India snakes kill 46,000 a year

Lack of anti-venom in rural areas and difficulty accessing health centres are among a number of factor contributing to 46,000 deaths every year.

A youth watches cobras during Naag Panchami, a Hindu festival dedicated to the snake god, in the southern Indian city of Hyderabad. Krishnendu Halder / Reuters
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NEW DELHI // Chirag Roy set off for the nearby Indian village of Kollara after receiving a call that fateful morning.

A spectacled cobra had been spotted in the neighbouring village, one kilometre away. Would he be able to come immediately?

As the resident naturalist at Svasara Resorts, in the Tadoba Tiger Reserve in eastern Maharashtra, Roy had wanted to rescue the snake. But that morning on March 1, he was bitten by the cobra and died on the way to hospital.

“The villagers had a tendency to kill any snake they saw,” said Ratika Sinha, Svasara’s executive director, adding that Roy often received such phone calls. “He was a very passionate herpetologist, and he tried to rescue the snakes instead.”

Roughly 46,000 people die of snakebites in India every year, according to the American Society of Tropical Medicine and Hygiene, accounting for nearly half of the 100,000 annual snakebite deaths the world over.

But most of these deaths are entirely avoidable, said Gerry Martin, a Bengaluru-based conservationist who works to reduce snakebite mortality.

A colleague had followed Roy that day, leaving Svasara minutes later after assembling a kit to rescue the snake. By the time he reached Kollara, Roy had been bitten by the cobra.

He was not bleeding, but he knew what had happened. “I need to go to a hospital,” Roy told his colleague.

The nearest government hospital was 14 kilometres away, and the doctors there failed to see the urgency of Roy’s condition. By the time he was given a shot of anti-venom, it was clear he needed further medical attention as he could not breathe and was vomiting.

An ambulance was parked at the hospital but its attendants were nowhere to be found.

Another van was commandeered, but the journey to the city of Nagpur took two hours. Roy died on the way, at the age of 30.

Roy’s death was quite unusual, Mr Martin said.

“Snakebite in this country doesn’t usually affect people of the middle and upper middle class. It’s a poor man’s affliction, it’s a farmer’s affliction.”

The infrastructure to deal quickly and effectively with snakebites is often inadequate in rural areas. Roads to the nearest hospital may be bad or non-existent, so ambulances may struggle to get victims to health centres. In remote hospitals, stocks of anti-venom can run low.

But the real problem, Mr Martin said, is a lack of awareness.

In villages where snakes are common visitors, victims tend to ignore bites, presuming they were bitten by non-venomous snakes. Often, they turn to faith healers or local medicine men instead of seeking prompt medical treatment.

Even more egregious, Mr Martin said, is how ill-equipped doctors and medical staff are to treat snakebite.

He recalled the case of a nine-year-old girl who went to a government health centre after being bitten by a Russell’s viper – considered one of the most dangerous snakes in Asia.

“She was given an anti-tetanus shot and sent home,” he said. “By the time her father was able to get her to a hospital, it was hours later, and she died after 18 hours of excruciating pain.”

Medical textbooks vary widely within India, and many of the outdated ones still instruct practitioners to tie a tourniquet around the bite or to cut the wound open and suck the venom out. “Which isn’t possible to do, and can be very damaging,” Mr Martin said. “That’s like something out of a Bollywood movie. It doesn’t work.”

In reality, snakebite is not a medical enigma. Anti-venom, administered at the right time, is sufficient to negate the effects of the bite.

Polyvalent anti-venoms can neutralise the effects of venom from multiple species of snakes.

The process of producing anti-venom is straightforward but painstaking, said M V Khadilkar, a veterinary doctor who co-founded Premium Serums and Vaccines, one of India’s leading manufacturers of anti-venom.

Even today, nearly all of the world’s anti-venom is generated by injecting horses with sub-lethal doses of snake venom. The horses produce biological agents – or antibodies – to fight off the effects of the venom. These antibodies, which can be collected from the horses’ blood, form the raw material of anti-venom.

A few years ago, a vial of anti-venom cost roughly 1,000 rupees (Dh55). “In 2014, the government started to control the price of anti-venom, and the price of a vial has now been fixed at 600 rupees,” Mr Khadilkar said.

India faces a shortage of anti-venom, he said. “It’s technologically challenging, and since it involves the use of live animals, there are many restrictions on the use of horses,” he said. “So it is impossible to scale up production in a short span of time. And this isn’t a very lucrative business, which is why the big firms haven’t ventured into this field.”

But Mr Martin argued that India had enough anti-venom. What it lacks is distribution – the ability to get anti-venom on to the shelves of every government health centre and hospital in the country, particularly in rural areas. Anti-venom must also be stored in refrigerators, but this is a problem in a country where power supply can be erratic, especially in rural areas.

In the case of the nine-year-old girl who died, even if her first doctor had run short of anti-venom, he could have sent her in an ambulance to another hospital that still had a stock of the drug.

“Something as simple as that could have saved her,” Mr Martin said. “All of this is avoidable. The reality of snakebite in this country is just terrifying.”