My lifelong love affair with snakes started with a heart-breaking incident that took place in the year 1987 when I was studying in class seven. Ganesh belonged to a very poor family from a small village in Latur district. He was one of my closest friends. He used to work in STD booths during the mornings and during holidays. Very hardworking and obedient by nature he used to stay in a modest rented room near my house. We loved each other’s company and we would share the day to day happenings with each other.
One day Ganesh suddenly disappeared without informing me about his whereabouts. I panicked at his absence and later went to the owner of the STD booth where he worked. Ganesh’s employer informed me that he had gone to his village as his sister was admitted in a hospital.
Since he was my best friend, I went to meet Ganesh and his family at the hospital. The entire family was under immense stress which saddened me further. Since both of us were kids, I didn’t know how to help my friend. I returned home after consoling Ganesh that everything would be fine.
Once back home, I was unable to control my tears. The stressed faces of Ganesh’s family members at the hospital kept haunting me. Eventually Ganesh came back and since he didn’t know anyone in our town, I convinced my mother to give him food regularly.
While talking to him I got to know that his married sister had come home for Diwali and while helping in the fields was bitten by a venomous snake. Though she was taken to the civil hospital, her condition worsened and she was shifted to Latur. Despite being shifted to a higher hospital, her condition worsened with each passing day. Due to the high hospital bill, the family had to take a loan by mortgaging their land. Unfortunately, Ganesh’s sister died despite best efforts by his family to save her. The family went into debt and lost their land, money and most importantly their beloved daughter. This incident ruined a happy flourishing family. The trauma saddened me to the core.
It is true that the most painful goodbyes are the ones that are never said and never explained. That day was the turning point in my life. I decided to learn about snakes and the effect of a venomous snakebite. I was determined to help victims of venomous snakebites.
I was too young to understand how snakes were caught or handled and how emergency treatment was to be given in case of a venomous snakebite. I was however determined to learn more on this subject.
A few days after this incident I was travelling to Pune with my friends. During a walk on Tilak Road I came across a scrap merchant. I asked him if he had any book on snakes. He gave me a book which was priced at Rs.10. Learning about snakes from the book perhaps was the defining event that led to my passion for snakes and other reptiles. My interest in reptiles kept increasing with each passing day.
I knew that if I travelled to Pune I could source more books on snakes. However, the issue was the money needed for the travel. So, I started saving money and waited for six months. Even after six months of saving, I was short of a few bucks. I had to resort to stealing and with that money I went to Pune and met the same scrap merchant and asked for few more books on snakes and other reptiles. After a long wait of four days he gave me an English book on snakes.
Though I was happy to have that book I was not sure if I could learn much from the book as I had a negligible command over the English language. I put all my energy into improving my English skills. A book by the name “Snakes of India” by P.G. Deoras fired my passion to be a snake rescuer.
If there is a burning desire within you, anything can be accomplished. Knowledge from the snake books and field guidance from a few local rescuers took me on a journey of rescuing more than 50,000 snakes and hatchlings in my region. Being a rescuer and social activist, I was able to help more than 100 snake bite victims to get to the hospital in time and in some cases donated towards the treatment of poor victims.
Snakes are grossly misunderstood creatures. Everyone in our community should be made aware of snakes and other reptiles. They are not the villains as portrayed in many of the Bollywood movies. They are the most shy and sensitive creatures and try to get away from humans. When we come in contact with a snake, it usually warns and tries to flee the scene. Snakes generally bite in self-defence when cornered. To illustrate this example, I would like to share a rescue incident where I was bitten by a juvenile Spectacled Cobra. It was night time and the snake was inside a house that was small and congested with furniture and other household items. The entire neighbourhood had gathered out of curiosity. As I entered the house and tried rescuing the snake, got distracted for a split second due to the onlookers shouting instructions etc. The juvenile snake bit me on my right-hand thumb. I suffered envenomation and was immediately rushed to the hospital. I was in the ICU (Intensive Care Unit) for two days and later shifted to the general ward for a day. In total I was administered 27 vials of snake antivenom. Learnt my lesson from this incident and try to rescue snakes in a more controlled environment and under the local forest department guidance.
