Save Lives of Snakebite Victims in Rural India

On 6^th July 2019, Neera, a 45-year-old woman from Sirpur village about 20 km away, came to Anjali Health Centre (AHC). She had been bitten by a cobra on her left foot at 7 am that very morning in the courtyard just outside her house. Neera reached AHC at 10.30 am. When she arrived she was conscious and responding, but had difficulty breathing and her eyelids were drooping. Even though the bite marks were hardly visible, there was significant pain and swelling in the bitten foot. Her blood pressure on arrival was a little high at 160/80 but other systems were within normal limits. The necessary blood tests were done to assess envenomation and status of organ systems - 20min Whole Blood Clotting Test, complete blood count, and kidney function tests. 10 vials of ASV were transfused and Neera was also treated with atropine and neostigmine. She showed remarkable improvement by 1.30 pm the same day and was discharged at 8 am the next morning in normal condition. Neera returned for followup two days later and had completely recovered with good wound healing.

With Neera’s treatment the number of anti venom vials at AHC dropped to below 100. With the monsoon season on, this stock is too low for comfort because there have been instances when up to 4 severe cases of snakebite have arrived at AHC on the same day! So 100 vials were ordered and these reached Raipur, the nearest town, and then from there to AHC by 2^nd August, 2019.

On 8^th August 2019, six days after the vials reached AHC, 62-year-old Sohadra was brought to the hospital. She had been bitten on her right hand at 2.30 pm that day while working in a paddy field in her village. Sohadra’s village, Kalmidadar, is about 22 km from AHC and she reached the hospital at 3.45 pm. Usually, the caregivers would have had some idea about the snake that had bitten the patient, but in this case nobody had seen the snake, not even Sohadra. Going by the presenting signs and symptoms and clinical tests, the doctor at AHC diagnosed viper bite. There were no signs of neurological involvement ie, no drooping eyelids and no difficulty breathing or swallowing. The patient was treated with 13 vials of ASV (10 vials on arrival and 3 vials 2 hrs later). As of 10 pm, the patient had improved considerably although the 20WBCT was still positive. Renal function test results were received the next day and were normal. Sohadra Bai arrived at the hospital with severe pain in the bitten hand and swelling up to the wrist. At the time of writing this, the pain in her right hand has reduced but swelling is still present. Sohadra was discharged in the evening the next day.

We would like to thank you for the good wishes and encouragement you have given us all these months. This project is taking part in the week-long Globalgiving Daan Utsav (#GivingTuesday) campaign starting 2^nd October. Your support during that time would go the extra mile with Globalgiving’s matching grants and bonus prizes pushing it along. So, please do reach out to your friends and family to help support treatment for snakebite victims in India.

25 June 2019, Pithora, Chhattisgarh, India: Harishchandra, a 25-year-old male with viper bite on the right big toe, was brought to Anjali Health Centre at 2.40 pm on 23^rd June, 2019. He was bitten at 12.30 in the afternoon while working in his field (harvesting okra) in his village - Dumarpali. Other people from this village had been treated earlier at Anjali Health Centre (AHC) for snakebite and he was quickly brought there on motorbike.

Harish had been bitten on the side of the right big toe near the toenail. On arrival, he had been bleeding profusely from the small puncture wound. He presented with very low blood pressure (70/60) and a weak pulse. He was conscious and talking but very frightened and in shock. He was reassured by Dr. Archana at AHC and slowly calmed down. He was also in severe pain and stated that the pain extended as far up as his right knee. By evening the same day, the pain had decreased and his blood pressure had improved.

A total of 25 vials of ASV were administered to the patient and it took more than 24 hours for his blood to clot normally. Four rounds of 20-minute whole blood clotting test (20WBCT) had to be drawn before normal clot formation was seen on 24^th evening. Discolored urine threw up concerns of kidney damage but, thankfully, renal function tests were within normal limits. Had that not been the case, Harish may have had to be referred to Raipur which has specialized hospitals, as AHC does not have a dialysis unit.

Harish’s blood test on admission also showed signs of infection for which he was treated with IV antibiotics. On arrival, he had a mild swelling in the foot, but that increased as the hours passed. At the time of discharge, the foot was still swollen and a cause for concern as it could result in tissue necrosis. Harish was switched to oral antibiotics and has been asked to return for followup every two days.

Viper venom is hemotoxic and the patients present with bleeding or clotting abnormalities and cardiovascular abnormalities. Patients may develop excessive bleeding from local bite site and also can suffer from severe internal bleeding if intervention is delayed. Patient can also develop cardiovascular symptoms like dizziness, fainting, visual disturbances, low blood pressure, heart rate abnormalities (arrhythmias), etc.

Snakebites kill close to 45,000 people in India every year. The first step to reducing this number is implementing 3A’s – Awareness, Ambulance, Antivenom.

With monsoons already setting in across the country, awareness is the need of the hour. Having knowledge of simple precautions and first aid measures can prevent snakebite and significantly decrease mortality. We have set ourselves the target of conducting 100 snakebite awareness workshops during the monsoons as this is when maximum snakebite cases are reported. It costs less than $40 to conduct a workshop that can reach out to about 100 people. The workshops have already begun and we will be sending you a report on them soon.

Thank you so much for helping us to take care of Harish and others like him. But we can’t rest… not just yet… not when every 5 minutes, somewhere in India, a person dies of snakebite.