'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.


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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The age of loneliness

Profound changes in technology, work and community are transforming our ultrasocial species into a population of loners.

Our dominant ideology is based on a lie. A series of lies, in fact, but I’ll focus on just one. This is the claim that we are, above all else, self-interested – that we seek to enhance our own wealth and power with little regard for the impact on others.

Some economists use a term to describe this presumed state of being – Homo economicus, or self-maximising man. The concept was formulated, by J S Mill and others, as a thought experiment. Soon it became a modelling tool. Then it became an ideal. Then it evolved into a description of who we really are.

It could not be further from the truth. To study human behaviour is to become aware of how weird we are. Many species will go to great lengths to help and protect their close kin. One or two will show occasional altruism towards unrelated members of their kind. But no species possesses a capacity for general altruism that is anywhere close to our own.

With the possible exception of naked mole-rats, we have the most social minds of all mammals. These minds evolved as an essential means of survival. Slow, weak, armed with rounded teeth and flimsy nails in a world of fangs and claws and horns and tusks, we survived through co-operation, reciprocity and mutual defence, all of which developed to a remarkable degree.

A review paper in the journal Frontiers in Psychology observes that Homo economicus  might be a reasonable description of chimpanzees. “Outsiders . . . would not expect to receive offers of food or solicitude; rather, they would be fiercely attacked . . . food is shared only under harassment; even mothers will not voluntarily offer novel foods to their own infants unless the infants beg for them.” But it is an unreasonable description of human beings.

How many of your friends, colleagues and neighbours behave like chimpanzees? A few, perhaps. If so, are they respected or reviled? Some people do appear to act as if they have no interests but their own – Philip Green and Mike Ashley strike me as possible examples – but their behaviour ­attracts general revulsion. The news is filled with spectacular instances of human viciousness: although psychopaths are rare, their deeds fill the papers. Daily acts of kindness are seldom reported, because they are everywhere.

Every day, I see people helping others with luggage, offering to cede their place in a queue, giving money to the homeless, setting aside time for others, volunteering for causes that offer no material reward. Alongside these quotidian instances are extreme and stunning cases. I think of my Dutch mother-in-law, whose family took in a six-year-old Jewish boy – a stranger – and hid him in their house for two years during the German occupation of the Netherlands. Had he been discovered, they would all have been sent to a concentration camp.

Studies suggest that altruistic tendencies are innate: from the age of 14 months, children try to help each other, attempting to hand over objects another child can’t reach. At the age of two, they start to share valued possessions. By the time they are three, they begin to protest against other people’s violation of moral norms.

Perhaps because we are told by the media, think tanks and politicians that competition and self-interest are the defining norms of human life, we disastrously mischaracterise the way in which other people behave. A survey commissioned by the Common Cause Foundation reported that 78 per cent of respondents believe others to be more selfish than they really are.

I do not wish to suggest that this mythology of selfishness is the sole or even principal cause of the epidemic of loneliness now sweeping the world. But it is likely to contribute to the plague by breeding suspicion and a sense of threat. It also appears to provide a doctrine of justification for those afflicted by isolation, a doctrine that sees individualism as a higher state of existence than community. Perhaps it is hardly surprising that Britain, the European nation in which neoliberalism is most advanced, is, according to government figures, the loneliness capital of Europe.

There are several possible reasons for the atomisation now suffered by the supremely social mammal. Work, which used to bring us together, now disperses us: many people have neither fixed workplaces nor regular colleagues and regular hours. Our leisure time has undergone a similar transformation: cinema replaced by television, sport by computer games, time with friends by time on Facebook.

Social media seems to cut both ways: it brings us together and sets us apart. It helps us to stay in touch, but also cultivates a tendency that surely enhances other people’s sense of isolation: a determination to persuade your followers that you’re having a great time. FOMO – fear of missing out – seems, at least in my mind, to be closely ­associated with loneliness.

Children’s lives in particular have been transformed: since the 1970s, their unaccompanied home range (in other words, the area they roam without adult supervision) has declined in Britain by almost 90 per cent. Not only does this remove them from contact with the natural world, but it limits their contact with other children. When kids played out on the street or in the woods, they quickly formed their own tribes, learning the social skills that would see them through life.

An ageing population, family and community breakdown, the decline of institutions such as churches and trade unions, the switch from public transport to private, inequality, an alienating ethic of consumerism, the loss of common purpose: all these are likely to contribute to one of the most dangerous epidemics of our time.