The importance of snakes and other reptiles in the environment is immense. They help strike a balance in nature. They fill the important role of being both predator and prey and their presence and removal directly impacts the health of the ecosystem.
SAVE A SNAKE & SAVE THE ENVIRONMENT……BE A SNAKE FRIEND
Story & Images contributed by Bhima Shankar Gadve, Latur.
India is famous the world over for its snake charmers and myths around snakes. While the common man of today’s India is peeved with this comparison, nothing much has changed in the last century in the snakebite scenario despite the fact that there was a ground-breaking invention of Anti Snake Venom to cure venomous snakebites as early as the 19th Century. However, this drug started being used globally after a much-refined version of the antivenom was manufactured in the early 50s.
Out of the 300+ snakes found in India, about 15 species can be categorized as medically significant snakes (whose bite can prove fatal). India clocks the highest number of death by snakebites in the world.
The impact of the problem is more evident and severe in the rural parts of India where religious beliefs coupled with dogmas and dependence on faith healing is tremendous. As if this problem was not enough to deal with, local medical infrastructure across the rural and semi urban belt is broken.
Despite the fact that more than 50,000 individuals die each year from snakebites, there is little much that is being done to upgrade the health care budget in India. Allocation of funds to build medical infrastructure is the need of the hour.
Snakebite Healing and Education Society (SHE) was founded in 2014 with the aim to collaborate with grass root level workers across India to dispel myths and create awareness about the snakebite issue. The focus is on how not to get bitten by a venomous snake in the first place. We believe prevention is better than cure!
As we downed the curtains on 2016, SHE collaborated with Sanctuary Asia’s field coordinator, Goverdhan Meena in Ranthambore, Rajasthan to create awareness in the region.
Snakebite Temple in Sawai Madhopur
Rajasthan is a state of traditions, rituals and beliefs especially regarding treatment of snakebites. The faith healers in this state are local temple priests, fakirs and village quacks. Each year hundreds of deaths due to snakebite go unreported in this state. A snakebite death is looked upon as one’s destiny and people carry on with their lives after mourning the dead. No one tries to reason how they can prevent such incidents by implementing simple precautions like using a torch, looking where they are placing their feet or hands, storing of food grains away from where they sleep, not stocking piles of dried wood etc inside their houses and a control on the rodent population which forms the prey base of the three most commonly found venomous snakes in the state.
Despite such a high number of deaths, the state government has not recognized this as a burning issue to be tackled on a war footing.
Sanctuary Asia has been working on the ground with the local communities through their Kids for Tigers programme. The Kids for Tigers campaign has been successful with the local villages situated on the fringes of the forest. These villages face many snakebite deaths every year. In fact, more people in these villages die of snakebites than tiger attacks. SHE has therefore collaborated with the local team to roll out the snakebite awareness program along with the Kids for Tigers initiative.
SHE conducted awareness programs in the local schools, a B.Ed. college, villages and the local cottage industry that promotes regional artisans.
This was the first step of a journey through a path less traveled. There is immense opportunity to work on the ground with the local people in dispelling dogmas. Team Sanctuary Asia and SHE intend to continue creating awareness in this beautiful country side in which the four most commonly found venomous snakes in India are distributed.
Written by Priyanka Kadam
Field Coordinator : Goverdhan Meena
Loss of life can never be compensated. The latest individual to fall victim to a venomous snake bite is Chirag Roy, a promising field biologist from West Bengal. Chirag was a well-informed budding conservationist and loved the wild. He had seen seniors in the field being bitten, a few had even died. And yet when one is a handler, the confidence of handling snakes’ day in and day out can make one complacent in the matter of taking necessary precautions.
Chirag was in a resort property in Tadoba (near Nagpur, Maharashtra). He was asked to relocate a cobra. I’m still unclear how he got bitten and what was the cause of death in this case. We will know for sure in the coming days. Chirag was 29 and married last year. He didn’t have any siblings.
