On 25th March I attended a talk by Gerry Martin about the snakebite dilemma occurring in India. Deaths of around 40,000 to 50,000 people occur annually in India due to venomous snake bites and around 150,000 to 20,000 people are seriously harmed by snake bites which can lead to limb loss.
The major problem of snake bites is the fact treatment is limited due to it the economic implications and there is only one legal anti-venom available in just one region of India. Venom can vary across species and across the country.
There are several challenges that need to be overcome which include:
- Government inertia
- Obsolete understanding of the situation (A guide written in 1943 was by someone who had not even visited India!)
- Diversity – there is no universal solution
- Lack of resources
- Obstinate perspectives
Species of snakes with medical significance
There are said to be four species of medical importance known as the ‘Big Four’; however at least ten other species have now been added. They are local anomalies and their morbidity has not been labelled medically significant, just the fatalities.
The Russel’s Viper (Daboia russelii) – This snake is the biggest problem in India and has a rather nasty bite. It is an ambush predator so stays hidden most of the time. There is a vast variation in its venom (clinicaly) and if you are to survive a bite from this snake extensive plastic surgery will be required therefore causing high expenses.
Image taken from – http://calphotos.berkeley.edu/cgi/img_query?enlarge=0000+0000+0604+0062
Saw-scaled Viper (Echis carinatus) – There are two sub-species of this species and have very different venom, but it is not as dangerous as the Russel’s.
Image taken from – http://en.wikipedia.org/wiki/File:Echis_carinatus_sal_(edit).jpg
Spectacled Cobra (Naja naja) – If a patient gets to hospital in time, the bite from this snake is relatively easy to treat. This species of snake is very common.
Image taken from – http://calphotos.berkeley.edu/cgi/img_query?enlarge=0000+0000+0705+1078
Common Krait (Bungarus caeruleus) – This snake is very common in rural areas. It has a pre-synaptic neurotoxin (this shuts down signals from the Central Nervous System). After a bite there is no visible wound but the victim will feel drowsy and experience stomach pains. It has been suggested that this snake’s bite may just be a feeding response as it doesn’t usually bite if it is handled.
Image taken from – http://rivughorai.blogspot.co.uk/2010/06/how-to-differentiate-between-common.html
There have been some new additions to this list which include pit vipers, kraits, monocled cobra and also sea snakes (very rare). There are more than 21 species of pit viper in India.
What is being done about this problem?
Scientists and researchers can be studying the venoms in India by finding out where the venoms occur, their potency and how well an anti-venom works, therefore understanding local scenarios. There is a need to determine species distribution, venom variation and anti-venom efficacy. There is likely to be a focus on the Russel’s viper due to it being the biggest problem.
Education is a major necessity to combat this problem as the people of India need to know more about the snakes, their venom and their treatment. It is the real solution to making sure people check for snakes. There is work being done at the Forest department to educate the educator and to spread awareness through snake club communities.
There are 150,000 to 200,000 permanent cases of morbidity but data on snakes in India is very unreliable.
I agree that education is vital in this situation in order for the people to deal with the problem more economically friendly efficiently. With more awareness people can avoid snake bites or be able to recognise one and get to a hospital quickly, therefore reducing costs of treatment.
Some papers of interest: