It’s only half past nine in the morning, but the line of the dog bite victims at the Sukraraj Tropical and Infectious Disease Hospital in Teku is so long that it has reached up to its eastern gate from the ticket booth.

Six-year-old Ashra Shrestha was one of the dozens of people waiting to see a doctor.

“I was about to enter the school when a dog jumped and bit me,” said Ashra, a student of City Montessori School in Shantinagar, who said she had to take a leave from school to come to the hospital for a vaccine. Ashra was accompanied by her father, who himself has been a victim of dog bite two years ago. “It’s too scary to walk in the city because of sickly stray dogs,” said Rajan, Ashra’s father.

On average, about 132 people in Kathmandu visit the Sukraraj hospital, the national medical centre that administers the anti-rabies vaccine, every day for free.

In fact, the number of patients at the hospital has spiked so much in recent years that it has to start an overnight service to meet demands for vaccines.

Since night services started at the hospital in April, hospital officials told the Post that over three dozen patients come for anti-rabies injection every night. In the past four and a half months of the night service, the hospital has given the anti-rabies vaccine to over 3,840 dog bite victims.

According to the latest hospital data reviewed by the Post, a total of 48,333 patients-32,748 male and 15,585 female-visited the Teku hospital in the fiscal year 2017/18. Last year, the total number of patients was 27,844—19,180 male and 8,664 female. A total of 20,945 patients—14,570 male and 6,375 female—checked into the hospital for an anti-rabies vaccination the previous year.  

The hospital in Teku also receives dog bite patients from across the Valley who have been referred by all government and private hospitals. The 85-year-old institution also provides anti-rabies vaccines for people who have been bitten by monkeys, pigs, horses, boars, and rats—but over 95 percent of its patients are victims of dog bites.

Dr Anup Bastola, chief consultant and spokesperson at the hospital, told the Post that the number of dog bites has been increasing rapidly in Kathmandu in recent years. Bastola says part of the reason is overpopulation—the Capital’s population has jumped to over five million now, up from 2.5 million, according to the 2011 census.

“The number of deaths after being bitten by rabid dogs has also increased every year due to people’s negligence and ignorance about the disease,” Bastola said.

According to Teku hospital, the number of patients is higher on Fridays, Saturdays, and other holidays, as more people tend to walk on the streets. Doctors say children are primary victims of stray dog bites during holidays because they come out of their homes to play in public spaces.

Hospital records show that at least 17 people died last year and 16 people died in 2016 from getting bit by rabies-infected dogs. “About half a decade ago, less than 10 people used to die from rabies, but now the number has been increasing,” said Dr. Sher Bahadur Pun, a research coordinator at Teku hospital.

Symptoms of rabies include a fever accompanied by  pain, an unusual tingling, pricking, or burning sensation. Medical professionals say people infected with rabies also develop an irrational fear of water, heights, and are sensitive to light.

According to Pun, a person affected by rabies could die within four to five days of the infection, while in some exceptional cases, the victim may live for a year. “If the bite is on the tip of a finger and above the neck, the symptoms of rabies can be detected earlier,” Pun said, before adding that in cases of Nepali patients, the symptoms may not be seen until six months later. “It could be because Nepalis have more immunity to the infection than outsiders,” said Pun, who has been closely observing patients infected by rabies for the last eight years.

The World Health Organisation defines rabies as an infectious viral disease that is almost always fatal following the onset of clinical symptoms. It estimates that 99 percent of cases are a result of domestic dogs bites.

However, veterinary doctors in Nepal say, most of the stray dogs were kept as pets once and would have been left on the streets after they get ill and try to bite people in their own house.

“The best solution is to vaccinate the street dogs,” said Dr. Rakesh Chand at the National Zoonoses and Food Hygiene Research Center in Chagal. “If people are sensitive to their pets and provide better treatment to their dogs, these animals won’t bite.”

A 2016 data from the Kathmandu Metropolitan City shows there are as many as 30,000 stray dogs in the Capital, and the numbers could have jumped higher because of lack of sterilisation and effective management of the canines. In the same year, the metropolitan office, with the support of Humane Society International and Jane Goodall Institute Nepal, declared Ward No. 20 as the first dog-managed zone in the country to mark World Rabies Day. A total of Rs35 million was spent on the programme to turn the city free of stray dogs.

That plan failed due to a lack of effective implementation and oversight. Hari Kumar Shrestha, head of Urban Health Division under the Kathmandu Metropolitan office said authorities didn’t allocate any money this year to his department for countering stray dogs.

“They said it was due to technical reasons, and now we only have Rs900,000, which is not enough,” Shrestha told the Post. “I have been lobbying for more funds and appealing other organisations for the drive,” said Shrestha.

The Urban Health Division looks after public health issues in the metropolis, and has been running community health clinics in 27 places across the city, providing free health check-ups and medicines.

An official at the hospital’s epidemiology division confirmed to the Post that the government spends over Rs60 million for anti-rabies vaccinations—about 300,000 viles—annually, most of which is imported from China. Doctors and administration officials at the hospital say the government should focus more on prevention rather than spending millions of rupees on treating dog bites.

“If the government spent a fraction of that amount to effectively manage or control stray dogs in the city,” said Rup Narayan Khatiwada, a section officer, “maybe that would actually help.”