'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?

DAVID YOUNG FOR NEW STATESMAN
Show Hide image

An English tragedy: how Boris, Dave and Brexit were formed by Eton college

It's said that the Battle of Waterloo was won on the playing fields of Eton. Was Britain's relationship with Europe wrecked there?

The brief window in which it was cool to be an Etonian has closed. That period was marked not just by Etonian success and visibility – in politics, on the stage, in the media, even on the balcony of Buckingham Palace – but also by a new-found unabashedness in expressing pride at having attended King Henry VI’s Thames-side ­college, founded for 70 poor scholars in 1440. David Cameron summed it up when he said he was “not embarrassed” that he had gone to “a fantastic school . . . because I had a great education and I know what a great education means”.

All this was quite strange and ­perturbing to me, as an alumnus of an older era, the 1970s, when being an Etonian seemed decidedly uncool. When asked which school we had attended, my contemporaries and I muttered that we had been to a comprehensive near Slough. It was perturbing because I always had my doubts about Etonian confidence, or arrogance.

The closing of this window can be dated precisely to the early hours of the morning of 24 June. At that moment, it became clear that David Cameron had taken an insouciant, arrogant and disastrous gamble, in the interests of maintaining Conservative Party unity, by calling an unnecessary referendum on Britain’s membership of the European Union that he believed he was sure to
win. The window closed even more tightly a week later, when Boris Johnson, having helped to lead the Leave campaign, suddenly declared that he was no longer standing for the Tory leadership – the glittering prize for which he had apparently abandoned his principles and betrayed his friends.

If the Battle of Waterloo had been won on the playing fields of Eton, it now appeared that Britain’s relationship with Europe, and even its continued integrity as a nation, had been wrecked there. It was no surprise that there should be a turning against Eton, with gleeful opinion pieces from the left-leaning commentariat mocking everything from Tom Hiddleston’s backside to the commitment to public service of one of our ablest MPs, Jesse Norman.

I find this reaction as shallow as the ­excessive pride that preceded it. Maybe that is not surprising, as I both love and feel dissatisfied, even disappointed, by the school where I spent five years of my boyhood and then two and a half years teaching English literature as a young adult. The feeling of let-down is more than personal. Eton has something to answer for, at a national level. A few years ago, I wrote these words: “I’ve often wondered whether this famous Eton confidence could be skin-deep: certainly people such as Boris Johnson and David Cameron do not lack chutzpah, but the confidence to believe you deserve the high position does not necessarily mean you possess the other talents – humility, for instance, and the ability to listen to others – needed to honour it.” Now the 11 Eton pupils who managed to secure an interview with Vladimir Putin have trumped even Cameron and Johnson
in the chutzpah department, but not necessarily added lustre to their alma mater.

I had a chance to reassess the ambivalence I feel about Eton, and to reflect on the role that this ancient and eccentric place has played in our national crisis, when I attended a reunion at my old school just three days after the dark night of 23 June.

This was not a reunion of old boys but a celebration of the 50th anniversary of the Eton English department, an institution for which I feel affection and profound gratitude. As a boy, I was inspired not only to read voraciously and widely – the novels of Thomas Hardy, Henry James, Dickens, William Faulkner; the poetry of Coleridge, Wordsworth, Emily Dickinson, T S Eliot, Charles Causley, Louis MacNeice, Henry Vaughan; Shakespeare at his most intense – but also to analyse, think and feel simultaneously. Alan Paton’s Cry, the Beloved Country and Dickens’s Hard Times opened my eyes to conditions as far from my comfortable Home Counties upbringing as you could imagine, to the realities of racial segregation and working-class ­deprivation; opened my heart, too, I hope.
I was being challenged to reflect on my privilege, even be discomfited by it – not just blindly perpetuate it.

For those reasons, I was honoured to be invited back to teach, initially for just a year, in the department that had given me so much mind-and-soul nourishment. I was not the most confident or organised of teachers, but pupils I bumped into years later said they had enjoyed and gained something from classes in which discipline was not always the tightest. A debate I set up to discuss the miners’ strike turned into a riot. Above all, I enjoyed directing motivated and talented boys in productions of Journey’s End and Death of a Salesman which moved audiences.

***

Inspiration, warmth and a streak of anarchy are, perhaps, not the qualities you associate with Eton. But they were present in the English department, which started as a sort of anti-establishment challenge to the hegemony of classics. Angus Graham-Campbell, my laconic head of department, summed up the department’s signature virtues as scholarship, exuberance and irreverence.

