The tale of the Stray Cat and Open Blister, including a possible lick under the table, sounded quite worrying, depsite reassurances at the time from a local doctor. Well, at least the latter had resulted in AH and her BF forgetting the whole drama and continuing to have a lovely time.
In bed, my mind went round and round in circles. Google to the rescue. According to the WHO Definition, the AH was potentially in category II - nibbling of uncovered skin, minor scratches or abrasions without bleeding, licks on broken skin. Thus gov.uk recommend two further vaccines for those such as AH who have been vaccinated. Read more here (The Indian sub continent health services do not seem to recommend post exposure vaccination)
A nice young man at 111 tells us a clinician will call back within 10 hours. 10 hours!!!! 10 minutes later a pharmacist rings and tells us to go to A&E. AH is getting upset so I take over and ask which A&E has the vaccine. He doesn't know. Rabies exposure is not common but it's standard stuff, not wierd and off the wall. Why doesn't he know? Why doesn't have a flow chart to hand?
I call the Royal Berks, Reading and get put through to a nice nurse practitioner, Claire, who is very helpful, consults her protocols, agrees we need treatment but says they don't stock the vaccine. Usually have to order it from Colindale and it arrives within 48 hours (48 hours!!!) by courier. 'Please could you order it now?' I ask. There is a No, we have to go in and be assessed clinically. What was the phone call if not a clinical assessment? Claire thinks somewhere in Oxford may have the vaccine.
I decide to call Colindale myself and get this sorted. I play the retired GP card. It doesn't work. Two hours have passed. We call 111 again. We are now in Groundhog Day mode.
A charming young man takes all her details and then a clinician (pharmacist) calls back and tells us to go to A and E. We decide to go to A and E at the JR, Oxford. Clealry we should have done this two hours ago. It's nearly sunset. 'But we don't have rabies in this country' says the receptionist. (Why do we have unqualified people front of house in the NHS?; don't tell me; money) We get past this barrier and find ourselves waiting. It's not busy. Things look up when we see the triage nurse. 'Oh yes, we keep the vaccine here. It's the bats you know' (Bats? Yes, bats )
We are referred to the doctor who we see within two hours. Now we hit a hurdle. The doctor trained in India so thinks we don't need vaccine. I tell her about Colindale. She is very sweet and calls the Infectious Diseases Team. She returns to say that we do indeed need the vaccine. PH England have been called and will give an order to release the vaccine. Just over an hour later we are called in to see the nurse who has the vaccine!! hurrah! Half of it spills so we wait another half an hour while another vial is sourced from pharmacy. We escape after 4 and a half hours. Targets have been missed and it is throwing it down but the staff in A&E was amazing and we can go home and eat and drink and be merry, thoughC hristmas in our house has been postponed till Boxing Day.
The AH was fascinated by A&E. For the first time in three and a half years, I missed my old job and wanted to roll up my sleeves and help. All the cases in minors were bread and butter general practice. Why is the GP service letting people down? GP's should be salaried and work in A and E. Problem solved.
Epilogue.
My girl didn't need to return to the JR for a booster; Public Health called her, sent the vaccine to her GP and made her an appointment in the New Year, which is within the time frame. We all lived happily ever after and the AH bought us a bottle of Crémant to say sorry for the rabies scare.
In bed, my mind went round and round in circles. Google to the rescue. According to the WHO Definition, the AH was potentially in category II - nibbling of uncovered skin, minor scratches or abrasions without bleeding, licks on broken skin. Thus gov.uk recommend two further vaccines for those such as AH who have been vaccinated. Read more here (The Indian sub continent health services do not seem to recommend post exposure vaccination)
I break this news after the victim has created a wonderful pancake breakfast for us.
A nice young man at 111 tells us a clinician will call back within 10 hours. 10 hours!!!! 10 minutes later a pharmacist rings and tells us to go to A&E. AH is getting upset so I take over and ask which A&E has the vaccine. He doesn't know. Rabies exposure is not common but it's standard stuff, not wierd and off the wall. Why doesn't he know? Why doesn't have a flow chart to hand?
I call the Royal Berks, Reading and get put through to a nice nurse practitioner, Claire, who is very helpful, consults her protocols, agrees we need treatment but says they don't stock the vaccine. Usually have to order it from Colindale and it arrives within 48 hours (48 hours!!!) by courier. 'Please could you order it now?' I ask. There is a No, we have to go in and be assessed clinically. What was the phone call if not a clinical assessment? Claire thinks somewhere in Oxford may have the vaccine.
I decide to call Colindale myself and get this sorted. I play the retired GP card. It doesn't work. Two hours have passed. We call 111 again. We are now in Groundhog Day mode.
A charming young man takes all her details and then a clinician (pharmacist) calls back and tells us to go to A and E. We decide to go to A and E at the JR, Oxford. Clealry we should have done this two hours ago. It's nearly sunset. 'But we don't have rabies in this country' says the receptionist. (Why do we have unqualified people front of house in the NHS?; don't tell me; money) We get past this barrier and find ourselves waiting. It's not busy. Things look up when we see the triage nurse. 'Oh yes, we keep the vaccine here. It's the bats you know' (Bats? Yes, bats )
We are referred to the doctor who we see within two hours. Now we hit a hurdle. The doctor trained in India so thinks we don't need vaccine. I tell her about Colindale. She is very sweet and calls the Infectious Diseases Team. She returns to say that we do indeed need the vaccine. PH England have been called and will give an order to release the vaccine. Just over an hour later we are called in to see the nurse who has the vaccine!! hurrah! Half of it spills so we wait another half an hour while another vial is sourced from pharmacy. We escape after 4 and a half hours. Targets have been missed and it is throwing it down but the staff in A&E was amazing and we can go home and eat and drink and be merry, thoughC hristmas in our house has been postponed till Boxing Day.
The AH was fascinated by A&E. For the first time in three and a half years, I missed my old job and wanted to roll up my sleeves and help. All the cases in minors were bread and butter general practice. Why is the GP service letting people down? GP's should be salaried and work in A and E. Problem solved.
Epilogue.
My girl didn't need to return to the JR for a booster; Public Health called her, sent the vaccine to her GP and made her an appointment in the New Year, which is within the time frame. We all lived happily ever after and the AH bought us a bottle of Crémant to say sorry for the rabies scare.
