I get knocked down
But I get up again
You are never gonna keep me down
When the dog bites
When the bee stings
When I'm feeling sad
I simply remember my favorite things
And then I don't feel so bad
My Favorite Things
by Rodgers and Hammerstein
We came to love the beaches and town of Las Terrenas in the Dominican Republic during our five week stay, but our first week put us through the most daunting trial of our year of travel to date.
There are many dogs on the beaches, some stray and some owned. The beach dogs are generally docile and used to people. Still, knowing how fickle dogs like our own Renzo can be, we generally keep our distance with the kids so that they don't get the dogs riled up.
On our third day here, Oliver, Vera, Erin's parents, and I were walking home on the beach. I was holding Oliver's hand and Erin's mom was carrying Vera. Near the end of our street, a couple of retirees were sitting on the beach with two small dogs and one larger dog. A friend of theirs on a moped had stopped to chat. We walked towards them, about ten to fifteen feet away as we turned up towards our street.
In an instant, the two smaller dogs charged towards us barking, and the larger dog got the wrong message. Oliver turned into my leg and screamed in pain. I lifted him up and turned away from the dogs, who were retreating back to their owners.
"Where does it hurt, Oliver?" I asked through his screams.
"My arm!" he cried, indicating his right arm.
I pulled back the short sleeve of his swim shirt and examined it. I didn't see any signs of a bite or bruise.
"Do you think the doggy bit you or did it just scare you?" I asked.
"It feels like it bit my arm!"
The owners now had the dogs under control. They were French but the woman spoke English. "They never do this," she said, which is the dog-owner's equivalent of "I only had two drinks, officer."
"Is he OK?" she asked with genuine concern.
"I think so," I said as Oliver's screams continued. "I don't think he was bitten, I think it just scared him." Oliver had recently had some episodes of overdramatic reactions, a skill he was honing from careful observations of his overdramatic little sister.
We talked a bit more and they continued to apologize, then we headed home, with Oliver still screaming. About fifty feet down our road he caught his breath and said, "It feels like it's bleeding."
I put him down and looked again at his arm. There were no marks. His swim shirt was not ripped anywhere. I lifted up his shirt to look at his back.
There on his right shoulder blade was an oval of bruises. At the top of the oval was a small cut. It was bleeding.
We walked back to the beach and told the owner's about the bite.
"They have all their vaccines," the woman said immediately.
"Including rabies?" asked Erin's father.
"Yes," she responded definitively. He asked again and again she confirmed.
They apologized again and we left to bring Oliver home to treat the bite.
We got home and told the story to Erin as we rinsed the bite, applied antiseptic cream, and gave him a band-aid.
Then we started questioning the situation.
They said the dog was vaccinated, and based on their sincerity, we believed them. But rabies vaccines expire. Was its rabies shot up to date?
The bite didn't rip his shirt. The saliva probably didn't make contact. But it's a swim shirt designed to let water through. Could the saliva have gotten through?
"Did you ask for their contact information?" Erin asked. She was on a mom's email list back home and had seen emails of mothers desperately seeking vaccine information from the owners of dogs who had bitten their children.
We hadn't asked. Having come from the beach, none of us had phones or even pen and paper. Beyond that, I doubted that they would be able to provide vaccination documentation in a timely manner. If someone asked us for our dog's records, we would have to dig into a box in our garage back in Somerville.
Should one of us go back and see if we can get their contact info? We discussed and thought that we had probably gotten as much information as we were going to get from them. Some time had passed, and they might not be there anymore.
This was the biggest mistake we made.
That night we emailed Oliver's doctor and started researching rabies. The first priority was to determine if the dog is vaccinated. With or without vaccination, the dog should be quarantined for observation for ten days, in which time a rabid dog will die.
If the dog has been vaccinated, the bite victim can wait these ten days to determine if vaccination is necessary. Without the dog, vaccination should start immediately.
Vaccination is a series of five shots given on days 0, 3, 7, 14, and 28. However, since it takes time for the vaccine to be effective, a separate shot of rabies immunoglobulin should be given within 24 hours of the bite, or as soon as possible, to provide immediate protection.
Without vaccination, symptoms can set in between fifteen days to a year after infection. Infection from bites on the hands, neck, or genitals can progress more rapidly than other bites. Once symptoms set in, it is no longer possible to get vaccinated.
This means certain death.
