An alernative vaccine schedule

Descending from Ban Rak Thai seemed nearly as harrowing as the ascent was slow, with nearly three thousand feet of beautiful, twisty, twenty degree hairpin turns to navigate on our loaded bikes. Once in the valley below, we turned eastward, climbing towards a guest house 35 miles away in Soppong. Brooke had found a trip report of a fellow cycle tourer describing a guesthouse whose owner guide guests through what she cooked for them. However, when we arrived several hours later, there was no sign of human life, so we continued up the road towards Cave Lodge as we had previously planned. On a whim, we decided to scout the village below Cave Lodge for other options that might keep our run of lesser known, more Thai guesthouses going. When I ran into Brooke fifteen minutes later, she was smiling and said she had found the spot - Pencave homestay. A Shan / Thai woman, Pen, has built several beautiful single room wooden houses in an enormous garden on land her family lived on for seventy years. While the garden deserved more immediate attention, with mangos, papayas, bananas, pineapples, several herb gardens, tomatos and a variety of Thai leafy greens spread across the grounds, we quickly headed towards Tham Lod.

Inside Tham Lod before the exchange heats up

Tham Lod, or Lod Cave, is a roughly mile long cave with a river running through the two hundred foot tall entrance and exit. You can raft through the cave on bamboo platforms hired out by locals, but we came to see a different phenomenon. At sunset, tens of thousands of swallows reenter the cave while tens of thousands of bats fly out to hunt for the night. The birds start first, but become progressively more dense as the sky darkens. If you stand near the mouth of the cave, you see thousands of swallows dodging each other as they dive, silhouetted against the last of the daylight. The bats begin swirling in a hundred foot tall vortex within the cave entrance, and when the night is sufficiently dark begin exiting as a group against the swallows.

I decided to brave the rain of bat and bird poop falling in the cave mouth and ascend seventy feet up some steps deeper in the cave for a new vantage. The view from outside the cave is different than anything I've ever seen, and the experience from higher up inside the cave is even more unique. The exchange of bats and birds can still be seen, but you also hear the birds cheeping and the bats echolocating, as well as feeling the wind created by thousands of tiny wings. Unfortunately, as I turned my light on to descend the guano covered stairs, one of these winged creatures flew into my arm. I didn't think much of it at the time, but when I returned to the outside world a few minutes later, I noticed a minute scratch on my right bicep. As I washed the tiny wound off in the river, I began to think of recommendations sent out by the Washinton State Department of Health a few months prior regarding rabies in bats. Basically, someone had found a dead bat at Green Lake Park in Seattle. It turned out to have rabies, and recommendations advocating vaccination in the case that a bat is found in a house were emphasized. The idea was that a person may have been biten by a bat without realizing it, and given the fatality of rabies, should be vaccinated whether they knew there was a bite or not. This seemed excessive to me at the time and still seems excessive. While bats are a major animal reservoir for rabies, the incidence per bat is not particularly high, and the idea of an unsensed bite combined with a fairly low prevelance seems like that situation would be exceptionally unlikely to give a human rabies.

I guess they were effective in instilling some degree of paranoia in me. Or perhaps it was the deep fear of HIV / AIDS I had as a ten year old resurfacing with an irrational fear of a fatal disease. A brief side story - when I was ten I picked up an unopened condom wrapper in a local park. I was convinced that I had gotten AIDS and would definitely die. I was so scared that I would have skipped my brother's birthday party, but my mom picked up on my odd behavior, and I confessed to my sinful deed in a flurry of tears. Anyways, I had only the faintest doubt about the need to do anything at all about the situation. Afterall, a bat would be unlikely to fly into me, and the fact that it happened when I turned the light on suggested it was a bird who would use light rather than sound to navigate. Further, bats become sick with rabies, and generally don't fly around like normal bats. Plus, the wound was barely a wound, and almost certainly was not contaminated with saliva. It all seemed to add up to a very low risk scenario, and I basically put the idea of going out of my way to get vaccinated out of my head.

However, doing some research on WHO / CDC / FDA recommendations regarding rabies and talking to my dad (who spent years studying bats for his PhD) required internet access, which meant that we weren't ready to leave until 10am. By that time, the tropical sun was beating down on the tarmac, and the idea of the 1800ft climb to Pai seemed less appealing. This same sunlight somehow pleasantly illuminated Pen's garden, and the air felt cool laying in bed with the windows open and the fan on. Momentum towards leaving fell apart, Brooke signed up for a massage, and we both signed up to cook with Pen that night. After a day (mostly) off the bike, we met Pen at five to harvest chiles and basil for pad krapow (Thai holy basil stir fry), lemongrass, kaffir lime leaves and galangal for tom yum (...tom yum, a delicious soup), then spent the next hour cooking these dishes along with tofu pad thai and nam prik jaew (a umami rich soy based dipping sauce made by Shan people of the region).

Making offerings at a shrine outside of Tham Lod

After that large and delicious dinner, we slept early and managed to ascend most of the day's climb before the sun burnt off the morning's mist. The smooth roads dropping into Pai were made even more enjoyable by the memory of our previous brake burning descent from Ban Rak Thai. Perhaps it was this euphoria, or perhaps it was simple fate, but we rode straight past our intended turnoff to Wiang Haeng and found ourselves next to the Pai hospital. At that point, I figured that asking about rabies vaccine would not even be out of the way, so walked into the emergency department. While being triaged, the doctor who was examing a Thai patient with abdominal pain about five feet away briefly stopped what she was doing (HIPPA be damned) and said "oh, you need a rabies vaccine." Well, crap.  Of course medical people would give this advice against common sense. "How much will that cost?" I asked, thinking that there was not a chance in hell I'd spend 1000 dollars to prevent something that had a lower probability than me being in the Tour de France. "400 baht," she replied and returned to her exam. This is about 13 dollars. I don't know how much it would cost to get a rabies vaccine through primary care in the US, but I bet that I could fly to Thailand, get a rabies vaccine and fly back to the US for not much more than it would cost an uninsured person to get the vaccine through the emergency department in the US. If I could explain how that works, Trump wouldn't be president and I wouldn't be riding my bike around Thailand.

Emormous climb aboard see-saw above Pai

Long story short, we stayed in Pai and I ended up dispensing medical advice to random foreigners for a few hours in the waiting room (you should get an x-ray of your ankle after getting hit by a car, no you don't have Lyme disease and your nausea is probably due to drinking heavily the night before, not the doxycycline.)

           

pizza in Pai

One more story deserves mentioning - while Brooke was a great sport waiting, she discovered a great restaurant run by a woman who made her own pasta and pizza. Since we've had access to only delicious Thai food the last week, we thought we'd mix it up and return to for pizza that night. Rungarun, the owner, helped us stumble through cooking related Thai phrases while playing Alan Jackson in the background and cooking up a fantastic home thrown pizza with more vegetables than I'd use at home. We'll write about the next day later, but I'll just say that between the pizza and the next day's ride, we unequivocally made the right decision staying in Pai.