'We don't do rabies'

When Alyssa McDonald was bitten by a stray dog in Romania, she was given excellent anti-rabies treat

"You want a babies injection?" asked the receptionist at my local GP surgery. "No," I explained as calmly as I could. "Not a babies injection, a rabies injection." "Oh ... I don't know about that," she said. "I'll have to check. Call back at six."

Two days earlier, at the end of a weekend trip to Bucharest, I had been walking through the city when one of the many stray dogs bit me - not badly, but hard enough to draw blood. I didn't really want the hassle of a trip to hospital, and I'd heard some horror stories about the Romanian ones. But then again, hospital was preferable to rabies. Virtually unheard of in the UK now, it still kills 55,000 people each year globally.

It is a particularly horrible way to die: within a week, sufferers become anxious and disorientated, developing an overwhelming thirst paired with an inability to swallow. Delusions, hallucinations and deranged behaviour (including thrashing, spitting and biting) follow; it usually takes another week or so before heart and lung failure lead to total paralysis, coma, and finally death. And once symptoms start to develop, rabies is nearly always fatal. So I was ready to put up with substandard treatment - I just wasn't prepared for quite how bad it turned out to be. And I didn't expect to find the NHS doling it out.

Dogs are a major nuisance in Bucharest. The rehousing programme during Nicolae Ceausescu's dictatorship forced many families to abandon their dogs, and now the city is home to about 200,000 strays. On average, strays bite 50 people a day; some of them carry tetanus and/or rabies. The city council has announced a couple of culls in recent years, but these programmes have never been extensive enough to tackle the problem. Fortunately, because the risk of being bitten is high, the city's hospitals are well set up to deal with the victims. The nurse I limped up to in Spitalil Colentina's anti-rabies unit spoke a little English, and within half an hour I'd been bandaged up, given shots for tetanus and rabies, and was out of the door with a prescription for antibiotics and directions on what to do when I got home. The days when rabies was treated with painful injections in the stomach are long gone; now you just need a series of five shots in your arm over the space of a few weeks. Easy.

The nurse gave me a leaflet containing information about the vaccine for my doctor in the UK. The entire service was free of charge.

As soon as I returned to London, I phoned NHS Direct to find out where to get my first follow-up shot. I was given the names of two NHS walk-in centres and a private Medicare centre before I was told that I could also see my GP.

"We don't do rabies," the receptionist at the first walk-in centre told me. "Tetanus we do, but not rabies." I called the second one. Then I tried again an hour later, and again an hour after that. Eventually I accepted that they weren't going to pick up, but I wasn't quite ready to accept the idea of paying for a treatment that I could get for free on the far side of the continent. So I skipped the Medicare option and phoned my doctor. Maybe I should have taken them up on that offer of a babies injection: I might actually have got somewhere if I had. When I called back at 6pm, the phone was engaged, and it stayed that way until the surgery closed at 6.30pm.

Life-threatening

Stuck for what else to do, I called the hospital closest to my office, St Thomas's in central London. Could they help me? The A&E receptionist was not keen. "Why didn't you call NHS Direct?" "I did," I explained, "and none of the options they suggested could help me. So now I am calling you, because I may have been exposed to rabies, and rabies is a life-threatening disease." "Where do you live?" I told her. "We're not your nearest hospital then, are we? You should have called the Royal London . . ." She was gracious enough to put me through to a doctor anyway.

"Yeah, we can do a rabies injection," the doctor told me. "But we shouldn't have to, really - you should be going to your doctor, because it's a community issue." I didn't ask why Romanian stray dogs are a community issue for Hackney Council.

So far, so incompetent. But the dismal service I'd received had nothing on what came next.

At A&E the next morning, I told the doctor what had happened, and about the five jabs the nurse in Bucharest had said I'd need. I didn't mention the antibiotics I'd been given for the wound itself; neither did he. Half an hour later, a student nurse appeared with a small syringe and the information leaflet from the vaccine, which she handed to me. She gave me the shot and smiled, "That's it! You're fine now." Really? What about the further three injections I'd been told I should have? "Oh, foreign hospitals are usually a bit overcautious with British patients. They're scared we'll sue." She assured me that I didn't need any further treatment, and that I was free to go. So I did. And I had got as far as the door when the doctor rang my mobile. He hadn't told the nurse to let me go, but since I already had, he just wanted to remind me that I'd need to see my GP for the remaining three shots.

