Is it safe to get Rabies vaccine in pregnancy & why is it still necessary?

Is it safe to get Rabies vaccine in pregnancy & why is it still necessary?

Rabies is associated with 100% fatality rate among all infectious disease and makes a risk for maternal death and an indeterminate risk to the fetus.

Let us review the statement of the Advisory Committee on Immunization Practices (ACIP) for rabies immunization that is applied to pregnancy and breast feeding women as well. First of all, clean the wounded site by soap and water and begin rabies post-exposure prophylaxis.

Secondly, if it is an owned dog, cat or a stray animal that is available for testing, the suspected animal should be observed for 10 days. If the animal remains alive, vaccination will be ceased. Thirdly, being bitten by wild-life animals that are not available warrants initiation of post-exposure prophylaxis (PVRV and HRIG) and vaccine is administered to deltoid area.

Currently, rabies post-exposure prophylaxis is a method of choice for prevention of rabies. Any pregnant woman who is bitten by stray animal is at risk. They need proper post-exposure management. Vaccination is not contraindicated in pregnancy and breast feeding. Different studies confirm that anti rabies vaccination are safe during pregnancy. One study has reported that no maternal or fetal side effects were seen among 21 pregnant women who received post exposure prophylaxis.

Another study has confirmed the safety of vaccination in post-exposure pregnant women and has emphasized that treatment should never be withheld or delayed if the patient is possibly exposed to rabies. One case study from Mexico reported two patients with rabies exposure during the second and third trimester of pregnancy who received immunization.

There were no side effects in mothers who were attributed to prophylaxis, which appears safe when it is given during pregnancy. Because of the fatal risk following a rabid animal bite, this case recommends that pregnancy not be a contraindication to rabies post- exposure prophylaxis.

Current vaccines provide an acceptable antibody response within 7-10 days but passive immunization by immunoglobulin (with 21 days, half-life) is used for filling this 7-10 days gap. We have to point that rabies is endemic in Iran however safety of rabies post-exposure prophylaxis in pregnant women had been mentioned in different studies, we are going to assess the efficacy of rabies antibody in pregnant women and newborns in Iran and correlation of antibody levels between them as well.

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Several studies have demonstrated the safety of anti-rabies vaccination during pregnancy and there is no association between treatment and adverse outcome, and public health authorities recommend the pregnancy not be considered a contraindication to rabies post-exposure prophylaxis.

The policy of our department is the same: Still some clinicians and patients are reluctant to vaccination as Abazeed reported about a pregnant woman whom was exposed to bat and refused to receive treatment, but fortunately the bat was not infected.

In a case study, among 21 pregnant women who received rabies post-exposure prophylaxis, no adverse effect was seen in the mother and the child. According to our recent report we also have not seen any serious side effects following the use of PVRV and HRIG.

Regarding the immunogenicity of rabies post-exposure vaccination in pregnant women, Sudarshan assessed antibody levels in infants whom their mothers received PVRV during pregnancy after being bitten by suspected animals, and found that PVRV had an effective immunity in the mother and the child and it was also safe during pregnancy.

Another point is that vaccination not only makes an acceptable protection, but also it causes no side effects in a mother and her child, and immunity will be achieved in the infant as well. There are many reports that confirm the safety of rabies immunization during pregnancy, but our aim was to determine the rabies antibody level and the immunization efficiency in mothers and newborns as well.

Rabies poses a 100% risk for death to pregnant women and an indeterminate risk to the fetus. Although a theoretical risk exists for adverse effects from rabies immune globulin and killed rabies virus vaccines, several studies assessing the safety of this treatment have failed to identify these risks. Indeed, the consensus is that pregnancy is not a contraindication to rabies postexposure prophylaxis (PEP). Despite this concensus, healthcare providers resist treating pregnant women with rabies PEP. We describe a case of a pregnant woman with uncertain rabies exposure.

A 35-year-old pregnant woman (at 34 weeks gestation) sought treatment 3 weeks after being exposed to a bat. The patient reported awakening at 3:00 am to find a bat flying in her bedroom. She attempted to confine the bat to 1 section of the home and then called for help. A relative trapped and retrieved the bat, then disposed of the animal without further incident.

The patient denied being bitten by the bat, and she had no obvious bite marks after the event. Initially, the patient sought information from online resources, her primary care physician, and her obstetrician. She was uncertain whether rabies PEP was warranted, given what she believed to be the low probability of the bat being rabid and the low likelihood of her having had direct exposure to the bat. The patient did express concern about the safety of rabies PEP in pregnant women. Because no unequivocal recommendations were made by either her primary care physician or obstetrician, she sought further advice from the Infectious Diseases Department at the University of Michigan on how best to proceed.

