In 2017 the World Health Organization finally listed snakebite as a highest priority neglected tropical disease, but the global effort to address it is only just beginning to gather momentum.
Snakebites kill or maim over 600,000 people worldwide every year in the developing world and efforts to address this crisis are complicated by a vicious circle that perpetuates tragic outcomes. The impact of a snakebite often reaches far beyond the patient alone, and many of these cases end in the death or permanent disability of the patient and an unrelenting cycle of poverty for the family who are forced to spend most of their annual earnings on a treatment that failed. Many of these tragic outcomes could be averted with effective antivenom use, yet it is estimated that less than 5% of patients receive lifesaving antivenom treatment.
The vicious Circle of Snakebite
Snakebite in the developing world is complicated by a vicious circle of failures that lead to tragic outcomes for patients and place a heavy burden on surviving family members that can persist for several generations. Take a look at the video below from our partner organization the African Society of Venimologie to learn more about the story behind the snakebite crisis and how we can address it.
Snakebite is a complex public health crisis
One of the greatest challenges of addressing snakebite in the developing world is that the overwhelming majority of snakebite patients do not arrive at a hospital until hours or days after a bite has occurred, which typically results from reliance on traditional healers for initial care and is further complicated by the logistical challenges of transporting a patient in areas lacking reliable infrastructure. Patients with dry bites or bites from non-venomous snakes appear to recover after traditional medicine treatment because they were never sick to begin with, while those with significant envenomations rarely seek medical attention until traditional remedies have failed and profound signs and symptoms of envenomation are present. These patients then arrive hours or days after the bite at a poorly equipped hospital that may have been deceived into purchasing fake or completely ineffective antivenoms from unscrupulous manufacturers, a problem that results in part from the critical shortage of high-quality antivenoms we are facing today. Many patients will spend a great deal of money on ineffective treatments that fail to work, and even in cases where good antivenom is available the clinicians may be unable to save the life or limb of the patient due to a lack of specialized training in snakebite management and the severe condition of a patient who has arrived days after the bite occurred.
Everyone in Africa, India, and elsewhere in the developing world has been touched by snakebite. Doctors and nurses grow discouraged and disillusioned, believing that snakebite patients are doomed to suffer from horrific outcomes regardless of their best efforts. Patients are deceived by a cruel sleight of hand into believing that they are better off seeing the local healer, which is the primary reason they suffer such horrific outcomes in the first place. The end result is a vicious circle where traditional healers appear cheap and effective while hospitals appear expensive and largely ineffective because they have neither the specialized training nor the antivenom to manage the complex envenomations that present hours or days after the bite occurred. Tragedy begets tragedy, and the circle begins again.
The video below was produced by our partners at the African Society of Venimologie and powerfully illustrates the complex challenge of addressing snakebite in sub-Saharan Africa and throughout the developing world.
Success Story: Madjidou's snakeBite
The photos above show Madjidou, a 7 year old boy who was bitten by a deadly carpet viper in northern Benin while herding his father's cattle, before and after antivenom treatment. He was taken to a traditional healer who made a series of incisions with a rusty blade and rubbed a mix of animal dung and dirt into the wounds, then gave him a mixture of ground up snakes and dried leaves and instructed him to drink it with his porridge every day for one week. On the first day, Madjidou began to bleed from the cuts the witch doctor had made. On the second day, he began to vomit bright red blood and developed a fever due to infection from the dung that had been rubbed into those wounds. On the third day when he began to cry tears of fresh blood his family finally realized that they had no choice and brought him to the hospital for treatment. When we first assessed Madjidou he was running out of time, his body ravaged by a venom that simultaneously stopped his blood from clotting and tore holes in his blood vessels to cause him to bleed. We stabilized and treated him with antivenom, IV fluids, pain medicine, and antibiotics for the infection he had developed from the witchdoctor. One day later he showed dramatic improvement, and after 5 days in hospital he gave us a hug and went home smiling after making a complete recovery. It cost less than $200 for us to save Madjidou's life. This is the power of antivenom, and it is cases like this that inspire us to take on this challenge.