The English department was not exactly typical of Eton as a whole. It was, I suppose, the haven for sensitive and artistic souls, for subversives and mavericks. Eton had other, for me less attractive, sides. I particularly disliked Pop, the self-elected club of prefects who strutted their stuff and lorded it over underlings in brightly embroidered waistcoats – the club to which Boris Johnson (but not David Cameron) belonged. This was more Game of Thrones than “The Love Song of J Alfred Prufrock”.

Eton, above all, was intensely male, intensely hierarchical and intensely competitive. Like Boris, I was a King’s Scholar; successors of the original 70 poor scholars, we lived apart from other Etonians in ancient quarters close to the 15th-century chapel, wore gowns and competed more for academic honours than for social kudos. Like Boris, I won the Newcastle Scholarship in classics and divinity, a strange 19th-century leftover that involved composing verses in Greek iambics, reading the Gospel of Matthew and the Acts of the Apostles in Greek and answering a paper on the doctrine of the Atonement – all in the term before A-levels.

I was proud of my academic achievements. But having had a chance to reflect on the Etonian male culture of competition from the outside, and then seeing it from a different angle when I went back to teach there, I began to doubt how healthy it was. I realised that coming top of the form and winning prizes had mattered far too much to me. It had even affected my choice of A-levels; I was good at classics and felt fairly confident of being the biggest fish in that smallish pond, rather than swimming in the broader waters of history and modern languages. Surely what mattered was finding yourself, your passion and your vocation?

I was artistically minded and Eton provided wonderful opportunities in drama (the groundwork was being laid for the flowering of acting talent we have seen recently) and music; but “creative writing” and painting, encouraged up to the age of 14, were suddenly put away as childish things when you reached adolescence (this, mind you, is not unique to Eton). From the age of 15, I never even considered choosing to go to music, art or drama school rather than taking the well-worn path to an Oxbridge scholarship. Achieving that seemed to be the pinnacle of Etonian success, and the only thing my worldly housemaster ever cared about.

Certainly no one talked much about happiness or emotional health. Eton’s pastoral care seemed close to non-existent. I kept my unhappiness to myself, with unhelpful consequences. For four of my contemporaries in college, who committed suicide in their late teens or twenties, the consequen­ces were more dire.

This may be sounding too much like a personal lament, or a reprise of Cyril Connolly’s theory of permanent adolescence in Enemies of Promise. I found my way eventually to what I wanted to be and do (it involved a lot of psychotherapy and a wonderfully liberating year in Barcelona). But I think my criticisms of Eton have a bearing on our national tragedy.

The atmosphere at the Eton English department celebration a few weeks ago did not lack the appropriate exuberance and irreverence, and the setting in the provost’s garden, surrounded with sculptures by Rodin, Jacob Epstein and Henry Moore, was exquisitely beautiful. Yet I could not help sensing the unquiet ghosts of Dave and Boris stalking the corridors behind us. I imagined them locked in an immature male rivalry that has ended up inflicting incalculable damage on a nation. Now Dave has decided to quit the political stage, leaving rather little in the way of legacy behind him.

Perhaps Boris, the King’s Scholar, could not forgive Dave for winning the ultimate prize. However, in taking revenge, he found himself hoist with his own petard, before somehow managing to emerge with a lesser prize, which some see as a ­poisoned chalice.

It all made me think of that supremely pointless sport, the Eton wall game. I played once or twice before giving up, repelled by the sheer unpleasantness of being ground into either brick or mud, and the tedium of a game in which the last goal had been scored in 1909. As a Colleger, though, I supported our team of brainboxes, drawn from the 70 scholars to play against the brawn of the Oppidans (the rest of the school, 1,200 of them). No doubting that it was antler-to-antler stuff, or like the contests of male musk oxen that knock each other senseless.

Eton remains archaic in its attitude towards women. It is still a boys-only boarding school (though a small number of girls, mainly the daughters of teachers, have been pupils there), and the staff are overwhelmingly male. Being largely cut off from women and girls for much of your boyhood and adolescence does not seem to me an ideal recipe for emotional health, or for regarding women as equals.

The school that has educated 19 prime ministers may provide a brilliant academic education and countless other opportunities, but it can leave its pupils emotionally floundering behind a façade of polish and charm. The effects of that emotional impoverishment can be far-reaching indeed. I am encouraged that the new headmaster, Simon Henderson, has signalled a change of tone at Eton, with more stress on “emotional intelligence” and “mental health”. That change is long overdue.

Harry Eyres is the author of “Horace and Me: Life Lessons from an Ancient Poet”, published by Bloomsbury

This article first appeared in the 15 September 2016 issue of the New Statesman, The fall of the golden generation