Most of the world’s estimated 60,000 annual rabies deaths occur in countries where canine rabies is endemic and where PEP is often inaccessible to bite victims (4). When PEP is available, documentation of vaccination hesitancy for prevention of rabies is rare. This investigation identified six rabies deaths among breastfeeding or pregnant women.

Based on information provided by family members, these deaths might have been associated with unfounded concerns about vaccine-associated risks to the fetus or breastfed child. A previous U.S. report also documented refusal to receive PEP by a pregnant woman with a potential rabies exposure because of concerns about the effect of PEP in the fetus; that patient did not develop rabies (5). Studies have found no increased risk for spontaneous abortions, premature births, or fetal abnormalities among pregnant women after receiving PEP

Several studies of the safety of rabies PEP for pregnant patients demonstrated no association between treatment and adverse outcomes. In 1 study, tissue culture-derived vaccines and human immune globulin did not lead to an increased risk for congenital anomalies; no effects were observed on intrauterine or infant growth or development with a follow-up period of 1 year postpartum. Although these studies are not comprehensive in their assessment of all reproductive outcomes, they do suggest that PEP is generally safe.

A growing body of literature documents peripartum rabies cases. Including the six cases reported here, case reports and a literature review found 20 documented probable or suspected peripartum rabies cases reported during the 114-year period, 1902–2016 (8,9). A total of 17 neonates survived, and were reported to be healthy, including eight who did not receive vaccine or immunoglobulin after caesarean or vaginal delivery (8). Among the three neonates who did not survive, one acquired rabies, and the other two died from complications unrelated to rabies

On the basis of the exposure and our literature review, we recommended that the patient receive rabies PEP. After discussing options with her husband, the patient chose not to receive treatment, citing continued concern about the effect of rabies PEP on the fetus. There must be a greater public health effort to educate clinicians and the public about proper response to bat exposures, particularly undetectable bite exposures such as this case. Had public health authorities been contacted to collect and test the captured bat for rabies, there would have been no ambiguity as to the appropriate course of action.

BALINESE GAMELAN: THE ENCHANTING TRADITIONAL ORCHESTRA

BALINESE GAMELAN: THE ENCHANTING TRADITIONAL ORCHESTRA

Balinese Gamelan, is a traditional music from the island of Gods. Timeless and even growing, gamelan becomes an inseparable part of Balinese life. It reflects the nature of Balinese society that welcoming the world.

The Balinese liked to call it “gambelan”, but in this article, we use standard Indonesian language which is Gamelan, to make it easier to identify that this is also one of the Indonesian heritage, besides Javanese Gamelan and Sundanese Gamelan.

While the range of gamelan music is not sufficiently competitive with classical orchestras, it is important to note that gamelan is more than just an art form. Music is the soul of every religious ceremony and traditional ritual on the island.

Balinese Hindus have a concept called Panca Gita, which means five songs or sounds that evoke feelings of spiritual and joy, which are needed to complete the ritual. First is the sound of Kulkul, wooden bells are usually hung on the Kulkul tower in the center of Banjar or the village.

Kulkul, with the sound of wood-like bells, is used as a call to meetings. Gamelan is one of the five sounds; the aim is to accompany each step of the ritual. Then there is the Dharmaghita, which is a hymn or kekawin, a sacred song. There is a bell or bell held by the priest. And the last sound, but perhaps the most important thing is the prayer sung by the priest.

Balinese gamelan music is popular especially through its explosive, dynamic, and high-speed sound. The fast rhythm mainly caused by a small cymbal shaped called Ceng-Ceng. Ceng-Ceng sounds very loud and played rapidly, and that is what makes the difference with the Javanese Gamelan which tends to be soft or Gamelan Degung Sunda which is a little bit lilting.

Balinese Gamelan has its own precise tuning system which called acoustic vibration. This vibration tuning applied in this gamelan which comes from metal bronze produces a distinctive twang.

Types of Balinese Gamelan

Related to the material of its manufacture, the Balinese people have categorized their musical instruments. There is a bronze gamelan which is better known as gamelan krawang because it is assembled by pande krawang (bronze expert). There is also gamelan made of bamboo, and there is also selonding, made of iron. Out of the three, selonding is the most antique and rare because it is rarely used.

Balinese gamelan permeates the entire life of the Island of the Gods that you could hear it almost everywhere. This traditional music always accompanies sacred ceremonies and also played as an accompaniment to various Balinese arts, such as dance, drama and theater. One of the oldest records of Balinese gamelan is written on the Bebetin Inscription. It is written that Balinese gamelan has existed since at least 896 AD. Back then, the gamelan was not as complex as it is today.