While this incident has deeply saddened me, any incident, however heartbreaking, is an opportunity to learn from the mistakes and ensure that there are no repeat cases. A few points that need immediate attention are:
For Forest Department of every state
For hotels especially resorts in the buffer zones and the periphery of reserve forests
For Snake rescuers / Field Biologists / Herpers / Trekkers / Nature Enthusiasts
Today, before Chirag’s mortal remains turn into ashes, let us take an oath to follow protocol and ensure no one dies of snakebites. To follow our dream with responsibility should be the mantra!
Written by Priyanka Kadam
Recently I was in discussion with a friend about snake rescue and we just decided to pen down a list of snake friends in our knowledge that have died due to snakebites. In 30 minutes we could come up with 29 names, there may be additions to this list if we start researching on a serious note. Also, we’ve not included those who’d lost their limbs or had disfigured them due to envenomation. And this we are talking only about western and central Maharashtra. When you look at this list it’s very disturbing.
What happened? Mistakes? Carelessness? Accidents? We do not know and I don’t want to go into the details of that. But in the end there is loss of life, there are broken families and worst is the impact on snakes, as after every such case the conservation of snakes is negatively impacted.
Deaths of snake friends in our knowledge due to snake bite –
|12||Rajan Kakade||Russell’s viper||Deorukh|
|21||Pappu Yadav||Russell’s viper||Morgaon|
|26||Rahul Suvarnkar||Russell’s viper||Latur|
|28||Tukaram Favare||Cobra||Mandangad, Dapoli|
TO BE STRICTLY AVOIDED –
And without showing any disrespect to those snake friends who have lost their lives (some of them were close friends) I would like to say, – if you still feel that snake handling is a glamorous thing and you will get popularity by excessive handling, showing off, not following procedures or making mistakes your name might (tragically) make it to the list above.
Written by Kedar Bhide
PS: Kedar Bhide has shared the above details of people who he knew and died due to snakebite in Maharashtra. There are many such incidents from across India. The author has requested readers to add more names to this list of people they knew who died in similar circumstances.
Snakebite management through free emergency ambulance service during Golden Hour in Himachal Pradesh
In India every half an hour there is death due to snakebite as the total mortality is pegged at 49,500 cases every year. Snake bites are a common cause of morbidity and mortality in the hills. The risk of snake bite is high due to the presence of a huge fauna flourishing in a favourable temperate climate–low environmental temperature and heavy rainfall. Delayed presentation to the hospital contributes to increased morbidity and mortality from snake bites. The timely and free ambulance service can save lives and lessen morbidity due to snakebites. This study aims at evaluating how a free, round the clock emergency ambulance service having facilities for anti-snake venom injection, can help save lives by responding to a toll free number 108 and transporting the patient to nearest appropriate hospital within the first hour of the bite which is also referred as the golden hour.
A total of 469 patients of snake bite cases availed the free emergency ambulance service between 25th December 2010 to 30th November 2011 by dialling toll free number 108. All patients were examined for evidence of snake bite and where possible the snakes were identified based on description, identification (if the snake was brought) and symptoms of envenomation. Based on signs & symptoms, ASV was used inside the ambulance, where applicable. All patients were shifted within the golden hour to the nearest appropriate health facility.
Seasonal variation in snake bite was seen, with a peak in the months of August. No bites were recorded in the month of December and January and only one case was reported in the month of February. Highest snake bite cases were reported in August (27%). 76% of the bites were on the feet (up to the ankle) where as 22% bites were on hand (finger & elbow) and only 1% bite cases were reported on the lower back and head. Female to male ratio was 54:46 percent .The age group most affected was between 11- 40 years (56%). Within this category the highest affected age group was 21-30 year (24.9%). Most bites occurred while the person was cutting grass, working in the fields or walking in the hills (75.3%). Snake bites while sleeping were at uncommon sites (Ear and Head). Highest 22.38% cases were reported in warm Kangra district just opposite to cold tribal district of Lahul and Spiti where only one case was (0.21%) reported. Out of 469 cases, in 47cases (10.02%) ASV had to be used inside the ambulance in critical condition. Only one patient had a mild allergic reaction to ASV and lives saved after ASV utilization was 42 ( 89.36%). Total life saved out of 469 cases was 451 cases (96.2%).