Yes, I do mean dangerous. The stress response triggered by loneliness raises blood pressure and impairs the immune system. Loneliness enhances the risk of depression, paranoia, addiction, cognitive decline, dem­entia, heart disease, stroke, viral infection, accidents and suicide. It is as potent a cause of early death as smoking 15 cigarettes a day, and can be twice as deadly as obesity.

Perhaps because we are in thrall to the ideology that helps to cause the problem, we turn to the market to try to solve it. Over the past few weeks, the discovery of a new American profession, the people-walker (taking human beings for walks), has caused a small sensation in the media. In Japan there is a fully fledged market for friendship: you can hire friends by the hour with whom to chat and eat and watch TV; or, more disturbingly, to pose for pictures that you can post on social media. They are rented as mourners at funerals and guests at weddings. A recent article describes how a fake friend was used to replace a sister with whom the bride had fallen out. What would the bride’s mother make of it? No problem: she had been rented, too. In September we learned that similar customs have been followed in Britain for some time: an early foray into business for the Home Secretary, Amber Rudd, involved offering to lease her posh friends to underpopulated weddings.



My own experience fits the current pattern: the high incidence of loneliness suffered by people between the ages of 18 and 34. I have sometimes been lonely before and after that period, but it was during those years that I was most afflicted. The worst episode struck when I returned to Britain after six years working in West Papua, Brazil and East Africa. In those parts I sometimes felt like a ghost, drifting through societies to which I did not belong. I was often socially isolated, but I seldom felt lonely, perhaps because the issues I was investigating were so absorbing and the work so frightening that I was swept along by adrenalin and a sense of purpose.

When I came home, however, I fell into a mineshaft. My university friends, with their proper jobs, expensive mortgages and settled, prematurely aged lives, had become incomprehensible to me, and the life I had been leading seemed incomprehensible to everyone. Though feeling like a ghost abroad was in some ways liberating – a psychic decluttering that permitted an intense process of discovery – feeling like a ghost at home was terrifying. I existed, people acknowledged me, greeted me cordially, but I just could not connect. Wherever I went, I heard my own voice bouncing back at me.

Eventually I made new friends. But I still feel scarred by that time, and fearful that such desolation may recur, particularly in old age. These days, my loneliest moments come immediately after I’ve given a talk, when I’m surrounded by people congratulating me or asking questions. I often experience a falling sensation: their voices seem to recede above my head. I think it arises from the nature of the contact: because I can’t speak to anyone for more than a few seconds, it feels like social media brought to life.

The word “sullen” evolved from the Old French solain, which means “lonely”. Loneliness is associated with an enhanced perception of social threat, so one of its paradoxical consequences is a tendency to shut yourself off from strangers. When I was lonely, I felt like lashing out at the society from which I perceived myself excluded, as if the problem lay with other people. To read any comment thread is, I feel, to witness this tendency: you find people who are plainly making efforts to connect, but who do so by insulting and abusing, alienating the rest of the thread with their evident misanthropy. Perhaps some people really are rugged individualists. But others – especially online – appear to use that persona as a rationale for involuntary isolation.

Whatever the reasons might be, it is as if a spell had been cast on us, transforming this ultrasocial species into a population of loners. Like a parasite enhancing the conditions for its own survival, loneliness impedes its own cure by breeding shame and shyness. The work of groups such as Age UK, Mind, Positive Ageing and the Campaign to End Loneliness is life-saving.

When I first wrote about this subject, and the article went viral, several publishers urged me to write a book on the theme. Three years sitting at my desk, studying isolation: what’s the second prize? But I found another way of working on the issue, a way that engages me with others, rather than removing me. With the brilliant musician Ewan McLennan, I have written a concept album (I wrote the first draft of the lyrics; he refined them and wrote the music). Our aim is to use it to help break the spell, with performances of both music and the spoken word designed to bring people together –which, we hope, will end with a party at the nearest pub.

By itself, our work can make only a tiny contribution to addressing the epidemic. But I hope that, both by helping people to acknowledge it and by using the power of music to create common sentiment, we can at least begin to identify the barriers that separate us from others, and to remember that we are not the selfish, ruthless beings we are told we are.

“Breaking the Spell of Loneliness” by Ewan McLennan and George Monbiot is out now. For a full list of forthcoming gigs visit: monbiot.com/music/

This article first appeared in the 20 October 2016 issue of the New Statesman, Brothers in blood