Balinese gamelan has many variations. However, according to timeline, Balinese gamelan could be divided into three big groups; wayah or the old gamelan, madya or the middle gamelan, and anyar or the new gamelan.

Gamelan wayah or old gamelan is a gamelan that was born before the 15th century. The instruments contained are small. Old gamelan is dominated by melodic instruments and not equipped with drum (or kendang in Balinese language). Even if there is a drum, the role is not prominent.

Gamelan madya or middle gamelan was born between the 15th century to the 19th century. Physically, the middle gamelan instruments are bigger than the old gamelan instruments. The music produced by the middle gamelan group has been colored by small cymbals called ceng-ceng and percussion instruments. Kendang has also been played.

Gamelan anyar or the new gamelan was born in the 20th century and after. Physically, the musical instruments in the new gamelan are much bigger than the middle gamelan. The music produced by the new gamelan has begun to be dominated by drums accompanied by ceng-ceng.

The Development of Balinese Gamelan

Balinese musical art has spread throughout Bali and even to other regions and abroad. This condition also makes gamelan composition more complex.

In recent times, new musical compositions have emerged that feature agile melodies and use many tones. This is very different from the melodies of the past where the melodies are very simple, use only a few notes and contain a lot of repetition. Freaky patterns that have emerged lately have used a lot of irregular rhythm or count patterns like three, five or seven. In the old composition, the steady rhythm pattern was very dominant.

In order for music to be heard by distant audiences, the addition of instruments becomes necessary rather than using an amplification system.

Outside of Bali, in some areas there have also been established several Balinese gamelan music groups. At the international level, the gamelan has spread across Europe, Australia, Japan, Canada, India and possibly the most in the United States. Initially, the gamelan was only placed in representatives of the Republic of Indonesia, but gradually some private groups and individuals begin to have their own gamelan. For example, Tunas Mekar Group from United States.

Tunas Mekar Group, located in Denver, Colorado, was founded in 1988 by Michael Fitts and trained by original Balinese teacher, I Made Lasmawan. The instrument played by Lasmawan students is angklung kebyar. Lasmawan who came from Baturiti, Tabanan also claimed to have taught at the Tunas Mekar Group since 1999. For Lasmawan, it is an honor to preserve Balinese culture by teaching foreigners.

Kathie, one of the students, said that it is a pride to learn Balinese gamelan. She studied Balinese gamelan for 5 years ago, and proudly happy to participate at the 41st Bali Arts Festival 2019. Performed with her Balinese make-up, she looked very happy.

Previously, the Tunas Mekar Group had performed in Bali in 1996. Twenty-two years later, the Tunas Mekar Group returned to perform with all the personnel who were almost entirely American. The return of Tunas Mekar in 2019 becomes a uniqueness of its own, because this group presents the skills of the Americans playing the Balinese gamelan.

The Function of Balinese Gamelan

As part of Balinese art, Balinese Gamelan is also inseparable from the function of art in Bali which initially appeared as a mere religious ritual. Furthermore, from time to time, there was a shift from the terms of function. In a broader perspective regarding the use and function of Gamelan Bali, we can refer to the formula of Alan P. Merriam in his book “The Anthropology of Music”

  1. Accompaniment of religious ceremonies

Gamelan is very important as a complement to the religious rituals of the Balinese Hindu ceremony. There are various ceremonies where most are accompanied by different types of gamelan, such as:

  1. Baleganjur as accompaniment of religious processions
  2. Gender Wayang gambling as an accompaniment to the tooth-cutting ceremony,
  3. Angklung gamelan as an accompaniment to cremation ceremonies and many more.

 

  1. Gives a Taste of Beauty

As part of the arts, Balinese Gamelan has fulfilled the elements of beauty through its harmony of the tones presented. From their magical sounds, it could satisfy the souls for those who listened.

  1. Communication tool

Gamelan is an ensemble consisting of a number of musical instruments which require a certain number of players to play it. From this point of view, gamelan has become a media that unites the Balinese people, and improve the integrity. As for the broader example, gamelan, through its sounds, presented is a sign of the community to gather, hold meetings or other activities.

  1. Entertainment

In the field of tourism, gamelan is often staged with entertainment purposes both for routine performances and at festivals, art exhibitions or other means. Even gamelan is now increasingly popular and has always been an icon of Indonesian representative both at home and abroad.

  1. Revealing History

From the description above which refers to the concept of Alan P. Merriam, it seems clear that gamelan has a central role in various historical events such as the appointment of a king, inauguration of a new area, and ceremonies.

  1. Education

As part of art and culture, gamelan also contains the values ​​of life. The skills, abilities, togetherness and sense of communality are very evident.

Although the explanation of the instruments is complicated, but its unique harmony creates its own beauty. In other words, gamelan is able to be an intermediary that educates people to continue to uphold the values ​​of local wisdom.