Oliver's doctor sent us information including brand names of vaccines, and the vaccine brands available in the US were different from those available outside the country. This meant that we may not be able to start a round of vaccines here and then finish them in the US. We did have time to get all five vaccinations here - if they were available. A friend of ours told us she works with an organization who recently had to evacuate three exchange students from the Dominican Republic because the proper rabies vaccines were not available anywhere in the country. They were given tetanus immunoglobulin instead of rabies immunoglobulin.
If we could not get access to all five doses of the vaccine, or the rabies immunoglobulin shot, we would have to fly back to the States for treatment.
But even without flying back, vaccination would be a trying ordeal for Oliver. While we were concerned about the severity of the disease, we still thought it highly unlikely that he was infected.
For him to be infected, the dog owners would have had to have lied or otherwise been wrong about its vaccination, and their dog would have had to have been recently bit by a rabid animal which the Owners didn't mention, and the dog's saliva would have had to have gotten through Oliver's shirt to the cut. This all seemed exceedingly unlikely.
Our French property manager told us that the French people here take good care of their dogs and likely have all vaccinations. He had never heard of problems with rabies and said that there are even people who vaccinate and neuter the stray dogs on the beach.
Before committing to vaccination, we decided to ask around for the dog owners on the beach. They had dogs and were talking to a friend, so they seemed like locals. They were sitting on the beach right at the end of our street rather than walking down the beach to a more desirable spot, so they might live in one of the developments on our dead end street.
Each development had a security guard, so I explained the situation in Spanish to each of the guards and asked if they knew any French owners of two small dogs and one larger dog. Most of the developments did not allow pets. We asked at a nearby cafe frequented by French people, and asked a couple of dog owners on the beach. No luck.
There was a veterinary clinic on our street, where we thought they might know the dogs or at least be able to tell us whether rabies was prevalent in this area. I took Oliver there that afternoon. The gated yard had a bell with a rope tied to the clapper which I pulled to ring once. Oliver thought that looked fun, so he grabbed the rope and swung it back and forth, making a racket.
Two dogs in the yard ran over to the chain link gate barking, and the veterinarian came out of the building looking irritated. I explained the situation, now well-rehearsed, apparently too well. He responded in rapid-fire Spanish, incomprehensible to me over the barking of the dogs. I apologized and asked him to repeat himself. He looked more irritated.
"Que hora ayer?"
He was bitten around five o'clock yesterday evening.
"Ha ido al hospital?"
No, we had not gone to the hospital.
"Vete al hospital!"
To the hospital?
"Si! Hoy, antes de las cinco de la tarde. Dentro de las veinticuatro horas de la mordedura."
By five o'clock, within twenty-four hours of the bite.
"Si, vete ahora."
There were two hospitals in Las Terrenas, one public and one private. From the parking lot, the public hospital looked like a concrete bunker from World War I. We turned around and drove to the private clinic, a relatively new and clean-looking facility. I explained the situation to a doctor in the lobby, and after making a phone call she told us to return in the morning to get the rabies vaccine.
Our English- and Spanish-speaking French property manager kindly accompanied us Wednesday morning to help translate. This proved unnecessary because the pediatrician, whom our property manger happened to know, spoke English reasonably well.
While waiting for our appointment, a father came in with his nine or ten year old son. The doctor walked by and said, "They're here for the same reason!"
They were from Switzerland, near Zurich, and the father spoke English. We felt like jetsetters as we sat in the Dominican Republic telling him about our recent travels to Zurich, and he told us about some of the traveling his family had done. Oliver showed the boy his red water bottle with the Swiss white cross that we had bought in Zurich after dropping his previous water bottle under a train.
They had been to the clinic two days earlier for a dog bite and had received an immunoglobulin shot. But when they got home his wife read that it was a tetanus immunoglobulin shot, not rabies immunoglobulin. Since then he had been calling hospitals around the Dominican Republic and in Switzerland (where there is no rabies) to try to determine his son's course of treatment, since they were returning to Switzerland the following day.
It occurred to me that the only reason this clinic had the vaccine that day may have been because the Swiss boy had been there two days before, and they may have ordered his five doses at that time. Since he was leaving, they may have had extra doses on hand to start Oliver's vaccination.
