Health: Snake bites are a forgotten global threat

NEW YORK — In most Indian villages there is an "ojha," or a magician who doubles as a medicine man. The ojha can cure snake bites with mantras and by rubbing leaves and homemade pastes on the wound.

In a village called Sameda, in Uttar Pradesh’s Azamgarh district, people put a lot of faith in these age-old remedies. The only problem is, sometimes they don’t work.

“The city hospital is three hours away and people cannot make it before the poison spreads,” said Jagram Chauhan, a resident of the village where snake bites are a common occurrence.

The global death toll from snake bites is estimated to be at least 100,000, though there are approximately three times as many amputations performed on people who have been bitten by snakes, according to the World Heath Organization (WHO).

Snakebites are described in several studies as a neglected health threat that claims thousands of lives every year, especially in rural parts of South Asia, South America and Sub-Saharan Africa. More than 5 million people are bitten by snakes annually, and 2.5 million get venom in their system.

In India alone, around 11,000 people die and 84,000 are poisoned by snakes every year. These deaths could be prevented if antivenom is used quickly.

Twenty years ago, Felipa Angeles, an inhabitant of Caraz in the highlands of Peru, said that people would rush on horseback to small clinics in the countryside that had antivenom in stock.

“Now some have cars but the poison spreads so fast that by the time they get to hospital, their arm or leg needs to be amputated,” she said.

Angeles grew up scared of rattle snakes that killed not only animals in her village, but also people.

“My family had to sacrifice our horse because it was crying from so much pain [after it was bitten by a snake],” she said. “This is very bad because people depend on animals for their livelihood.”

In Africa alone there are an estimated 1 million snake bites annually with about half those bitten needing treatment. WHO says the actual number of bites is likely to be much higher because available figures are based on hospital statistics, while most victims don’t make it to the hospital.

“The scale of human suffering remains unknown,” said Ann Padilla, a WHO scientist. “This problem continues to be neglected by many countries.”

There is no doctor to cure snake bites in the Bhluahi village of Bihar, India. The first thing villagers do is to tightly tie a rope around the area that is bitten to stop the poison from flowing and then make a small incision to drain the venom.

“Some people keep medicines but they are usually hard to find and expensive to buy,” said Santosh Kumar, a villager.

There are 3,000 snake species in the world out of which 600 are deadly and 200 are needed for medical purposes. They are found in every continent except Antarctica. Snakes usually attack in self-defense when they feel threatened, startled or provoked.

The casualties are mostly women and farmers living in poor rural communities. A bite can cause bleeding, muscle paralysis, tissue destruction, kidney failure, permanent disability and death. Children are more severely hit because of their smaller body mass and need treatment immediately.

Combating the problem is difficult because of the dearth of information. After three years of organizing regional workshops to collect data, WHO has launched its first website with facts about the deadliest snakes in the world, their geographical presence, the suitable antivenom and where it can be found.

“Many countries have no access to the antivenoms they need. Others use antivenoms that have never been tested against their target snake venoms. So often when people get bitten, they can’t get the treatment they need," said Carissa Etienne, WHO Assistant Director-General. “These new tools will help bring this to an end.”

For instance, the database shows the lethal sharp-nosed pit viper lives across China, Taiwan and parts of Vietnam and responds to the antivenom called Agkistrodon Acutus antivenin, which is manufactured by the Shanghai Institute of Biological Technology.

In another case, the South American rattle snake lives in most parts of the continent, and responds to multiple antivenoms being made in Brazil, Argentina, Mexico and Bolivia.

A virtual database, of course, is of little use to the villagers that tramp barefoot around in their fields without electricity but it is helpful to healthcare professionals and manufacturers, according to Padilla.

At present very few countries produce snake venoms of adequate quality. Knowing the location of the snakes is especially helpful for manufacturers of antivenom since they need the venom to put in the antidote.

Both training to treat snake bites and distribution of antivenom remains a major challenge.

“The medicines need to find a way out of the cities into the remote areas,” said Padilla. “We are pushing governments to put it in their national health programs.”

Meanwhile, ancestral wisdom prevails. Sometimes in India, when it isn’t clear if someone bitten by a snake is dead or in a coma, the body is not burnt — a traditional Hindu rite — but immersed in the river to allow for revival. “Many times after a few days they come back,” said Chauhan.

Betwa Sharma is the New York/United Nations correspondent for the Press Trust of India and is a freelance journalist.