“It must be something I did in my last life; I have been bitten by snakes some five times,” rues Ameresan. We are walking through his lush paddy field in Ponneri, 30 km north of Chennai and Ameresan points to a termite mound. “Every time I get bitten, my wife runs to Nagathamman (Shakti worshipped as a snake). She pours milk on this mound and prays. And every time, I am saved. Our god is truly powerful.”
Ameresan never goes to a primary health centre to treat his snakebites, even though the nearest one is just 6 km away. Instead, he goes to Chandran Vaithyar, a traditional healer. “He gives me juice made from a root and some leaves. Last time I couldn't even open my eyes fully. He poured a drop of the juice in my eye and ear. In four or five hours, I was okay.”
This story shook me. It also disturbed S. Ragunanthanan, chief of the Poison Control, Training and Research Centre at Rajiv Gandhi Government General Hospital in Chennai. “Anti-snake venom is the only treatment for snakebite with envenomation (when venom has been injected through a bite). It is provided free at all government hospitals. We need to increase awareness among people and get them to rush to a hospital.”
Big bites
The reason Ameresan escaped is probably because the snakes he was bitten by would have had mild or no venom, explains Dr. Ragunanthanan. Only about 30-40% snakebites in India are by venomous snakes. “The dangerous ones are the big four — the Indian cobra, the common krait, Russell’s viper and the saw-scaled viper. Anti-snake venom targets the bites of these four.
At the Poison Control Centre’s ward I meet Raja (name changed on request) from Red Hills near Chennai. Raja chirpily shows me a picture of the krait that bit him. “Technology has come in handy,” says Dr. Ragunanthanan; the picture taken on Raja’s phone helped them treat him early. Luckily, the snake did not inject any venom — it was a dry bite as doctors call it — so he didn’t develop classic symptoms such as droopy eyes, weakness or trouble breathing. “He will be discharged soon.”
Deva on the next bed hasn’t been as lucky. His arm is alarmingly swollen. “My friends and I tried to hit the snake. It turned around and bit me,” he says. The doctor’s expression says it all — not the wisest decision to attack a snake. Deva has already received about 10 vials of anti-venom.
According to the World Health Organization (WHO), snakebites claim more than 100,000 lives globally. India sees 45,000 snakebite deaths every year, finds the 2011 ‘Million Death Study’. Interestingly, the Minister of State for Health and Family Welfare, Ashwini Kumar Choubey, came up with much lower figures in the Lok Sabha — 689 deaths only in 2018.
At the farm
Official numbers might be low because most snakebite deaths don’t happen in hospitals. “The poorest of the poor working in farms get bitten, and they rush to quacks or traditional healers. We need more studies and ground data to understand the correct figures,” says Romulus Whitaker, founder, Madras Crocodile Bank Trust and Centre for Herpetology. Whitaker is one of the authors of the ‘Million Deaths Study’, and says that prevention is as simple “as carrying a torchlight with you at night, not sleeping on the floor, and using a mosquito net. But it’s easier said than done.”
Researchers are trying to end snakebite deaths in South Asia. But the lack of research, funding, data, and even the lack of prioritisation by governments are major challenges, finds a recent paper by Ravikar Ralph, researcher with the Department of Internal Medicine at Christian Medical College, Vellore.
The production, potency, and safety of antivenom are key, says Ralph. It is also essentially that regional venom collection centres develop a pooled antivenom (combination of different regional snake antivenoms) with better efficiency, he says. Whitaker and Dr. Kartik Sunagar from the Evolutionary Venomics Lab at Indian Institute of Science, Bengaluru, are working on identifying how snake venom varies across different States to come up with more potent antivenom.
Silent killer
On May 23, WHO launched a new programme — ‘Snakebite Envenoming: A Strategy for Prevention and Control’, the core of which is to bring down the number of snakebite deaths and casualties by 50% before 2030. In 2017, WHO included snakebite in the list of ‘Neglected Tropical Diseases’ to improve research and funding, and to draw the attention of policy-makers to this silent killer.
Priyanka Kadam is a member of WHO’s Snakebite Envenoming Group and founder of Snakebite Healing and Education Society, which works towards lowering snakebite casualties. The society conducts awareness drives, teaches people how to live with snakes, and to seek medical help in case of a bite. “Snakebite is fully treatable. If there is a fully functional hospital within a 5 km radius, the death and disability numbers will most certainly come down,” she says. Kadam and many other doctors recommend that snakebite be made a notifiable disease — that is, a condition that is mandated by law to be reported to public health authorities.
Ralph calls for subsidising antivenom in private health clinics. Each public health care centre is supposed to keep at least 10 vials of antivenom. Though there is sufficient antivenom in the country, the distribution is not even. “Just like the nationwide HIV and polio drives, the government needs to put a new programme in place for snakebite.”
This might be unlikely because snakebite “is a poor man’s disease,” as a doctor from Kochi points out. The doctor, who requested anonymity, says: “The chances of you and I, living in high-rise apartments in cities, getting bitten are low. Tomorrow, if a minister or bureaucrat gets bitten, the situation will change immediately. A policy will fall into place, awareness drives will increase. Fatalities will decrease and we will have an environment where humans and snakes coexist in peace.”
aswathi.p@thehindu.co.in