When the doctor was ready, Oliver went in first. I asked to see the vaccine label and verified that it was on the list Oliver's doctor had given us. I asked about the rabies immunoglobulin. He did not have it that day (I wasn't surprised that they didn't stock it). I asked if he could get it with his next vaccine dose on Saturday, and he said yes. This was a little longer than I would have liked to have waited, but I was relieved that he would be getting the proper treatment.
As the doctor prepared the shot, Oliver got wise about what was going down. Erin and I hurriedly explained to him that doggies can have germs in their mouth, so we need to get medicine if they bite us to make sure we don't get sick. He got more agitated, and I hugged him while lifting him up to the exam table. The doctor had me hold his arm and gave a small injection in his shoulder.
Oliver screamed to high holy hell. Over and over.
Erin tried to calm Oliver with promises of special treats from the French bakery after we left. I asked about the schedule for the follow-up shots, and the doctor said he thought there were three shots but needed to check this. I thought the standard schedule was five doses, but I had read about alternate vaccination schedules, especially if the first dose is delayed. I asked again if Oliver would get the rabies immunoglobulin on Saturday, and he said yes.
As we left the office with Oliver in tears, the poor Swiss boy looked white as a ghost after hearing his screams.
Knowing that we were getting the appropriate treatment was a huge relief, after our initial concerns about unavailability of the vaccines on the island. This first week in the Dominican Republic, as in many of our other destinations, had been stressful to begin with as we sorted out getting money, food, bottled water, internet service, and transportation alternatives to our rental car. Oliver's rabies scare compounded this stress by a factor of ten. Now that we had a plan of action, we could start relaxing a bit.
Erin and I had planned to go out to dinner on Friday night while her parents stayed home with the kids. This was our first dinner out without the kids in the previous three months, since we had no babysitters while traveling. That morning Erin asked me to call the doctor to confirm the time for Oliver's second shot on Saturday, and to make sure they would have the vaccines and immunoglobulin (he had given us his cell phone number). The kids were going nuts so I got them out of the house and planned to call after lunch during Vera's nap.
That afternoon, his status on WhatsApp said he couldn't talk but could respond to texts. I sent him a text message confirming the time that Oliver should come for his vaccine and immunoglobulin shots. He responded an hour later and said he would see us tomorrow - but that they didn't have the immunoglobulin.
My head exploded. I scraped my brains off the walls, shoved them back into my ears, and texted him back asking if it was possible to get rabies immunoglobulin anywhere in the Dominican Republic. No response. I asked what the full vaccine schedule would be. No response.
I broke the news to Erin. She stopped working to allow me to use her computer to Skype with Oliver's primary care practice in Massachusetts. After getting bounced around to a few different people, I got a nurse who was knowledgeable about rabies treatment. She confirmed much of what we already knew about the required treatment and said that without being certain about the dog's vaccination status, the immunoglobulin was necessary. She said there was no way to ship it since it required cold storage and a proper chain of custody. The location of the bite on his shoulder made it unlikely that rabies would develop quickly compared to a bite on the neck or hands, but waiting until we returned to the States in a month was too long to risk going without it. If we couldn't get it here we would have to get a flight back for one shot.
I started calling nearby hospitals to see if any had rabies immunoglobulin. Several had a circular phone answering system or dropped my call after I spoke to someone. I finally spoke with someone in an emergency department, but we had a hard time understanding each other. I eventually realized she was repeating "centro antirrabico," which I took to mean some kind of rabies specialty clinic. Some googling confirmed this and with some difficulty I found a phone number and address for the government-run Centro Antirrábico Nacional - in Santo Domingo, two and a half hours away.
It was now after five o'clock on a Friday and no one answered the phone, but the machine said they were open until noon on Saturday. I had to drive Erin's parents back to the airport in Santo Domingo on Saturday, drop off the rental car, meet a visiting friend at the airport, and take the bus back. I could conceivably take Oliver with me and get to the Centro Antirrabico before they closed at noon.
We decided to go to the local clinic for Oliver's vaccine shot first thing in the morning and have the doctor call the Centro Antirrabico to ask when they were open and whether they had rabies immunoglobulin.
Erin's parents took the kids up the street for pizza and she and I left for the dinner date we had waited three months for. We both felt sick to our stomachs.
"I asked you to call this morning," she said after a long silence as we walked down the beach toward town.
"The kids were going nuts this morning, and WhatsApp said he wasn't available."
"How hard would it have been to send that text message earlier?"
"What difference would it have made?"
"I don't know, maybe you could have gone to the rabies place today. At least we could have figured it all out!"
