Snake bites: The deadly health crisis that's hidden from our gaze

Monsoons are the time when snakes come out — to play, hunt and mate. Their dens flooded, they seek refuge in dry patches where often the reticent reptiles cross path with humans, resulting in a season of fatal snake bites every year.Sunil Limaye’s phone doesn’t stop ringing in these months. The additional principal chief conservator of forests in Maharashtra gets an average of two snakebite complaints daily June to September. “We’ve received more than 70 calls this year,” said Limaye last week. large70465975Unknown to many, India is likely the world’s snakebite capital. In 2017, the Union health ministry collated countrywide data between April and October. The survey recorded 1.14 lakh cases across the country in the six-month period before and after the monsoon. Maharashtra led the pack of states with 24,437 cases, followed by West Bengal, Andhra Pradesh, Odisha and Karnataka. Herpetologists, doctors and science-ecology experts have long held that official numbers in India are grossly underestimated. The World Health Organisation (WHO) listed snake bites under ‘neglected tropical diseases’ in 2017. Its datasheet said under-reporting of snakebite incidence and mortality was common. “A very large community-level study in India gave a direct estimate of 45,900 deaths in 2005… over 30 times higher than the official figure”. medium nocaption70480025It was referring to the national mortality survey of 1.1 million homes as part of Centre for Global Health Research’s Million Death Study in 2011, which put the annual death from snake bite at 45,900 in 2005. There are no accurate records to determine exact mortality. National Crime Records Bureau noted just 8,554 deaths from snake bite in 2015.In a unique initiative, a 257-member WhatsApp group called ‘Snakebite Interest Group’ is striving to attend to cases across the country. Created in 2015 by Dr Dayalbandhu Mazumdar, a Bengal-based ophthalmologist and an expert in snakebite management, and administered by Priyanka Kadam, a Mumbai-based crusader against snake bites, the community of 240 doctors spans 14 states and Nepal. It works alongside activists and herpetologists and says it has saved more than 3,500 victims in the past four years.large70466410In a country where snake bite features fleetingly under forensic chapters of the MBBS syllabus, the group handholds junior doctors at the block level to identify and manage snake bites at the first point of contact instead of referring patients to district hospitals, which often leads to time lapse and death. “Only when snake bite is made a notifiable disease, will it be considered for mainstream treatment, taught in medical schools,” says Kadam, who was part of a panel of experts from 16 countries that helped WHO author a global strategy launched in Geneva this May to prevent and control snakebite envenoming.Kadam founded the Snakebite Healing & Education Society that is documenting stories of victims and engaging experts from different fields including veteran herpetologist Romulus Whitaker. Not just in the countryside, snakes thrive in urban spaces too — homes, toilets, gardens and rodent-infested gutters.boxcontent medium nocaption70478009WHY INDIA LEADS IN SNAKEBITE DEATHSPoor health facilities in rural areasDelayed treatment because victims in rural areas unable to reach health facility in timeHealthcare personnel have inadequate knowledge of snakebite treatmentPeople seek traditional healers instead of visiting healthcare facility (In pic: Ritual being performed to 'heal' a snakebite victim)Unavailability of effective anti-venom, poor distribution in rural areasProblems in cold storage and transportation affect quality of anti-venomAnti-venom is expensiveThe death of 10-year-old Manan Vora from Gujarat’s Bhavnagar — while holidaying with his family at a luxury resort in Diu when a cobra hiding in his pillowcase bit him — showed how ill-equipped urban centres are in dealing with snakebites. Although Manan was rushed to a hospital, he was put on antibiotics instead of anti-venom and advised transfer to a hospital 17km away. More harmful than the venom is belief in occult practice and healers. Devendri in Bulandshahar, UP, was collecting firewood when a cobra bit her. Her husband chose a faith healer. She was buried in dung for 75 minutes. She didn’t survive. For another it was burial in salt, and for some it’s stones and leaves, roots and twigs. Dr Dilip Punde who has treated around 7,000 snakebite cases in Nanded (Maharashtra) over three decades says he urges traditional healers to redirect snakebite victims to a health centre. It takes 100ml of anti-venom within 100 minutes of a bite to save a life. But even when available, it can be prohibitively expensive, pushing poor victims further into poverty and debt. A vial of anti-snake venom costs Rs 250 to Rs 500, and a loading dose for a venomous bite requires at least 10 vials. Snakebite treatment is free in statehospitals but when there are none close by, the victim’s family is forced to go to a private or missionary hospital which charge for treatment,” says Kadam.The WHO roadmap is expected to defray such costs but Dr Soumya Swaminathan, chief scientist at WHO, points at an important weapon against the threat — “digital engagement” and “mobile phone tech”, primary driver of human behaviour today. boxcontentDOS & DON'TS WHEN BITTEN BY A SNAKERemain calm and seek immediate medical attentionKeep affected part of the body as still as possible, and remove jewellery or watchesLoosen, but do not remove, clothingBIG DON'TSDo not suck, cut, burn the woundDo not try faith healingDo not apply anything to wound, including ice, heat or chemicalsDo not use a tourniquet that could make swelling worse