Snake bites occur frequently in the hills of Himachal Pradesh. The initiation of toll free and user charge free emergency ambulance service 24X7 called Atal Swasthya Sewa in PPP (public-private partnership) mode with GVK-EMRI helped snakebite victims to avail of the services anytime in an emergency.
Recommendation: We recommend a fully equipped free emergency ambulance network equipped with ASV in all the states of India to save victims of snakebite. A timely medical response helps in treatment and increases the chances of survival and recovery in patients.
Way Forward: The GVK-EMRI has done a great service to mankind by transporting more than 30,000 patients of snakebite across the country within the golden hour in 2014. The endeavour is to induce ASV inside the ambulance if patient is in critical condition. Efforts are on to equip the boat ambulances with ASV in water logged areas. GVK-EMRI has done this in Assam to save lives that required immediate medical attention.
Since the modern ASV is free of reactogenic segment Fc, the reaction rate due to serum administration is low. Keeping this in view we need to think of new protocols that are simple, effective and easy to administer so that patients need not face complications of haemorrhage and dialysis. Since the issue of snakebite is internal (national) with various facets to this problem, let’s not look externally to solve this issue for us. The solution has to come from a national level protocol that addresses regional challenges. This requires all of us to collectively share our experiences and expertise just as we are doing on the Whatsapp group created by Dr Dayal Bandhu Majumdar from West Bengal.
Lastly more frequent conferences and sharing platforms need to be developed and hands-on training for young doctors need to be given top priority for better management of snakebite cases in India.
Snakebite is a treatable disease. Let nobody die of Snakebite in India!
Written by Dr. Omesh Kumar Bharti and Dr. Gaje Singh
The following is written with the hope that somebody who reads this has enough ‘everything’ to make life saving decisions.
DARK FAIRY TALE VERSION #1
Once upon a time, not so long ago, lived a beautiful princess. Her evil stepmother made her go into the forest to collect firewood – hoping that leopards would eat her. They didn’t. One day she stepped on a venomous serpent, which bit her. Fortunately some woodcutters were passing by and carried her to the nearest primary health center. A charming young doctor-prince, who was doing his rural internship, was certain he could save the princess’ life. He administered anti-snake venom serum – the liquid type. Despite this, she died. Unfortunately, somewhere along the chain from manufacture to treatment, the electricity had gone off. Due to global warming the temperature was much higher than 10 degrees C and the ASVS ‘died’ much before the poor princess. Our fairy tale ends unhappily ever after. It needn’t have.
LIQUID ANTI-SNAKE VENOM SERUM (ASVS) SHOULD NOT BE MADE
Liquid ASVS requires refrigeration, usually below 10 degrees C, to remain viable. Electricity in India is at best unreliable – especially in rural areas – where most cases of snakebite occur. Deaths due to snakebite compounded by electricity failing – thus causing ASVS to lose its efficacy, are avoidable if lyophilized ASVS is used.
If the stuff doesn’t work – it’s a waste of snake venom … and human life.
A government directive enforcing the manufacture of only lyophilized ASV might help . . . if such a ruling were ever passed. It probably won’t be, so when one has a choice, I suggest using lyophilized ASVS (see box). If people don’t buy it, commercial pressure may persuade manufacturers to make lyophilized ASVS only.
DARK FAIRY TALE VERSION #2
Once upon a time, not so long ago, lived another beautiful princess, this time in Rajasthan. Her evil stepmother made the young maiden sleep on the floor. One night the princess got up to drink water and stepped on a venomous serpent. It bit her. Unsure of the beneficiaries of the princess’ will, the stepmother sent her to the nearest primary health center. The same charming young doctor-prince (still doing his rural internship) was dead sure that this time around he’d save the princess’ life. He administered anti-snake venom serum – the lyophilized type. Despite this, she died. Unfortunately, the snake that bit her was Bungarus sindanus. Anti-venom made in India is effective against Bungarus caeruleus (and three other species). The tale ends unhappily ever after. And it needn’t have.