"I'm going tomorrow anyway. We'll figure it out in the morning with the doctor."
"The doctor who doesn't know what he's doing."
"I don't know what he knows. It sounded like he understood when I asked twice about the immunoglobulin. Maybe he found out afterwards that he couldn't get it."
"Which is why you should have called this morning. I knew this was going to happen."
"Really? You knew? After the doctor told me twice that they would have it?"
"We knew there was a problem with getting it on this island. The doctor didn't even know the right vaccination schedule. I just knew, which is why I asked you to call this morning."
I started to respond but stopped myself. It's hard to remain indignant when you know you're wrong.
"I feel sick. I can't eat," she said as we approached the restaurant. She stopped and sat on a bench facing the ocean. I silently agreed and sat on the other end. The sky turned blood orange as the sun settled into the sea.
"Three adults and no one thought to ask for their goddamn contact information," she said.
I took a breath. "We didn't know what we were dealing with. I knew nothing about rabies. We all talked about it, including you, and we all decided not to go back. It's done. This is where we're at. We can get to the rabies center. We'll figure it out in the morning with the doctor."
"Has he even confirmed the time? We have to be there at 8 AM if you're going to get to Santo Domingo before the rabies center closes at noon."
I pulled out my phone and looked back through the messages. My last message had asked if we could see him at 8 AM. He hadn't responded.
At that moment the phone dinged in my hand and a text popped up saying only "Yes" to confirm the time.
"It's him," I told Erin, "he can do eight o'clock."
It dinged again, this time saying "I'm going to give you all the informations."
I instantly responded asking if I should plan to bring Oliver to the Centro Antirrabico on Saturday.
He replied, "Yes."
"He says we should take him," I told Erin.
"He's on his phone now? Can you call him?"
"Yes, I'll try-"
My phone rang. It was the good doctor.
I was seething but I listened while he talked. His tone was conciliatory and I had nothing to gain from berating him. Even if he wasn't familiar with rabies treatment, he spoke English and was the best advocate we had for getting it. He was trying to get it right.
He had talked to another specialist who had sorted out the vaccine schedule for him and recommended contacting the Centro Antirrabico about the immunoglobulin, but she had told him they could do the shot on Monday, not Saturday. We agreed to see him first thing and call the center from his office to find out if they would take us on Saturday.
We went to the restaurant, ordered our food, and tried to think of other things to talk about.
In the morning we all loaded into our rental car with both kids, Erin's parents, and their luggage. Vera sat on Erin's lap, and Erin planned to take a taxi back with Vera while the rest of us went on to Santo Domingo.
"I think that's them!" Erin's mom exclaimed as we passed an open-air French cafe on the way to the clinic.
"I think so, those people sitting at the cafe looked really familiar."
We had all been actively looking for the dog owners every day, up and down the beaches, in restaurants, and on every motoconcho that zipped past.
I took the next left to loop back around past the cafe. I slowed as we approached.
The cafe was empty.
Oliver screamed again for his shot, but I pacified him quickly with a new Paw Patrol game I had downloaded to my phone the night before to sweeten the pot. Ironic that his favorite cartoon was a show about dogs.
The doctor called the Centro Antirrabico and spoke for a few minutes with someone, then hung up.
"Do they have rabies immunoglobulin?" I asked him immediately.
"Yes. But I talked to the doctor. He says that because of the location of the bite, he does not need the immunoglobulin."
"That's wrong," I said, "he needs it."
"He says they cannot give the shot today, only on Monday."
"But they're open today?"
"Yes, until twelve o'clock."
"Please call them back and tell them we'll be there by eleven."
Erin's parents marvelled at the scenery as we drove up over the mountains along the coast, but I couldn't take my eyes off the road. I was driving faster than I should have been, swimming in anxiety as I rehearsed everything I would need to say in Spanish and tried to anticipate the responses.
We made it to the airport in under two hours and said our goodbyes to Erin's parents, then Oliver and I headed off to the Centro Antirrabico a half-hour away through the city.
"Why are we leaving the airport?" Oliver asked. He was looking forward to picking up our friend, and thought that was the only reason we were coming here.
"Her plane hasn't landed yet. We have to go to an... office... to ask some people some questions."
I had no good explanation, but I didn't want to spook him, especially if he didn't end up getting the shot that day. This negotiation was going to be difficult enough without Oliver losing his cool.