I was confused - the nurse had said I didn't need any more treatment. "Did she? Oh, uh, then that's right." "Are you sure?" "Yes." I wasn't. But as I had the vaccine information leaflet, I could check: and like the Romanian one, it said I needed three more doses. (Not surprising, really, as that's the WHO's recognised regimen for rabies.) Why had the doctor needed me to tell him the dosage? When I went back to A&E and spoke to him, I discovered what had caused the confusion: he hadn't even read the information leaflet. And quite clearly, neither had the student nurse.

Rabies is hardly the UK's most pressing health issue, but the Health Protection Agency still treats about a thousand travellers each year who have been exposed to the disease abroad. Its line on treatment is unequivocal: as rabies is a fatal condition, the only available precaution - vaccination - must be used. The substandard treatment I received has serious implications for everyone who uses the National Health Service. In the end, my health was fine, but that doesn't excuse the level of service the NHS offered me. Being misheard, misinformed and passed from pillar to post is bad enough. But for two members of hospital staff to handle a less-than-everyday complaint by dishing out medication and advice without checking the facts is completely unacceptable, and potentially very dangerous. I contacted St Thomas's to ask for an explanation, but it was not prepared to comment unless I made a formal complaint.

According to research by the National Patient Safety Agency last summer, I'm not alone in receiving such poor service: almost 25,000 patients a year receive the wrong treatment in British hospitals. Whether the result is serious harm or just frustration and inefficiency, this is a pretty appalling track record. So, if you're looking for efficient, safe health care, try Romania. You might be less likely to end up foaming at the mouth.

This article first appeared in the 31 March 2008 issue of the New Statesman, Is Boris a fake?

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“Yes, it was entertaining”: A twisted tale of Twitter trolls and fake terror victims

Here’s what happened when I contacted people involved in the insidious new social media trend.

When I reach out to Sam to ask why she stole the image of a 19-year-old Minnesotan man to post on her Twitter account, the first thing she says is: “Am I getting paid?” The day after the Manchester Arena bombing, Sam took the profile picture of a man named Abdulfatah and posted it alongside a 137-character tweet. “Please retweet to help find Abdul,” she wrote. “He has chemo and we're very worried. We last heard from him before Ariana's concert”. She rounded it off with a hashtag. #PrayForManchester.

Abdulfatah was not a victim of the Manchester bombing and nor was he at Ariana’s concert, as he has been living in Cairo for the last year. Sam’s tweet was a lie that generated (at the time of writing) 1,280 retweets, mostly from people simply trying to help after a tragic terrorist attack. Over the last few years, trolls have responded to terrorism and other catastrophes by opportunistically pretending that their friends and family are among the victims of attacks. After the Manchester bombing, a handful of accounts continued this trend – for varied reasons.

“I had no aim,” is Sam’s simple response to being asked why she posted her tweet.

Sam explains that she wants me to pay her so she can “feed [her] team”, who she says are called the Halal Gang. After explaining that I cannot ethically pay for her interview, she concedes to speak when I say that I will link to her twitter account (@skrrtskrtt).

Born a male, 18-year-old Sam tells me she “prefers female pronouns” and immediately gives me her full name, town of residence, and the name of the English university where she studies civil engineering. When I ask for a form of ID to prove her identity, she claims she left her wallet on campus. When I ask her to simply email from her university email address, she says – over Twitter’s direct messaging service – “unfortunately i cannot provide u with evidence at this very moment”. For this reason, I will refer to her by her first name only. Her quotes are here copied verbatim from the messages she sent me online.

“I chose that mans image because he seemed like an easy target. I was quite intrigued by the huge number of retweets because i got the attention i never got at home. And yes i did him a favour by getting him clout. He's ugly so i guess I got him some girls. People who also made fake missing people are G's and i salute them.”

Why did you do it, I ask? The reply is one word. “Entertainment”.

***

Abdulfatah was casually scrolling through Twitter when he realised his profile picture had been stolen. “Honestly, it was horrific,” he tells me – again over Twitter’s messaging service – “I hope nobody has to go through what I did. Just imagine scrolling through Twitter only to find that some random person used your photo to claim you’ve gone missing in a bombing.”

When Abdulfatah decided to confront his troll on Twitter, his tweet got 63,000 retweets and 98,000 likes. “i'm from Cairo and i don't have Chemo... who tf are you? how do you know me???” he wrote – and his response went on to be featured in articles by The Sun, Yahoo!, Mashable, and AOL.com. The tweet is part of a larger story that has spread over the last few days – of “sick Twitters trolls” targeting innocent people by pretending they are missing. 