Where can you watch Balinese Gamelan?

  • Puri Saren Palace

You guys could watch the Balinese gamelan performance at the Puri Saren Palace, Ubud or known as the Ubud Palace. Gamelan plays an important role as a companion aspect of traditional Balinese dance performances. One of them is Legong Dance, which is usually performed at Ancak Saji’s court. Starting with a gamelan chant performance, then followed by the entry of Legong dancers. The place, which is located at Jalan Raya Ubud number 8, has a ticket for around IDR 112.000. Puri Saren Ubud Palace is open every day from 9am to 9pm, with a variety of traditional performance schedules.

  • Ubud Water Palace

The Ubud Water Palace, opens from 7 pm offers a number of traditional performances such as Balinese gamelan. The ticket price is around IDR 100.000, free of charge for children under 7 years old. This performance was begun with Beleganjur gamelan, which has a historical function; it was used as an encouragement for the soldiers before the war.

  • Bale Banjar Kelod

Bale Banjar Kelod, which is located at Monkey Forest street number 15, Ubud, also features a Balinese gamelan performance. And all of the players are women, interesting, right? You guys could watch this show by preparing a ticket of around IDR 98.000 per person. Gamelan shows are held every Monday, Tuesday and Friday starting at 7:30 PM. Not only gamelan, you can also watch Balinese dances which are played by Balinese women.

  • Bentuyung Village

The place to watch traditional Balinese performances including gamelan is Bentuyung Village, located on Jalan Suweta, Ubud. Ticket to watch this performance is approximately IDR 100.000. The instrument in this Balinese gamelan performance is made from bamboo, played with energetic and full of strength. The show is played every Friday and Sunday at 7 pm

Don’t forget to note those places to watch the Balinese gamelan performances. You’re not traveling to Bali if you don’t stop by to watch these performances. See you there later!

RABIES IS DEADLY! PATIENT MUST NOT SKIP 3RD RABIES VACCINE

RABIES IS DEADLY! PATIENT MUST NOT SKIP 3RD RABIES VACCINE

Rabies is a serious disease. It is caused by a virus. Rabies is mainly a disease of animals. Humans get rabies when they are bitten by infected animals. At first there might not be any symptoms. But weeks, or even months after a bite, rabies can cause pain, fatigue, headaches, fever, and irritability. These are followed by seizures, hallucinations, and paralysis. Human rabies is almost always fatal. Wild animals—especially bats—are the most common source of human rabies infection in the United States.

Virtually all infections with rabies resulted in death until two French scientists and developed the first rabies vaccination in 1885. This vaccine was first used on a human on July 6, 1885, on nine-year-old, who had been mauled by a rabid dog. Their vaccine consisted of a sample of the virus harvested from infected (and necessarily dead) rabbits that was weakened by allowing it to dry for 5 to 10 days. Similar nerve tissue-derived vaccines are still used now in some countries, and while they are much cheaper than modern cell culture vaccines, they are not as effective. Neural tissue vaccines also carry a certain risk of neurological complications.

Skunks, raccoons, dogs, cats, coyotes, foxes and other mammals can also transmit the disease. Human rabies is rare in the United States. There have been only 55 cases diagnosed since 1990. However, between 16,000 and 39,000 people are vaccinated each year as a precaution after animal bites. Also, rabies is far more common in other parts of the world, with about 40,000–70,000 rabies-related deaths worldwide each year. Bites from unvaccinated dogs cause most of these cases.

If you got bitten by these animal, here are some things you can do. Thoroughly clean the wound site with soap and water for 5 minutes. If available, an antiseptic that kills viruses such as povidone-iodine, iodine tincture, aqueous iodine solution or alcohol (ethanol) should be applied after washing. If exposed, mucous membranes such as eyes, nose or mouth should be flushed well with water. It is important to follow these processes with appropriate treatment with rabies vaccine. If it is possible, call the animal control authorities.

Rabies is a viral infection of the brain that is transmitted by animals and that causes inflammation of the brain and spinal cord. Once the virus reaches the spinal cord and brain, rabies is almost always fatal. The wound from the bite may be painful or numb. Bat bites typically cause no symptoms. Rabies symptoms appear when the rabies virus reaches the brain or spinal cord, usually 30 to 50 days after a person is bitten. However, this interval can vary from 10 days to more than a year. The closer the bite to the brain (for example, on the face), the more quickly symptoms appear.

At first there might not be any symptoms. But weeks, or even months after a bite, rabies can cause pain, fatigue, headaches, fever, and irritability. These are followed by seizures, hallucinations, and paralysis. Human rabies is almost always fatal. Most people become restless, confused, and uncontrollably excited.