The Centro Antirrabico Nacional was a nondescript facility set back in a small parking lot surrounded by chain-link fence in a bustling but otherwise unremarkable urban neighborhood. The security guard directed us to a narrow passage between two low-slung derelict concrete buildings. The dark hallways were empty and the building was quiet. The first room I looked in had a large desk at the front facing several rows of tightly packed plastic chairs, like a cramped classroom. The chairs were empty but there was a woman at the desk looking down at papers she was pushing around. I explained why we were there and she led us down the hallway.
In the next room was another large desk with three people sitting around it chatting idly. The man on the right looked like facilities staff, the woman on the left was dressed like a nurse, and another woman in the center wore a collared shirt with an official-looking embroidered insignia. I assumed she was either a doctor or an administrator. She would be the decision-maker.
The other two didn't get up when I sat down. I was going to have to negotiate with not one, but three people. It would have helped if any of the three had known any English.
I gave them the whole story, answering questions when they asked. Oliver had been bitten by an unowned stray dog on the beach, completely unprovoked. It ripped his shirt and drew blood. We couldn't find the dog and had no idea if it was vaccinated.
By now I knew the criteria for vaccination, so I might have taken a little artistic license with some of the details.
I pulled up Oliver's shirt to show them the bite. Five days later the cut was healing nicely, which didn't help my case.
The woman started telling me that immunoglobulin was not necessary due to the location of the bite. The vaccine would become effective before there was a significant risk of developing rabies symptoms from such a shallow bite on the shoulder.
"Lo siento, no entiendo."
I knew what they were going to tell me before I walked into the room, but I pretended not to understand what they were saying whenever they told me something I didn't want to hear. They were very nice, and I was very polite, but this conversation was going to end with one of us getting fed up and capitulating, and that wasn't going to be me.
His doctor in the United States says he has to have the immunoglobulin, I told them.
Yes, but this is not the United States. The immunoglobulin is very expensive. We have different standards for when it is required.
I understand, but if we can't get it here, his doctor wants us to fly back to the United States for treatment.
Fly to the United States! That is not necessary. The vaccine is sufficient.
But his doctor has told us it is not. He needs the immunoglobulin.
And around and around. This went on for about twenty minutes, until at one point they stopped talking to me and conversed with each other. The woman said something to the man, and he got up and asked us to follow him.
He took us into another room and weighed Oliver on an old mechanical scale. He wrote the weight down on a piece of paper and brought it back to the woman, who scribbled some more notes on it.
We cannot give you the vaccine today. Come back on Monday, ask for this doctor, and give him this paper.
And they will give him the immunoglobulin?
Yes, on Monday.
We are staying in Las Terrenas. Is it possible to get it today?
For all I knew, they were just trying to get rid of me and hoping I wouldn't come back. it was another five hours of travel to get something they probably had in a refrigerator in the next room, plus we would no longer have the rental car on Monday.
No, it is not possible today. Come back on Monday and he will get the immunoglobulin.
I didn't understand why they couldn't do it then, but it seemed like this was as good as it was going to get for today. Just getting to yes had made the trip worth the while. I took the paper and thanked them, then Oliver and I returned the rental car, picked up our friend at the airport, took a cab to the bus station, and got on a bus for the two hour ride back to Las Terrenas.
"What about 'Oogie la boogie la'?"
"That's a good one."
We had decided to come clean with Oliver about the whole situation. He had to know why we were getting another rental car and going back to Santo Domingo. He hadn't handled the shots well when we surprised him with them, so maybe he would do better if he knew what to expect. He listened and understood, and while he wasn't happy about it, we told him that he would always get a special treat afterwards. Erin also told him that his cousin says silly words like "Oogie aagy ouchy" whenever he gets a shot to make it hurt less.
"How about 'La moogie la boogie'?"
"That is definitely silly."
"Do you think that will work good?"
We spent a good part of the two-hour car ride through a thick morning fog trying to come up with the silliest sounding words we could think of. Oliver's words had taken on a decidedly Spanish flavor.
The Centro Antirrabico was much busier than it had been on Saturday. I showed our golden ticket from Saturday to the first person we saw, who led us to an office with a young woman behind a desk pushing papers around. I gave her our paperwork with a brief explanation. I planned to give out as little information as possible, since anything else I told them at this point could only give them cause to deny the treatment we had been granted on Saturday.
