Preventable deaths

Snakebites kill 50,000 a year

The Indian film industry and the so-called traditional healers have together perpetuated myths surrounding snakes and snakebites. The first one does so for entertainment, the second does so as a gimmick to claim to have saved lives, though actually they put lives in jeopardy. But the fact remains that in India, snakebites kill some 50,000 people every year. This staggering number of deaths is perhaps the highest for any country in the world and is of paramount importance because all these deaths are preventable.

Unfortunately, the government figures regarding death by snakebites are almost 30 times lower as they take into account only deaths that have occurred in government hospitals. Snakebites can also cause physical deformities and render the individual invalid. The number of people thus affected is not available. There are gaps in our understanding of snakebites because we lack facts and figures. These need to be garnered first if we are to address the problem.

In July 2017, the World Health Organisation (WHO) announced snakebite to be a “Neglected Disease”. It said, “neglected tropical diseases persist under conditions of poverty and are concentrated almost exclusively in impoverished populations in the developing world”.

Snakebites disproportionately involve the poorest of the poor, mostly in rural areas. WHO says, “Although very expensive, provision of treatment for the majority of cases does not bring sustainable profit to manufacturers — and this is the main reason for the current anti-venom shortage”. It is obvious from this that market forces won’t address death and morbidity due to snakebites. It’s therefore for the government to address it with all seriousness and concern.

The mainstay of preventing disabilities and deaths due to the bite of venomous snake is by administration of anti-snake venom (ASV) and this is listed as ‘essential medicine’ by WHO. The earlier the ASV is administered following a snakebite, the better the chances of recovery and preventing deaths. But there are major hurdles to this.

First and foremost are the local healers, as they keep assuring people that they can treat all snakebites and that they have cured many. In reality, they would have treated a bite by a “non-venomous” snake but falsely claimed that the snake was poisonous. The second major hurdle to access ASV is the distance that patients have to travel for it.

That is not all, because even when ASV is administered, there are major hurdles. Firstly, the ASV itself may induce a life-threatening reaction when administered. Patients will then need to have immediate access to a well-equipped hospital where they can be put on a ventilator and administered intravenous fluids. The non-availability or scarcity of ASV in government set-ups and lack of properly trained medical professionals is also a hurdle. It also automatically leads to private hospitals charging exorbitantly.

But again, there are several flaws inherently in the ASV itself. For example, the ASV is currently prepared with extracts from the venom of snakes at only one facility in Tamil Nadu, so this may or may not include all the four major venomous snakes that are found in India.

The current method of extraction is to catch the snake in the wild and release it once the extraction is done. This practice is neither standard nor accepted. Instead, what needs to be done is to harness venom from snakes that have been bred under artificial and monitored conditions.

The big four venomous snakes in India are the Spectacled Cobra, Krait, Russell’s Viper and the Saw-Scaled Viper. Again, scientists have found that apart from regional variations in different species, even genetic variations may exist among the big four species themselves. Last but not the least, state forest departments do not permit extracting venom from snakes. One needs to pass through a bureaucratic procedure for the same, which at times can be testing.

Bring experts onboard

India has all the technical know-how and knowledge to prevent all these deaths. One just needs to remove these issues and hurdles and involve experts from diverse sectors like herpetologists, wildlife sanctuaries, geneticists, epidemiologists, health economists and behavioural change-makers, including clinicians, anti-venom manufacturers, drug regulatory authorities, traditional healers, snake rescue organisations and medicine-procuring authorities. Above all, our governments and politicians need to take a stand that we need to prevent the unnecessary human suffering that results from snakebites, of which it is mostly the poor and marginal people who are victims.

There is much to be done in bringing awareness among common people. Some simple rules to follow: avoid walking in the dark, especially without a torch; sleep inside mosquito nets that are tucked into the bed if you sleep in the open; maintain clean surroundings so that they do not attract rats which, in turn, attract snakes.

All these need to be made part of the teaching programme for high-school children. Remember that there are only four varieties of snakes in India that are dangerous; the vast number of other snakes are non-poisonous. It is often the fear and anxiety of having bitten by a snake that needs to be dealt with first with proper reassurance.

Do not forget that snakes are extremely afraid of humans and want to avoid you as far as possible. It’s only when they are confronted in their bid to escape that they bite humans as a last resort. In nature, we need snakes because they keep pests, such as rats and mice, in check. We humans will have to learn from nature, for our own survival.

(The writer is president, Drug Action Forum, Karnataka)