My Twitter chat with Abdulfatah spans a few hours, and he hammers home how “vile and disgusting” he finds the act of spreading fake victims on social media. “I hope people come to their senses soon and stop this type of behaviour. It’s not funny at all.” Half an hour after we exchange goodbyes, he messages me to explain that there is something else he wants to say.

“I totally forgot to mention this,” he begins. “I couldn't have done this without this groupchat I'm in called ‘Halal Gang’.”

***

In their 2017 book, The Ambivalent Internet: Mischief, Oddity, and Antagonism Online, authors Whitney Phillips and Ryan M Milner dedicate an entire chapter to “Identity Play” on the internet.

“Online and off, identity is a series of masks,” they write. “Whether online deceptions are harmless or targeted or somewhere in between, determining why anonymous or pseudonymous actors do the things they do can be very difficult.”

So why do people use the internet to deceive? The authors’ argue it is simple: “because they’re able to: because the contours of the space allow it.”

Creating a person online is incredibly simple. Believing that someone online is who they say they are is even easier. Many newspapers now create entire stories based around a single tweet – taking what is said and who said it as fact, and covering their backs with a few “appears to have” and “allegedly”s. By taking viral tweets at face value and crafting stories around them, media companies consistently break one of the internet’s oldest rules. Do not feed the trolls. 

***

Abdulfatah sent me a copy of his provisional driver’s license to prove to me that he is who he claims. After his announcement about the Halal Gang, I became suspicious that both the victim, Abdulfatah, and the perpetrator, Sam, were in fact working together to go viral. Why else would they both independently reference the same group? Instead of a random troll picking on a random person, was this the case of two friends working together to achieve social media fame?

“I have never met this person prior to this incident,” said Abdulfatah over Twitter, promising me that I could call him for clarification (at the time of writing, he has not answered his phone). “I feel offended that someone like that would ever try to claim to be a part of our group.” Abdulfatah was added to the Halal Gang (which is a Twitter group chat) in January, and says to me: “I promise you this isn't a troll.” It is worth noting that a Twitter search shows that Abdulfatah and Sam have never previously interacted publicly on the site.

From 19:43 to 20:30 on Wednesday night, I was added to the Halal Gang chat. The group describes themselves as a place for young people to “find peace and tranquillity” through the Islamic faith. The 12 members told me Sam was a “lost person” who used to be in the chat but was kicked out for inappropriate behaviour. Abdulfatah was her replacement (he says he didn’t know this) and thus Sam targeted him in her tweet after the Manchester attack. One member of the Halal Gang said that Sam was his ex and went on to send a sexually-suggestive picture of her in the chat.

“It wasn’t our intention to go viral, just to help out Abdul but I guess it was kind of cool to go viral lol,” said one member.

Rather than trolls targeting random people, this incident therefore seemed to be a case of personal rivalry and revenge. This goes some way to explaining the psychology behind, and the motivations of, people who claim to have missing friends and family after terrorist attacks. According to the Halal Gang, Sam was simply targeting her replacement, Abdulfatah, because she likes trolling.

But then, at midnight, I received another Twitter message, from a person wishing to remain strictly anonymous.

“This is a MAJOR conspiracy,” they wrote.

***

Most of the time people make up fake victims on social media, the motives are cut and dried.

Andrea Noel is a Mexican journalist whose picture was circulated after the Manchester bombing, in a collage purporting to show 20 missing people. She has been trolled extensively in the past after speaking on social media about her sexual assault, and believes some of the same “anti-feminist” trolls may have been at work.

“I started getting Facebook messages and Twitter messages from various people that I know… getting in touch with me to make sure I wasn’t in Manchester,” she tells me over the phone.

The collage Andrea appears in also includes photographs of YouTubers, and was featured on the Daily Mail’s Twitter and Fox News as a legitimate collage of missing people. According to Buzzfeed, 4Chan trolls may have been behind the picture, choosing people they disliked as their victims.

Yet when a handful of people create a fake image, it is thousands more who are responsible for its impact. In 2013, researchers found that 86 per cent of tweets spreading fake images after Hurricane Sandy were retweets, not original tweets.

