point vaccinations

954 dogs where brought by owners to pop up static points for vaccination only of which 45.3% were already sterilised.

Resight surveys

Resight surveys confirmed overall vaccination coverage of 79.76% and roaming dog coverage of 78.18 %

Surveys were conducted from tuk tuk’s with 1 member of Dogstar team accompanied by 1 IG . In zone 205 when 2 static points / spay neuter clinics were held in advance of the door to door flying teams working in the area the resight survey recorded 29.96 % vaccinated as opposed to 75.25 after the door to door teams and flying squad had worked in the area.

7 static points were additionally held to gauge public response in areas the door to door teams were not working , attendances varied between 56 - 160. At the time of writing , survey data from 2 zones ( 204 and 210 ) was not available to download due to a server issue. Dogstar baseline population data from those zones indicated that vaccinations cover in those zones exceeded 70%.

Zones 200-201 required a repeat visit from a vaccination team , zone 202 first survey was carried out before the zone had been completed for IG training and was repeated again once the zone was completed.

VIP visit

On Wednesday 20th September a delegation of 6 newly appointed public health veterinarians led by Dr Perera from North Western Province Department of Animal Production of Health visited the sterilisation clinic , static point vaccination and door to door teams.

The visit was a great success and Dr Perera and his team have requested assistance and guidance from Mission Rabies and Dogstar to help them set up a pilot rabies eradication and dog population management program in 2018.

Health and Safety

Being a project involving the general public, paid staff and international volunteers, health and safety is of the highest concern to Mission Rabies and Dogstar. International volunteers received a pre-project briefing covering Rabies and post-exposure protocols, in the field risks, medical emergencies, personal safety, behaviours and local customs and natural disasters. During the project team leaders were available at all time to answer any questions regarding health and safety and provide advice for situation management. Team leaders received a more detailed briefing covering project roles, first aid and standard protocols for dealing with various situations e.g. civil unrest and road accident. There was a 1:3 ratio of specifically first aid trained individuals to volunteers and contact was maintained with the project leaders at all times, who were no more than 30 minutes away should their assistance be required. All phones also had the St Johns Ambulance Application which could give advice on basic first aid situations.

Any person who was potentially exposed, via a category 2 or 3 exposure, were instructed to wash the affected area for 15 minutes using soap or iodine and water. All members of the public were advised to seek medical attention and that they would require post exposure prophylaxis, especially if their dog or cat became sick or died within the following 10 days.

3 volunteers required post exposure vaccination all of which was completed before the end of the trip. There were 6 other medical situations which were dealt with by the volunteer coordinator and team leader and resulted in 2 hospital visits and the loss of 4 volunteer working days. All volunteers were back to full fitness by the end of the project. See Sri Lanka Health and Safety report for further details

Vehicles are always a health and safety concern and vehicle safety is of the utmost importance to Mission Rabies and Dogstar.

This project used 3 vans with seats and seat belts to transport the volunteers to and from the locations and around the project zones. One van had a flatbed on the back, all staff were strictly forbidden from sitting in there when the vehicle was moving. Of the 3 drivers employed for the volunteers, 2 were well known to Dogstar having participated in the previous 2 years and the third came with these drivers recommendation. Vehicle checks were performed on a daily basis by Mark Green. Day 1 revealed a flat tyre on vehicle 3 which was replaced in the field. No other issues were reported with the vehicles. For the flying squad, volunteers travelled in the Best Care ambulance which there were 2 front seats and 3 lateral bench seats. When dogs were in the back of the van, volunteers would travel in the front seats with the catching team in the back.

The survey team used a tuk tuk owned by Dogstar and driven by an experienced driver who has worked on all previous campaigns. Team blue, who sourced the locations or the clinic, advertised the clinic and vaccination drive and organised the lunches for the field teams, travelled in a tuk tuk as well using an experienced driver. No problems were reported involving any of the vehicles or the way they were driven during this drive.

There were no health and safety emergencies during this campaign and if all future campaigns are run to these standards, it is predicted that there will not be any emergencies in subsequent drives.

International Guests

9 Mission Rabies volunteers participated in this project from the UK, Spain, Portugal and Australia. The project ran with 2 volunteers per team plus 1 with our Mission Rabies volunteer coordinator. Team members were made up of principally 1 vet and one student or nurse. All volunteers were new to mass vaccination drives, although one had previously volunteered for Mission Rabies in a spay/neuter clinic in Malawi. The volunteers swapped teams frequently so they could work with every team member and experience door-to-door, the flying squad and survey work. This improved their day-to day working dynamics and, with an understanding of how each team operated, ensured the 4 teams worked together for maximum coverage. All volunteers engaged with the project and especially enjoyed a trip to the office to see what is done with all the data they collect. They frequently expressed wishes to volunteer again with Mission Rabies and believed they had gained a lot from the experience.

Volunteers stayed at Sachal Mirs bed and breakfast where breakfast and dinner was provided. This was in an ideal location by the lagoon and the owners were very accommodating. It also had the advantage of being just down the road from the Dogstar staff house.

A tour had been arranged by Samantha and Mark through a contact. This left on the evening after finishing work and was for two nights, returning in the evening before work started the next day. All but 1 Mission Rabies volunteer participated and a Dogstar volunteer also joined the trip, alongside a Mission Rabies employee to act as an emergency contact. The trip took volunteers to stay at Inn on the tree, which meant staying in luxury treehouse accommodation, which was enjoyed by all. The following day Sigirya rock was visited, all volunteers had a massage and went on a safari in Kandulla National Park where they got to see hundreds of elephants. The next day was a trip to Dambulla caves and Kandy for the temple of the tooth and Kandyan dancing in the evening. The trip costs was £170 GBP per person (for 10 people) excluding lunch, dinner and drinks. It was enjoyed by all and was well worth the money.

All volunteers have been asked to fill out a post-project survey that covers all aspects of the volunteer experience, including accommodation, by Mission Rabies. The data shall be analysed once participants have completed the survey and details can be obtained at a later date.

Lessons learnt

The ability to adapt to changing circumstances and challenges is a fundament part of Mission Rabies project management. As ever in such a dynamic field setting a number of issues arose during the live project stage which are recorded here to assist with future planning of Mission Rabies programs.

Issue Countermeasure

Due to more rural landscape , time taken to cover one zone by one team could be 2-3 days

Multiple teams deployed to one zone

Spay neuter clinic placed in same zone

Covering multiple zones with Flying squad team ineffective

Multiple teams deployed to one zone including flying squad

1 batch of Local produced animal friendly paint was to runny and difficult to apply and spot for re sight survey

Stock paint from UK used and applied with toothbrush

Temp yellow collars used on owned dogs to assist identification of vaccination dogs

From 2018 - imported stock marker crayons to be used

Survey data from WVS app unavailable to download from zones 204 and 210 due to technical issue

All further surveys completed on Mission Rabies app

Baseline data for 204 and 210 confirmed over 70 % coverage

Pre Monsoon rains arrived earlier than expected in Western Province

All IGs reminded before departure to bring suitable clothing shower proof clothing

Weather forecasts where obtained daily from the Department of Meteorology Sri Lanka

Large golf style umbrellas purchased for all teams for light showers

Vehicle remained with teams at all times to allow shelter from heavier rain

Additional Photographs

Samantha Green : Project Manager Sri Lanka

Amy Lewis : Programmes and Research Intern

September 29th 2017