“It is a problem of economically and socially backward people, for whom no one wants to invest resources” – scientists and public health experts have the same opinion regarding snakebite deaths in India.
To put things in perspective, let’s look at the numbers: At least 1.2 million Indians lost their lives to snakebites between 2000 and 2019 – an average of 58,000 deaths every year. These figures also show that India accounts for more than half of the snake bite deaths worldwide.
Yet snakebite is one of the most neglected tropical diseases in the country – the only official data available from the Registrar General of India – a study of one million deaths, and another in Bihar.
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The Indian Council of Medical Research (ICMR) announced a first of its kind study a few months ago on the incidence of snake bites among a population of 8.4 crores in 13 states of 5 zones of India.
So why is the problem of snake bite ignored?
Snakebite envenoming was listed by the World Health Organization (WHO) as a high priority neglected tropical disease in 2017. But snake bite is as old as the old world.
Dr. S.P., who works at the Mahatma Gandhi Institute of Medical Sciences in Sevagram, Maharashtra. According to Kalantari, nine out of 10 snakebite cases in India occur in small villages.
“India lives in villages and this is the place where snakes live. Snake bite is a natural risk associated with work for people working in agriculture and related work. When they go to the fields in the rainy season, they often come across poisonous snakes. Even those people live in small huts where snakes can easily enter. Most of the roads in the places where these people live are also bad, especially during the rainy season.”
Dr. S.P. Kalantari
Farmers, labourers, tribals, homeless populations and snake catchers – and any community with limited access to healthcare, are among the groups at high risk of snakebite. But another reason for the increase in cases is the conflict between humans and the environment.
Dr. Soumyadeep Bhowmik, co-head of the Meta-Research and Evidence Synthesis Unit at the George Institute for Global Health India, told, “One of the reasons for the year-on-year increase in the number of snakebite victims and cases is human- Environment is a struggle. As the population increases and humans occupy the areas of traditional habitat of snakes for almost a thousand years, the cases of snake bites are increasing. The reason for these incidents in India is urbanization and industrialization.
What is the reason for its neglect?
Dr. Bhowmik pointed out that most people who are victims of snakebite are from poor and politically vulnerable communities – which makes it difficult for them to reach the hospital in time. Making changes is a distant thing.
For example, he reminds that the process of making anti-venom for an antidote has not changed for many years.
Dr. Bhowmik said, “Venom is extracted from the snake, and then injected into the horse to make the anti-venom. It has not changed for the last 100 years because it is a disease of those who do not have political clout. They can’t pay the drug companies a lot – so it remains neglected.”
Dr. S.P. Kalantari also agrees with this. He explains that the treatment of snake bite is a neglected part of the research area.
“Though the ICMR is now preparing to study the disease, government agencies and the pharma industry are not interested in sponsoring the research as the actual money it will bring is very little.”
Types of Snake Bite – Do’s and Don’ts
It is important to remember that not all snakes are venomous. In India and most parts of the sub-continent, most cases of snake bites to humans are called ‘Big Four’ in the eyes of medical science:
- Corivala or Russell’s viper
- Common krait
- Indian cobra
- Carpet viper (Indian saw-scaled viper)
There is no way to know immediately whether a snake bite is poisonous or not.
“The bite of a cobra or viper will cause severe pain to the victim, swelling of the limbs, vomiting and no blood clotting. They need to be taken to the hospital immediately. Although the bite of a krait is the most dangerous, it does not cause pain immediately after the bite, in many cases the victim remains unaware that an animal has bitten. But after a few hours neuromuscular paralysis sets in and one becomes helpless by opening the eyes or swallowing something. He needs to be kept in the ICU immediately.“
Dr. S.P. Kalantari says that in case of snake bite some things should be taken care of:
- Do not tie a tourniquet (cloth or band) around the wound – this will cut off blood circulation, and can lead to gangrene. It can be harmful rather than beneficial.
- The edge of the wound should not be cut, this can cause bleeding too much, or make the wound more infected
- Take him to the primary health center as soon as possible or to someone who is a doctor of modern medicine.
Strengthening the Public Healthcare System
Experts say that modern medicine should be treated. But it has to be noted that this does not happen for two reasons:
- There is a strong belief in alternative medicine, due to which they put aside their trust in modern medicine.
- Lack of primary health centers, or worse, lack of doctors in these places.
“When it comes to snake bite, home remedies or alternative medicine are the first thing to rely on. There is a need to create better understanding among people on the dangers of snakebite.”
“The best thing to do is to take the person who has been bitten by a snake to the hospital within an hour – so that he can get better help. However, I cannot expect too much from the public health system as most of these places lack facilities. Even if a person reaches the hospital, there are no doctors of modern medicine to take care of them. If there is a doctor, there are problems like electricity and water supply which can affect the treatment.” This is what Dr. Bhowmik has to say. He also says that strengthening the public health system can go a long way in reducing the number of deaths.
What to do for the better
Emphasis on good diagnostics
Scientists and public health experts working on the issue of snakebite in India insist on better research to provide better diagnostics.
Dr. Kalantari says, “Just as there are many types of diagnostics for cancer, heart attack, there are no such types of diagnostics for the detection of snake bites. Research can help in creating a diagnostic system, which will tell whether a snake bite is poisonous or not, and if it is poisonous, then what kind of snake has bitten. This can be done at the Primary Health Center. Early and early diagnosis can save lives.”
Need for affordable treatment
He also points to the dire need for more affordable treatment – pointing out that three vials of anti-venom cost Rs 6,000 to Rs 7,000 and a patient needs at least 10 vials. Apart from this, in most cases, the patient needs long-term care even after recovery, for which they are helpless.
Dr. Kalantari says, “People are not aware that the cost of snake bite can be more than the treatment of heart attack or stroke. Often people do not go to the hospital for fear of high expenses and die due to poison.