Soon a jovial doctor came in and the young woman briefed him. He looked at the bite and the paperwork, including a letter we had gotten from Oliver's primary care provider in English and Spanish referencing World Health Organization recommendations requiring immunoglobulin. He led us and the woman out into the hallway and asked again about the date of the bite. He stopped in the middle of the hallway.
"Siete dias," he said, "ah, no necesita la immunoglobulina!"
"No la necesita? Porque?"
He started explaining in Spanish but I struggled to keep up. He kept saying "anticuerpa," so I stopped him to look up the translation on my phone. It meant "antibodies." Then I understood. He was saying that the antibodies from the vaccine alone would be effective after seven days. It was Monday, and the bite had been the previous Monday. Oliver didn't need immunoglobulin.
"Pero... su medico dice que..." I stammered. He had caught me off guard.
"Tiene la vacuna, esta bien!" He said cheerfully. He thought he was helping us. He excused himself and stepped into his office to see another patient.
I was reeling. Was I going to have to fight this fight all over again? For god's sake, we had been standing in this same hallway two days ago, well before this contrived seven day deadline, and they refused to give it to us. Had they known this would be the result when they told us to return on Monday?
I tried to think. He thought the antibodies from the vaccine were effective after seven days. From the vaccine. Wait a minute -
The young woman had been studying our paperwork and figured it out before I did. She put up a finger for us to wait and hovered outside the doctor's door. When the doctor finished with his patient she walked up to his desk. I watched both of them looking intently at our paperwork while she talked. Then an expression of realization came over his face and he looked up at us.
"Cinco dias!" he yelled to us out the door. "La vacuna, solo cinco dias!"
Oliver had been bitten seven days prior, but he hadn't gotten the first dose of the vaccine until two days later. It had only been five days. By the doctor's own standard, he still needed the immunoglobulin.
I quickly understood why the handful of people working on Saturday couldn't administer the immunoglobulin. There was an elaborate charade of bureaucracy that had to be satisfied before anyone could give us a shot. After completing some forms with the doctor, we were bounced back to the young woman's office, then to the room where I had faced the tribunal for more forms, then to a scale to weigh Oliver, then to the small clinical subwaiting area, then back out to the room I had thought was a classroom.
It wasn't a classroom, and today every seat was filled with people engaged in boisterous conversation. The same woman was sitting at the desk at the front of the room looking down at the papers she was pushing around like an apathetic middle school detention monitor. I gathered that the people were all trading war stories about why they were there.
This was the waiting room for people who had been bitten by dogs.
Fortunately we did not have to wait, thanks to the hall pass I had gotten on Saturday. As the young woman who had been escorting us around spoke with the woman at the desk, I wondered how many of the people in this room would get immunoglobulin? How many would know to ask? How many would accept the doctors' advice that it was not needed?
The woman on Saturday had implied that there was scarcity of immunoglobulin here. Was Oliver, with his exceedingly minimal chance of actually having been infected with rabies, taking a dose away from someone in that room who had actually been bitten by a rabid animal? Did I care?
Of course I didn't. Oliver was not the one who socialized and nationalized their rabies treatment program, resulting in an inevitably underfunded system incentivized to reduce standards of care to cut costs. The scarcity was of their own making. If the Centro Antirrabico didn't have another dose for the next person who walked in the door, that was on them and their parent government, not me, and certainly not Oliver.
"What about 'la munga la bunga'?"
We were seated in plastic chairs back in the small clinical subwaiting area. A brusque nurse sat across from us pushing papers around at a large desk, another nurse ran in and out fetching supplies, and a third was with another patient in the treatment space separated from us by a curtain.
The second nurse came back with a toothpaste-sized box, and I recognized the name as one of the immunoglobulin products on the list Oliver's primary care provider had given us. Behind her came the young woman who had been our escort, and the woman I had spoken with on Saturday, whom I now took to be a doctor.
This was going to happen.
"What about 'la chunga la munga', Dad?"
"Ha! Those are the silliest words yet."
They brought us into the treatment space and sat Oliver on an exam table while I stood beside him. The doctor, three nurses, and young woman shuffled around the 8' by 10' space preparing the shot.
"Which arm are they going to do, Dad?"
"You got your shot in your left arm on Saturday, so I'll ask them to do your right arm today."
They pulled up his shorts and placed an ice pack on his thigh.
"Why did they put that on my leg?"