Their behavior may be bizarre. They may hallucinate and have insomnia. Saliva production greatly increases. Spasms of the muscles in the throat and larynx occur because rabies affects the area in the brain that controls swallowing, speaking, and breathing. The spasms can be excruciatingly painful. A slight breeze or an attempt to drink water can trigger the spasms. Thus, people with rabies cannot drink. For this reason, the disease is sometimes called hydrophobia (fear of water). As the disease spreads through the brain, people become more confused and agitated. Eventually, coma and death result.

The cause of death can be blockage of airways, seizures, exhaustion, or widespread paralysis. In 20% of people, rabies begins with tingling or paralysis of the limb that was bitten. The paralysis then moves through the body. In these people, thinking is typically unaffected, and most of the other symptoms of rabies do not develop.

Once you got bitten by animal, it is better to get the vaccine for rabies as soon as possible. A person who is exposed and has never been vaccinated against rabies should get 4 doses of rabies vaccine – one dose right away, and additional doses on the 3rd, 7th, and 14th days. They should also get another shot called Rabies Immune Globulin at the same time as the first dose. The patient must be take all of the vaccine including the 3rd time to minimize the risk of the rabies itself.

The first rabies vaccine was introduced in 1885, and was followed by an improved version in 1908. Millions of people globally have been vaccinated and it is estimated that this saves more than 250,000 people a year. It is on the World Health Organization’s List of Essential Medicines, the most effective and safe medicines needed in a health system. The wholesale cost in the developing world is between 44 and 78 USD for a course of treatment as of 2014.

One of the best ways to protect not only your pet but also yourself is to vaccinate your pet against rabies. Although wildlife in the US typically accounts for the 90-plus percentile of yearly rabies cases, your pet can be exposed via the rabid wildlife and bring the disease into your home. In many states, including Texas, it’s required by law to get your dogs and cats vaccinated against rabies. Texas law also recommends that you get vaccinations for livestock (especially equines and others that have frequent contact with humans), domestic ferrets and wolf-dog hybrids.

Although vaccinated animals still need to be observed for rabies if they have potentially exposed a person (due to the rare possibility that the vaccine was not effective in that animal), healthcare providers feel more confident with observing the animal for rabies rather than testing it if the animal has been previously vaccinated. If you were to test an animal for rabies instead of observing it, the testing procedure requires euthanizing the animal and removing its head to submit to the laboratory for testing.

Rabies case is not rare in the world and people who get rabies almost always die. In the United States people are most likely to get rabies from wild animals. If you’ve been bitten by an animal that could have rabies, or are at risk of coming in contact with rabies, it’s very important to get the vaccine. Vaccine can be very good prevention to stop the rabies to develop. The rabies vaccine is recommended for people at high risk of coming in contact with rabies. For example, you may need the rabies vaccine if you work as a veterinarian or animal handler, study or explore caves, study the rabies virus, are traveling to other countries where rabies is common.

A vaccine, like any medicine, is capable of causing serious problems, such as severe allergic reactions. The risk of a vaccine causing serious harm, or death, is extremely small. Serious problems from rabies vaccine are very rare. In the mid problem it can caused soreness, redness, swelling, or itching where the shot was given (30% – 74%) also headache, nausea, abdominal pain, muscle aches, dizziness (5% – 40%). In moderate problems it can cause hives, pain in the joints, fever (about 6% of booster doses). Other nervous system disorders, such as Guillain Barré syndrome (GBS), have been reported after rabies vaccine, but this happens so rarely that it is not known whether they are related to the vaccine.

You need to tell your doctor as soon as possible if the side effect of rabies vaccine and occurred. Also, before you get rabies vaccine, you have to tell your doctor if you ever had a serious (life-threatening) allergic reaction to a previous dose of rabies vaccine, or to any component of the vaccine; tell your doctor if you have any severe allergies, have a weakened immune system because of HIV/AIDS or another disease that affects the immune system, treatment with drugs that affect the immune system, such as steroids, cancer, or cancer treatment with radiation or drugs.

If you have a minor illness, such as a cold, you can be vaccinated. If you are moderately or severely ill, you should probably wait until you recover before getting a routine (non-exposure) dose of rabies vaccine.

If you are pregnant or still in breast feeding phase, there is no evidence that the vaccine can harm unborn babies. Follow up of 200 pregnant women in Thailand found that the vaccine was safe. It is not known if the vaccine is secreted in human milk, but any vaccine present in breast milk should not have harmful effects. For the safeties of the mother and baby you have to always consult first with your doctor first.  If you still want to learn more about Rabies Vaccine and during your visit in Bali, you can go and contact Unicare Clinic Bali.

