Wednesday, 30 October 2013

Snakebite: it's not just about the victim

Hello, everyone! My name is Vishal Santra, and I am currently residing at Vellore. My area of interest is wildlife conservation, particularly reptiles and snakes. I have been studying snakes and trying to understand them for about 12 years now.

I graduated in English Honors and completed my masters in Environmental Studies. I have worked on many projects that directly or indirectly involved reptiles, both as a volunteer and on a professional basis.  As you can see from this short intro, there’s not much to write home about as far as I am concerned, but I can assure you that when it comes to snakes, more specifically, snakebites, there’s quite a bit.

Let me start with a personal account.

In 2008, I got bitten by a Spectacled Cobra (Naja naja) that I was photographing. I did not panic, convinced that I had no cause to, because I knew what to do and did it. Twenty-two hours following the bite, my clotting time was 36 minutes. After 42 hours, it was 40 minutes and my urine showed plenty of RBCs.

At this point, the doctors attending me took me in for dialysis. (Why? To this day, I don’t know.) And that was the moment when I began to panic – because for six years before the incident, from what I had heard, read and understood through various discussions, I knew, without a doubt, that the Naja naja venom is neurotoxic - and neurotoxic venom does not lead to hematological complications.

I was administered 36 vials of anti-snake venom (ASV) and was back to shooting the same cobra, after five days of hospital stay. Now, if a person like me can panic following a snakebite, think of all those millions of people who get bitten, throughout the country, every year. Most of them know nothing of snakes and how to manage a venomous snakebite; in most cases, the snake species and consequently, the type of venom is not identified. Think of the degree of their panic and fear – so intense that, sometimes, it can lead even to shock and hypertension.

Folks, I have seen people dying of snakebite; seen families doomed after a bread-winner dies of a snakebite; seen people commit suicide out of superstitious fear; seen people losing the last penny of their life’s savings to snakebite treatment.

Some of you may be doctors who treat snakebite victims and no doubt, you do your best for them. You treat them to the best of your ability and know that sometimes, you can save the patient and be blessed and thanked by the family members and there are also times when nothing you do can save an unfortunate patient.

But your involvement ends there.

Relative of a snakebite victim

You don’t follow the family home with the dead body to share their pain.

You don’t hear heart-wrenching stories of a poor boy who was excellent in studies and had his bright future come to an abrupt end; of the death of the girl who was to be married the following month; of the tragedy that befell a family when its sole earning member was taken away or the cruel twist of fate that rendered a new bride a widow, the day after her wedding.

The complications that arise out of snake bites are not medical - they have a wide social significance making the issue of snakebites an extremely complicated one in India.

As far as I can see, in our country, snakebite management is still in the trial and error method, and as yet there is no standard protocol. But I have some good news for you. In order to tackle this problem, the Toxicology Special Interest Group at the Christian Medical College (CMC), Vellore, and the South Asian Cochrane Centre (also based at CMC), along with 20 other hospitals across 11 states of India, has conceived and is in the process of conducting a nationwide study on snakebite.

The main objectives of the study are:

1. To correlate clinical envenomation syndromes to snake species according to geographical region; this would be done by identifying dead snakes that are brought to the hospital, and venom detection tests.

2. To describe the geographical variability of snake envenomation syndromes, management practices and their outcomes, with special emphasis on dosage of anti-venom and prevention and treatment of ASV allergy.

3. To determine factors that influence clinical outcome in relation to:

(a) geographic location
(b) clinical syndrome
(c) severity of envenomation
(d) ASV dose and
(e) preparation of ASV

4. To develop a centralized Snakebite Specimen Bank at CMC, consisting of serum, urine, bite swabs and samples of snake tissue from dead snakes; these would be used for further studies towards development and evaluation of venom detection tests from urine and serum, and DNA identification tests from bite swab.

All the centres involved in the study will collect data for 24 months. If things go as planned, we will be able to pull off something significant – something that will fill a vacuum that has existed for way too long – for our country. We will be in a position to advocate to the governments and departments concerned, to develop protocols that is based on data and evidence - not on individual opinions.

What I would like to say here is that along with the scientific and systematic approach, we need to sensitize people - the common man, the doctors, the health advocators, the ministry – our citizens, about this issue. We should talk about why snakebites should be taken seriously; why we should look beyond merely the treatment; understand that a snakebite brings with it a whole new level of challenge, when it comes to matters of management and understanding...and in the long run, benefit humanity by indirectly using our knowledge as a tool for reptile conservation.

As a small, first step for us to do this together, we will be starting a Facebook page and a blog. These would be our platforms where participating centres can put up stories - about how the doctors fought day and night to save a 11-yr-old boy; how timely infusion of ASV prevented a woman from going into respiratory paralysis; how a couple brought their only son dead to hospital; how a farmer lost his hand following an amputation after a snakebite...stories that will challenge you, inspire you and involve you in our quest and our mission.  A platform for discussion, debates, possibly even comments from international experts …

And you, my readers, welcome aboard… jump on, fasten your seat belts, and join us for a rocking drive for the next two years!

Last but not least, do not hate snakes - and don’t make ‘that’ face when you see one!

Learn about them, try to understand them, and respect them for their unconditional service to mankind. This will make our work, not just a lot more easier, but complete.
Thank you!

Vishal is the co-ordinator for the snakebite study