Caroline Leo is a 16-year-old from Florida who gained over 15,000 retweets on her tweet of the collage. “I felt good about it because I was helping find so many people and my phone was literally freezing and I had to turn it off for a little while,” she tells me of the initial reaction to the tweet. Yet when multiple people contacted her to say it was fake, she decided not to delete it as some of those featured in the picture were actual missing people. “I was so happy to make their faces familiar to over one million people and I wanted to keep it up because I like Ariana so much and I wanted to help other people who love her just as much as I do,” she says.

Andrea understands Caroline’s motivations, but does think people need to be more careful about what they spread online. “If you realise that half of these people are YouTubers then just delete it, you know. Make a new one,” she says. “I understand that she’s trying to be sweet but after a couple of hours everyone knew this was fake… so, really just make a new one.”

Yet a big part of the reason people create fake images – or accidentally spread them believing them to be real and then don't want to delete them – is for the likes, retweets, and comments. The buzz that we feel from social media attention doesn’t go away just because of a tragedy, and Dr Linda Kaye, an expert in the psychological impacts of technology, explains social media interactions facilitate our “need satisfaction”.

“Humans are social animals and have a basic need for social belonging,” she says. “Perhaps these individuals who [use social media] in this way to gain ‘social approval’ are not having their social needs fulfilled by their existing relationships with friends and family. Adolescents may be particularly prone to this sort of behaviour, as this is a period of great change, in which peer relationships often become more fundamental to them than parental ones.”

John, a YouTuber who was also featured in the collage and in a separate tweet claiming he was missing, urges people to think before they act on social media. “If there is one thing I would like to say about this all... I understand that during events such as this, information can develop and spread very rapidly,” he tells me, “but it doesn't hurt to try to confirm information through a second source.

“For instance, say that a story on Yahoo is claiming that I was a victim - is the BBC reporting the same story? During a crisis situation, I feel that disseminating the correct information to the general public is absolutely crucial and potentially lifesaving.”

***

The Twitter user who contacted me about the Halal Gang “conspiracy” refused to speak when I said I would not transfer $10 to his PayPal account. “$10 is a steal for the info I have not gonna lie,” they said. When I refused, they sent me this offensive meme from the adult cartoon The Boondocks.

At 3:05am, another anonymous Twitter user messaged me. They claimed that the man in the Halal Gang who claimed to be Sam’s ex and had sent me a sexual picture of her, was in fact trying to humiliate his ex. “It’s embarrassing don’t use that picture in any articles,” they wrote.

As it stands, there is potential that the Halal Gang were working together to get multiple viral tweets. There is also potential that the man who asked me for $10 was also trolling in turn by trying to tell me the Halal Gang were acting like this when they are, in fact, innocent. Yet if not Abdulfatah, some members of the group seem to be corresponding with Sam, as she changed her story after I spoke with them. “I believe they kicked me way before the incident and I’ll be completely honest with you, I wanted to get them back, yes,” she says, despite moments earlier saying that they kicked her out after her Manchester attack tweet.

It is impossible to work out Sam’s true motivations for creating a fake victim, as she is hiding behind her online persona and simply answered “nope” when I asked if there was a number I could call her on. Her comments – that she lives in a foster home and is emotionally abused by her family, that she is “not dumb enough to go to an Ariana Grande concert”, and that people critical of her actions “need to move on init” – read as though she is simply trolling me, a journalist, in turn.

There is no real way for me to know who is who they say they are, and whether the Halal Gang are telling the truth that they didn't collaborate with Sam (they refuse to send over screenshots of her being kicked out from the groupchat, as the chat has a “no SS” rule). As Phillips and Milner note, even experts have great difficulty identifying people online. Either way, there is clearly more of connection between Sam and Abdulfatah than the two initial tweets made it seem. 

The reason why this matters is because this story isn’t really about Sam, nor is it about Abdulfatah. If two friends (or people involved in the same group) seek to get revenge or go viral by attacking each other on social media, it is not their actions that have wide-reaching ramifications. It is the actions of the hundreds of thousands of people who choose to Retweet uncorroborated claims, and the journalists who take tweets as gospel. Naturally, in the painful hours proceeding a terror attack, we all make mistakes about what we share on social media. But we can fix them and we can avoid making the mistakes again.

Before claiming she wanted revenge, Sam told me she was acting on a desire to be entertained. I check with her, after this revelation, whether she succeeded in this aim. “So did you find it entertaining?” I ask.

“Yes,” she replies. “It was entertaining.” 

Amelia Tait is a technology and digital culture writer at the New Statesman.

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