We will provide you the information that you needed for Rabies Vaccine. Also, they will provide you the vaccine when you needed it with the handling of our professional health care.

Amazed by Bali Sculpture Masterpiece? Meet These Balinese Maestros

Amazed by Bali Sculpture Masterpiece? Meet These Balinese Maestros

Sculpture is a branch of fine art whose work is formed in three dimensions, usually created by sculpting, modeling (for example with clay) or casting (with mold).

Along the development of modern sculpture, the sculpture works become increasingly diverse, both the shape and materials and techniques used, in line with the development of technology and the discovery of new materials.

Various types can be found in many different regions in Asia, influenced by Hinduism and Buddhism. A large number of statue in Cambodia are preserved in Angkor, but organized looting that has a major impact many heritage sites in the country.

In Thailand, most sculptures are devoted into Buddha form. In Indonesia, statues influenced by Hinduism are often found at Prambanan temple site and many places on the Island of Bali, while the influence of Buddhism is found at the Borobudur temple site.

Sculpture in Indonesia is art that was created with its own function. For example, in Bali where more than half of its population  are of Hindu religion, statues made are used for worship purposes while in many other region statues are made and widely used as a monument that perpetuates important events or respected figures especially country’s hero from the independence era.

Bali, which has been a world well known Island in Indonesia, is famous with its richness in tradition and culture, included sculpture. You can easily find many kinds of statues and sculptures scattered in the whole Island and their presence is inseparable from the inventions from the sculpture artists.

In general, Balinese sculptures and carvings are made from teak, moja and cempaka woods. However, besides made of woods many sculptures and carvings in Bali also uses padas as their main material. Padas stone carving art is commonly found in the construction of shrines and their completeness. This padas stone carving is also used in the making of souvenirs. Many of the padas stone carvers can be found in Belayu Village in Tabanan region.

There are some characteristic in Balinese sculptures and carvings, namely fruit, flower and leaf motives which are a combination of convex and concave shapes. Other also say that there is another characteristic, the existing of a loop that is circular in birth which the ends are curled on the carvings as well as the sculptures.

There are many carving & sculpture artists in Bali but here are some of the best world well known through their passions & creations, both traditional or modern ones.

  1. I Nyoman Tjokot

Born from a farmer family couple I Gentar and Ni Kinut in Banjar Jati, Sebatu village Tegallalang, Gianyar Bali around 1886 and died in Bali in 1971. Tjokot’s interest in statues started when he often meditated in a temple which is about 5 kilo from his birth village called Pura Taro (Taro Temple).

It is said that Pura Taro is a relic of Majapahit Kingdom which has some carvings that shows primitiveness, rough but pleasing to the eye and magical. Starting from here, Tjokot began to dare himself to try to make carvings on wood. There is not any information about the motive or style he learned at that time.

Whether his carving motives are the archipelago origin or not, his works are favored by many people around him.  In fact, the carvings and statues made by Tjokot were so simple yet so full of wholeness.

His works trademark was that he made each of his carvings without changing the shape of woods but still has ornamentation so with this trademark, new style was born, ‘Tjokotism’. Tjokotism is not just a nickname or the name of the style or flow in the art of sculpture but physically it can be described as a sculpture full of ornaments that at a glance of a similar a relief (two dimensional artwork) but in a three dimensional version. In fact, at the beginning of this style it had often laughed at and bullied, even by the genius painter maestro form Banjar Taman Ubud, I Gusti Nyoman Lempad who called all Tjokot’s works as ‘kayubakar or firewood’.

However, Tjokot didn’t budge and keep his faith and consistency. His determination was very strong and mounting. He established himself with positive toughts that his creations was not firewood but artworks with superior art quality and this pay off. People who once ridiculed him began to appreciate his works. The public and art observers began to pay attention to his efforts in his works, though this happened after decades of hardworks.

Tjokot was indeed a great artist with superior works who stayed very modest, humble, innocent and spontaneous in his daily life. From that moment, Tjokot’s name began to soar overseas. His name is parallel to dancing maestro I Ketut Maria and painting maestro Affandi.

I Nyoman Tjokot became more popular and people as well as elite and prestigious institutions from abroad started to hunt and collecting his artworks. Thanks to all of his dedications, perseverance and hard work, he won The Art Award in 1969 as well as the cultural award in the ‘Cultural Satyalencana Honors’ category in 2015.

  1. I Wayan Winten

Sculptures by Wayan Winten are many to be found in the Island of Bali which not a wonder because he started sculpturing when he was just seven years old.

Aside from being his hobby, his got his passion in sculpturing from his father, I Made Pasta, who was also an accomplished sculpture artist back in his days. I Wayan Winten took formal sculpting education at Denpasar Fine Art School (SMSR) and Yogyakarta Arts Upgrading Center (PPPG).

