Save Lives of Snakebite Victims in Rural India

Anjali Health Centre in Pithora had an eventful year in 2020. Well… the whole world had an eventful year in 2020. There is no downplaying the impact of the pandemic as we all struggle to find our balance in the new normal. And there is certainly no question about how devastating the death of a family member or a friend can be. Be it death from any cause – the coronavirus, a road accident, or snakebite.

A chance encounter in 2013 on a train travelling northward from Kerala to Delhi is what connected Indiansnakes.org to Anjali Health Centre (AHC). A casual conversation brought out the on-the-ground difficulties encountered by a small medical facility deep in rural India when treating snakebite cases.

When the Pithora Project began seven years ago, AHC was buying antivenom from the open market – sometimes at exorbitant rates when supply was limited. The lone doctor in the facility had never received training on snakebite management and followed standard treatment practice - every snakebite patient received antivenom, whether or not the patient displayed signs of envenomation. Over and above all of this was the fact that the community typically took a snakebite victim to a faith healer rather a mainstream medical facility. Most of the snakebite cases that AHC received were those that had been sent away by the faith healer as ‘past redemption’. Such patients were usually critical by the time they reached AHC and did not survive long.

Today AHC tells a very different story. Having received snakebite management training for a month at the start of the project in 2013, the doctor was able to treat patients much more effectively. Indiansnakes.org also ensured that AHC would never be in a situation where they would have to purchase antivenom at inflated prices by establishing a direct connection with the manufacturer. A low-cost ventilator was also procured for the hospital. Most importantly, the doctors were informed about simple do’s and dont’s of snakebite first aid and the significance of the ‘Golden Hour’. The ‘Golden Hour’ is the first 60 minutes after a bite when treatment is most effective. All of this information was passed on to each snakebite patient and the caregivers during their hospital visits.

Soon the snakebite recovery rate at AHC started to improve and word spread through the community about this hospital that was saving snakebite victims. Today, AHC has a recovery rate of over 95% and the local community prefers to take snakebite victims here rather than to a faith healer. The doctors report that they get regularly get patients from villages almost 50 km away. Looking back on 2020, AHC received about 120 snakebite cases between January and December.

As is common practice for snake identification, either a photograph is taken and shown to the doctors, or the snake is killed and brought to the hospital. In almost 15% of the snakebite cases, the snakes were killed to facilitate identification.

The community around Pithora are mostly farmers and snakes are natural rodent controllers. Removal of snakes from the environment will eventually result in increased rodent population and hence damage to standing crops and stored grain, severely impacting the farmer.

The Indian Snakebite Initiative and Indiansnakes.org work on the principle of ‘One Health’ and believe that the health of a person cannot be divorced from the wellbeing of the environment that he or she lives in.

In 2021, we are looking to begin community awareness workshops and snake rescue facilities in Pithora in addition to continuing support to AHC. The Pithora Project now aims to further reduce snakebite incidents through intensive awareness workshops and bring down the number of snakes being killed through interventions of the Indian Snake Rescue Network – the rescue and rehabilitation wing of Indiansnakes.org.

We are most deeply grateful to you for your patience and support and we look forward to being able to share frequent updates and stories on our newest initiatives.

For Anjali Health Centre (AHC), it has been life as usual. The villagers around AHC have been coming to the hospital as they used to before the crisis, but in lower numbers. As most of their livelihood avenues have shrivelled away to almost nothing and they are confined to their homes and villages, the incidents of accidents and work-related ailments have significantly reduced. A situation more bitter than sweet.

Snakebite cases have also been coming in, but thankfully, the months of April and May saw the total of only four venomous bite cases. Of these, three cases were successfully treated and discharged. One patient, a 32-year-old male, could not be saved. Almost four hours had elapsed since the bite and the patient was already critical when he arrived at the hospital.

The one we lost

Babulal was a 32-year-old man residing in a small village about 30-40 km from AHC. He sustained a krait bite on his left hand in the early hours of 17^th April 2020. Although he was bitten at 4 am, he arrived at the hospital at 7.45 am, almost four hours later. The family had chosen to visit a local faith healer and he was brought to AHC only when he failed to respond to the faith healer’s rituals.

Krait venom is neurotoxic and paralyses muscle tissue, including those that control respiration and circulation.  When Babulal reached AHC, he was in the final stages of collapse. There was severe ptosis and he could not open his eyes. The muscles controlling eyelid movement were paralysed. He was unconscious and his breathing was shallow, blood pressure was too low for the machine to record and pulse was erratic and feeble.

The doctor at the centre worked on resuscitating him with oxygen, medications and CPR (cardiopulmonary resuscitation) but it did not help. Babulal was declared dead at 8.25 am, less than an hour after he reached AHC.

In retrospect, the reason for Babulal’s untimely demise is quite obvious - the hours spent fruitlessly at the faith healer’s. The first 60 minutes after a bite is called the ‘Golden Hour’ when the patient has maximum chances of survival given proper treatment. Even though his village was less than an hour away, Babulal was long past the Golden Hour when he reached AHC. 

Now, more than ever we see the need to reach out to rural India and educate communities on how to respond to a snakebite emergency and also avoid potential human-snake conflict situations. The awareness workshops we had been conducting had picked up momentum but we had to suspend operations due to the Covid-19 lockdown. Snakebite cases peak during the monsoons and the rains have already hit India. Our field persons will be restarting workshops from next month keeping in mind this urgency. We will keep you posted on the progress that we make through subsequent reports.

We hope that you and your loved ones have been safe during this global crisis that we are facing together and, most of all, we are so very grateful to you for your continued support despite all the difficulty and worry you must be contending with.

Please do feel free to reach out to us with your thoughts with an email to support@ties.org.in. We would be more than happy to hear from you.