Snakebites – a health priority!

In India, snakebites kill around 50,000 people every year. Almost five times more victims survive the bites of venomous snakes but suffer lifelong disabilities such as paralysis, heart failure, irreversible kidney damage, blindness and much more.  The magnitude of this crisis is underestimated. In spite of the WHO adding snakebites to the list of ‘Neglected Tropical Diseases’ (NTDs) in June 2017, snakebites are not a health priority in India. This is a grave issue, which requires immediate attention.

The snake, serpent, or ‘Naga’ plays an important role in mythology in Asia (e.g. India, China, Cambodia, Korea, Japan, and Nepal), and also in Africa, Egypt, North America, South America and Europe. Pottery, bronze-ware and gold depictions of snakes have also been found in the UAE.

Every year on Naga Panchami, on the fifth day of Shravan (July/August), Hindus worship the ‘Naga’. Snakes are offered milk. Do snakes really drink milk? Veterinary experts say snakes cannot digest milk. They are carnivorous reptiles.

Snake worship is prevalent since ancient times. Snake idols exist all over in India. Several myths and superstitions revolve around snake worship. Infertile couples worship the ‘Naga’ in order to bear children. A snake in the house is said to guard the ancestral treasure. Hindus worship the King Cobra because according to mythology, Lord Shiva, the God of destruction, wears him around his neck. Lord Vishnu, the preserver, rests on the ‘Sheshnag’, the mighty five or seven-headed serpent.

Snake charmers in India earn their living using snakes. They defang the snakes, remove the venom and carry them around in a cane box. They even carry a ‘Been’ or ‘Pungi’, a musical instrument played to charm the snakes. But can snakes hear the music played by the snake charmer? Do they dance to the tune of the snake charmer? Scientists say that snakes feel vibrations and may hear low-frequency sounds.

It is unfortunate that many false beliefs about snakes still prevail in the minds of people. Even urban communities are not spared from snake worship. Perhaps it is out of fear that snakes are worshipped? Amongst the 275 species of snakes in India, 20 per cent are poisonous. There are nearly 60 different types of poisonous snakes in India, but the most feared are the venomous snakes – the ‘big four’ – the spectacled cobra (Naja naja), the common krait (Bungarus caerulus), the saw-scaled viper (Echis carinatus) and Russell’s viper (Daboia russelii).

King Cobra

Snakes are the farmers’ friends: they eat frogs and rodents such as mice and rats, which destroy the crops. They are found mostly in farms, tall grass, haystacks, dense jungles and hilly areas. As venomous snakes prefer open forest boundaries, fields and areas around villages, snakebites are very common in and around these areas.

Kraits attack during the night: they will bite a sleeping person. Vipers and cobras bite during the day or evenings. The bites occur when farmers are working in the farm or watering their crops, walking barefoot in grass or attending to nature’s call. Poverty, poor access to sanitation, and occupational hazards make it difficult to prevent snakebites occurring.

The remedy for a snakebite is injection of anti-venom specific to the particular snakebite, which is administered only at medical centres. In remote parts of India, medical centres and hospitals are situated far away from homes in villages. Transportation is also a problem. The ambulance may take a long time to reach a person bitten by a snake.

In many cases, the victims or their relatives are not sure about the type of bite: whether it is a snake, a scorpion or even an insect bite. Even when they can be certain it is a snake, the snake typically bites and then slithers away, making it difficult to identify which type of snake has done the biting.  And, even when they know for certain the person has been bitten by a venomous snake, instead of taking the victim to the medical centre, family members often waste valuable time trying out home remedies, traditional medicines and treatments such as scraping off the affected part, sucking the poison out of the wound, or applying black stone. These delays can cause death or life-long morbidity. Unfortunately, people are not really aware of all the consequences of being bitten by a poisonous snake.

In urban areas, snakes mostly venture out in the open, especially during the rainy season, looking for food and shelter. Thick shrubbery around homes and rock walls provide cover for mice, lizards, frogs and insects. Poor maintenance of yards, tall grass, overgrown weeds and shrubberies encourage an increase in numbers of snakes and the prey that attracts them. Garbage strewn around homes also invites rodents. Therefore, keeping surroundings clean and clutter free is critical.

It is impossible to eradicate poisoning due to snakebites. As a consequence, millions of affected people across the world lose out on a healthy productive life. Yet, education can help in creating awareness. We have many groups that impart knowledge about snakebite management of which Snakebite Healing Education Society (SHE) is the first such initiative dedicated solely to snakebite issues in India. A WHO Working Group is also developing a roadmap for addressing the global affliction resulting from snakebites.

In order to spread community awareness especially amongst local communities, education must begin at the elementary level. Teachers and science communicators have a great role to play here. Doctors need to be trained in snakebite management. Distribution of anti-venom in every medical centre and the regional manufacturing of anti-venom would be of great therapeutic help.

Deforestation and global warming both contribute to increasing the risk of snakebite poisoning.  Improving the facilities in rural healthcare centres with a ready availability of anti-venom, trained health workers, trained snake-catchers and, most importantly, helping the victims to return to productive life can save many lives and prevent morbidity.

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