The difference in Wayan Winten’s works with other sculptors is that most of his works use concrete. His reason for choosing concrete and non-wood materials is solely to anticipate if later in the future time woods will become increasingly difficult to obtain in Bali. In addition, I Wayan Winten also revealed that artists can more freely create the form of sculpture using concrete material because if one uses wood than likely they will have to follow the shape of the wood.

One of the famous statue made by Wayan Winten is ‘Dewa Ruci Statue’ which is located at the border of Kuta and ByPass Ngurah Rai. This statue tells Bima in searh of Tirta Amerta and when he had to penetrate the Ocean he was blocked by Naga Baruna. However, Bima won and met with Dewa Ruci and this statue was made to resembles the figure of Bima wrapped by Naga Baruna whilst there is also the God Ruci in the form of Sang Hyang Acinthya on it.

  1. I Nyoman Nuarta

A Bali born sculpture artist who is very famous in Indonesia, and known as statue maestro from Bali with his most spectacular creation, ‘Garuda Wisnu Kencana’.

He also made another phenomenal is statue of a warlord facing the Sea at Ujung Madura Pier which is very famous in the East Java region and is called ‘Jalesveva Jayamahe’. Nuarta did not stop there and he began campaigning and started to spread the modern art virus to the community especially the young generation of Indonesia.

I Nyoman Nuarta built his own art studio, Studio Nyoman Nuarta & NuArt Sculpture Part in Bandung and Bali where art exhibitions were often held. The types of exhibitions he organized are also diverse and often involved by many other artists.

  1. I Wayan Mudana

Not as famous as The Maestro Nyoman Suarta, his ability to carve woods (which he started since his young age) into beautiful statues and scultures can not be underestimated. Mudana is famous for his distinctive style in mixing traditional art with a touch of modern aesthetic which brings a big success in Bali as well as abroad where he got attention from art lovers, in this matter is sculptures, around the world. Wayan Mudana, who is now 64 years old did not get his success easily. Instead he started with his first carving work sold for just 1 ringgit rupiah (1 ringgit IDR) following the Indonesian money currency at that time which is not used anymore nowadays.

Following this first artwork, he then created many more sculpture from his magic hands which seem lively and accompanied by beautiful stories taken from old legends in them. The situation is clearly illustrated when viewing the result of his work visually. Mudana shows the high value of the process of making works that make us, the viewers, curious about the touch of this wood carving craftsman, how he blew in breathe into each of his great works.

Most of Mudana’s works were created through religious rituals and offered prayers, which is intended to get ‘taksu’. To the Balinese, this ‘taksu’ determines success of all aspects of life. Mudana believes that with rituals there wil be enlightment when making each one of his works. According to him, the key to do his work is also to seek guidance and enlightment from the AlMighty. Mudana also believes that the heritage of the Balinese wood carving will last because it is strengthened by the extraordinary skills possessed by wood carving artists in Bali.

Though some or more thinks that this carving industry is in deep sleep, it actually remains productive and in the end will always be received by various circles.

 

BE AWARE OF THESE RABIES SYMPTOMS AND THEIR TRANSMISSION AMONG HUMAN

BE AWARE OF THESE RABIES SYMPTOMS AND THEIR TRANSMISSION AMONG HUMAN

The spread of this disease virus to humans occurs through bites or bursts of saliva that enter through the wound or mucous lining. Scratches by an animal’s finger nails are contaminated with a virus, causing injury to the skin and also could be a cause of rabies. In other words, rabies cannot absorb or enter into human skin that is not injured.

When rabies-carrying animals bite humans, the virus starts attacking by entering blood vessels and spreading in the body. Slowly, the attack will reach the brain and the virus will begin to multiply quickly, then becomes the cause of severe inflammation of the brain and spinal cord. This inflammation can be risky and can potentially cause death in an infected person.

How can someone get rabies?

People are usually infected after a deep bite or scratch by an infected animal. Dogs are the main source and contagious disease. Besides dogs, bats are also the largest source of rabies virus. Meanwhile, deaths from exposure to foxes, raccoons, skunks, rats, and other wild carnivorous species are very rare.

Transmission could also occur when the infectious material, usually saliva, comes in direct contact with the human mucosa or a wound that is still fresh on the skin. Human-to-human transmission by bite is theoretically possible, but this has never been confirmed. In addition, consumption of raw meat or other tissue from infected animals has not been proven to transmit rabies to humans.

During the incubation period

Virus incubation is the time needed to consider. The incubation period for rabies usually occurs 2-12 weeks, although it can also occur for 4 days. The nearer the area of infection, the shorter the incubation period. The length of the incubation period is important, because that is the only acceptable period agreed.