"Oh... I think they're going to give you the shot in your leg instead of your arm."
"This is a different kind of shot, it works better in your leg."
They removed the ice pack. Then they placed it on his other leg.
"Why did they put that on that leg too?!"
"Oliver, I think they're going to give you a shot in both legs."
The young woman had been standing at the back of the room observing us and noticed Oliver tensing up. She stepped in between the nurses and directed me to sit in a plastic chair next to the exam table. She got Oliver down and sat him on my lap. I put my arms around him to calm him and hold him still.
They removed the ice. This was it. The shot was ready.
Apparently they had run out of the kids' needles, because when the nurse turned around she was holding what looked like something they would use to inoculate a horse.
Oliver and I both stared at the needle as they turned towards him and brought it closer.
"What words are we gonna say, Daddy?"
I wished I knew.
"I think 'la chunga la munga' is good. Let's say that. Ready?"
"Okay. La chunga la munga la chunga la munGAAAAAAAAAAAAAAH!"
"La chunga la munga la chunga la munga -"
"- la chunga la munga la chunga la munga -"
They had impaled his left thigh and slowly depressed half the vial of cold goo into his lean muscle. They removed it and shifted position.
"Oliver, now they're going to do your other -"
"CHUMBAWUMBA CHUMBAWUMBA CHUMBAWUMBA -"
"That's it, Oliver, they're done! You did it! I'm so proud of -"
"You're such a brave boy, I know that was hard to -"
"It's okay buddy, we're all done and we're going to go home and see Mommy and have a special -"
"I have a new Paw Patrol game on my phone for you."
"GAAA - What kind of game?"
After the shot the young woman brought us back to her office for observation to make sure Oliver didn't have a reaction to the shots. She sat down at her desk to push papers around. He played his new game on my phone. I sat still and breathed deeply.
I half expected someone to walk in with a bill, although I sure wasn't going to ask for one. The consultations and vaccinations at the private clinic had cost us a total of less than $300 USD, which didn't even hit the $500 deductible on our travel medical insurance. I had read that rabies immunoglobulin can cost at least $3,000 and possibly much more, but here this was a government service, for better or worse. I had gotten Oliver's treatment pre-approved by our travel medical insurance company so it should have been covered, but based on every experience I've ever had with health insurance claims, actually getting it reimbursed would be a hellish nightmare to rival the experience we had just been through. Free was much better.
No bill came, and after fifteen minutes the young woman told us we could go home. I didn't know how to thank her enough. She had hovered over us through the whole process, correcting the doctor about the dates, guiding us through the maze of documentation, and calming Oliver before his shot. If only I had known the Spanish word for "angel."
On the way out the front door I saw the female doctor I had talked to on Saturday. I stopped and thanked her as sincerely as I could, which meant that I said "muchas" before "gracias." At the end of the day, this had been her decision. For all I know she may have bent the rules for us. Even in the midst of a cold and thoughtless system, good people can do good things.
The next day Oliver got his third vaccine at the clinic in Las Terrenas. This time I told him about yet another new Paw Patrol game right before the shot. He hardly noticed the shot. For the fourth shot a week later, I didn't have to tell him anything. He was looking forward to his fifth shot two weeks after that.
The morning fog had given way to a bright blue sky as we drove home from the Centro Antirrabico. This was my fifth trip on these roads, but I hadn't yet been able to take in the scenery. Our first trip from the airport had been at night; I was racked with nerves during my first drive to Santo Domingo; we took the bus back home that day; and this morning we had had the fog.
I remembered passing a scenic overlook in the mountains about a half hour from Las Terrenas. I found it on the way back and pulled in.
"Why are we stopping?" Oliver asked.
"I want to show you something."
There is much to fear when we're traveling with our young family. When we travel to a place with deadly diseases and substandard health care, we are putting our children at elevated risk. Events like Oliver's rabies scare force us to question if we're making the right choices for our family. How do we justify taking such risk? What is there in this place that compels us to be here?
I wanted to show Oliver what all of this was for. That he had suffered for something that mattered. Why we were here.
He wouldn't understand, but I needed him to see it. I needed to see it.
I lifted him up and held him sitting in one arm. He wrapped his arm around me to hold on. We looked.
The red rock mountains, green with life, cascaded down thousands of feet to miles of untouched tropical coastline below, and beyond it the endless sapphire sea.
God, was it beautiful.