For centuries, huge numbers of people have died of snakebite in India. In recent decades, there have been several attempts to quantify “huge numbers”. Unless we have these figures, there is no way to assess whether the problem is increasing or decreasing, and which areas are more prone to snakebite, so that something can be done about it.
Joseph Fayrer reported that 19,060 Indians succumbed to snakebite in 1880. After a year-long campaign of snake extermination (467,744 snakes were killed for rewards), he reported a marginal decrease: 18,610 people died. But in 1889, the number had shot up to 22,480 deaths when India's estimated human population was 250 million.
In 1954, Swaroop and Grab put together the World Health Organization's first global snake bite estimates but they lacked real data from India; they quoted a mere 20,000 deaths. Were they simply using the 1889 figures? In 1972, two Japanese researchers, Sawai and Homma, took a crack at the problem. They visited numerous hospitals around the country and did some extrapolation and came up with 10,000 deaths per year with the caveat that 90 per cent of the victims never approached a hospital.
Then in 1998, Chippaux estimated that snakes killed between 9,900 and 21,600 people annually — this was when our population was on the threshold of hitting one billion. In 2005, WHO estimated 50,000 Indians died of snake bite, but in a study it funded in 2008, the fatality was pegged at 11,000. The same year, the government of India jumped into the number-crunching fray and came up with, ahem, 1,400 mortalities! Apparently, six of the worst-affected states never sent their figures.
These estimates don't tell us much about the nature of the problem — has it worsened or become better? So far there has been a little bit of science, but in the face of a huge logistical challenge, numbers were extrapolated to arrive at wildly unstable numbers. Sort of like our wildlife census data.
A part of the problem is that snake bite is not a “notifiable disease”, that is, the Health Ministry has not issued a data-collection directive to the states as it has done in the case with AIDS. The other problem is, of course, the obdurate belief in country medicine and quacks rather than anti-venom serum.
Recently, Rom took part in a major study to provide the first credible figures ever for India. Codenamed ‘The Million Death Study', it overcame the problems mentioned above by using a method called ‘verbal autopsy'.
The results of the study, published last week, provided some astounding figures. Annually, there are a million cases of snakebite in India and of these, close to 50,000 succumb to the bites.
When you look around the countryside, where most bites occur, and notice people's habits and lifestyles, these figures aren't surprising. People walk barefoot without a torch at night when they are most likely to step on a foraging venomous snake.
We encourage rodents by disposing waste food out in the open, or by storing food grain in the house. Attracted by the smell of rats, snakes enter houses and when one crawls over someone asleep on the floor and the person twitches or rolls over, it may bite in defence.
Once bitten, we don't rush to the hospital. Instead, we seek out the nearest conman, tie tourniquets, eat vile tasting herbal chutneys, apply poultices or spurious stones, cut-slice-suck the bitten spot, and other ghastly time-consuming deadly “remedies”.
As Rom cattily remarks: “If the snake hasn't injected enough venom, even popping an aspirin can save your life.” That's the key — snakes inject venom voluntarily and we have no way of knowing if it has injected venom, and if it is a lethal dose. The only first aid is to immobilise the bitten limb like you would a fracture, and get to a hospital for anti-venom serum without wasting time.