Initial symptoms

The initial symptoms of rabies often feel vague and we can easily mistake them for other diseases. The following are the initial symptoms of rabies:

  • Fever
  • Headache
  • Feeling unwell
  • Feeling scared or anxious

In addition, about half the sufferers also experience pain and tingling in the infected location.

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Symptoms continue

Initial symptoms will last for 2-10 days before more severe symptoms begin to develop. This usually includes aggressive behaviour, hallucinations, agitation, and the production of lots of saliva.

Symptoms of Rabies in Humans in details

After infection, the rabies virus needs time before it finally causes symptoms. The time before the onset of rabies is called the incubation period. Generally, the incubation period of the rabies virus is around 4 to 12 weeks after the bite of an infected animal. There are several factors that cause the time of the onset of symptoms to take place faster or slower.

There are some common symptoms that often appear early in the rabies virus attack:

  1. Rheumatic like tingling

After being bitten by an animal carrying rabies, usually a person will not immediately feel obvious symptoms. Only after a few days, some symptoms begin to appear and begin with rheumatic pain or pins and needles in the place that is bitten. People who are infected with the rabies virus will also feel itchy, even sore in the part that is attacked by animals carrying the virus.

  1. Symptoms Resembling the Flu

The bad news, the initial symptoms of rabies are often mistaken for flu symptoms because they have similar characteristics. In the early days, rabies infection to humans could cause symptoms, such as high fever, chills, fatigue, muscle aches, difficulty swallowing, to difficulty sleeping at night. Some other flu-like symptoms may also occur, if not treated immediately, these mild symptoms could turn into worse conditions and cause the condition to get worse.

  1. Feeling Anxious and Confused

Rabies virus infection could cause people to have symptoms like hallucinations and certain anxiety disorders. Humans who have been infected will suffer anxiety, and easy to feel confused.

Therefore, it is very important to always pay attention to the health of pets in order to avoid deadly virus infections. One way is to give rabies vaccine to animals. The government has eradicated stray dogs in Bali because of the danger of rabies. As many as 98 percent of human rabies cases are transmitted by dogs. The rest is caused by cats and monkeys. If not treated immediately, this will certainly lead to death. That’s because of the tendency to ignore the condition of the body after being bitten or scratched by rabies.

After all, not many people know the symptoms of rabies in humans. According to Control of Animal Sourced Diseases Department (P2PB) from the Ministry of Health of Indonesia, the symptoms of rabies in humans are divided into four stages: prodromal, sensory, excitation, and paralysis.

Prodromal Stadium (beginning)

At this stage, there are no specific symptoms of rabies. Many consider it as an ordinary virus infection. Signs: weakness and lethargy, decreased appetite, fever, insomnia, nausea and vomiting, severe headaches, and sore throat.

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Sensory Stadium (stimulation)

At this stage, the stadium has attacked or overreacted to sensory stimuli. Symptoms include pain, burning sensation and tingling in bite wounds or scratches, as well as increased feelings of anxiety. Symptoms of physical changes begin to appear. Someone who have been infected with rabies at this stage starts screaming, running, and jumping around. He also grabbed hair, afraid of water, light, and sound, excessive drooling, and bodily fluids such as tears.

Stage Paralysis (paralysis)

If it is severe, rabies can cause paralysis. Characteristics: mouth gaping, and paralyzed from the feet to the respiratory muscles making breathing difficult. Within four to six days after the first symptoms appear, a sufferer can die.

How to treat rabies in humans?

After knowing the symptoms of rabies, a patient must immediately deal with the pain. The first step that must be done is to clean the wound with running water for 15 minutes. Also add soap or detergent. Then, clean with an antiseptic. Furthermore, it is advisable to go to the nearest health service centre for immediate medical treatment. There, patients will be given anti-rabies serum and periodic vaccines.

Post-exposure prophylaxis (PEP) is a bite treatment that starts immediately after someone is exposed to rabies. This must be done so that the virus does not enter the central nervous system which will result in death in the short term. This PEP consists of:

  • Local treatment of wounds that begin as soon as possible after exposure.
  • Provides an effective and effective rabies vaccine that meets WHO standards.
  • The injection of rabies immunoglobulin (RIG) vaccine, if needed.

In spite of that, don’t rely on vaccines. They are effective against the disease, but still, prevention is the best as it is. Make sure to not feeding or get too close to stray dogs, monkeys, bats or any warm-blooded animals if you really want to reduce your health risk. When you’re get scared of seeing the suspicious stray dog, raise your hands as if you are going to throw a stone, they usually run. And also keep your children from getting too close to them. Remember, once symptoms have already developed however, there is no treatment and death is the usual outcome.