THERE ARE MORE THAN 4 SPECIES OF SNAKES IN INDIA WHOSE VENOM IS CAPABLE OF CAUSING DEATH IN HUMANS
The catchy term ‘Big Four’ is probably one reason for the common misconception that there are only four species of venomous snakes in India. Absolutely untrue! Snakebite deaths caused by any snake are attributed to either – Naja naja – the Common Indian Cobra or Spectacled Cobra; Echis carinatus – the Saw-scaled Viper; Daboia russelii – Russell’s Viper and Bungarus caeruleus – the Common Indian Krait. The truth is that there are several species whose venom is capable of causing human death. Most (not all) of these are rarely encountered and recorded deaths are few. Due to the ‘only four venomous snakes in India’ misconception and the ‘Big Four’ moniker, anti-venoms have not been made for several of the venomous snakes of medical significance. Translation – has enough ‘juice’ to kill humans.
A few examples:
Maharashtra (also parts of the Gangetic plain, parts of U.P., Bihar and Bengal)
has two species of similar looking kraits – Bungarus caeruleus – the Common Indian Krait, and Bungarus cf sindanus walli or Bungarus cf walli. The Common Indian Krait has 15 midbody dorsal scale rows and the ‘other’ krait has 17. Two additional scale rows may seem like no big deal, but their venoms are different. No ASVS is made for Bungarus cf walli. Despite no known tests having been carried out on the efficacy of polyvalent ASVS against venom of this ‘second krait’, it is routinely administered for all cases of snakebite. If death occurs, it is usually attributed to Bungarus caeruleus.
Bungarus sindanus – the Sind Krait and Echis sochurecki – Sochureck’s Saw-scale Viper occur in Rajasthan (and probably adjacent Gujarat). Deaths resulting from a krait, are most often attributed to Bungarus caeruleus and ‘Saw-scaled vipers’ bites are still attributed to Echis carinatus. No specific ASVS is made for either species.
Parts of Haryana, most of the Gangetic plain, West Bengal up to Arunachal Pradesh
There are (at least) two species of cobra: Naja naja – the Common Indian Cobra/ Spectacled Cobra and Naja kaouthia – Monocellate Cobra/ Monocled Cobra. Though it is easy to recognize typical forms of both species, there is still no ASVS made specifically for Naja kaouthia in India.
An endemic cobra Naja sagittifera – the Andaman Cobra is found on some of the Andaman Islands. No ASVS is made for this species.
Though bites are extremely rare, no ASVS is made in India for Ophiophagus hannah – the King Cobra. It is uncertain whether the anti-venom made in Thailand is effective against the venom of king cobras found in India.
It is up to herpetologists (me included), animal rights groups (instead of shutting down ASVS manufacturing facilities, they could regulate them), pharmaceutical companies (nix the liquid ASVS folks. You might need it yourselves one day) and politicians (dead people can’t vote) – to work together to ensure that dark fairy tales like those above never happen. The beautiful princess might easily be related to you.
Written by Ashok Captain
On Sunday, 9th July 2015, my beloved junior Dr Sk Rajib called me over the phone from Dhoniyakhali Rural Hospital of Hoogly district of West Bengal at about 9.30 am. Dr Rajib wanted to draw my attention to a picture of a patient sent to me on WhatsApp (WA). Rajib informed me about a very interesting case of mysterious Common Krait (CK) bite admitted at his Rural Hospital. This incident triggered an idea to start a WA group for Snakebite case discussions.
Dr Rajib’s case deserves wide circulation among not only the medical community but also the regular public. The patient was a 40yrs old lady admitted with only complaints of pain in the abdomen on 7.7.2015 in the afternoon. Three doctors treated her in Dhoniyakhali RH in routine schedule of a common pain abdomen case. Third doctor had written the refer letter to send her to Burdwan Medical College for Ultra Sonographic examination. Dr Rajib was the 4th doctor to examine her. Dr Rajib had no doubt it was a case of CK bite. The only symptoms manifesting at that point was abdomen pain and bilateral Ptosis. He not just diagnosed the case accurately but confidently treated the snakebite victim at the Rural Hospital itself. He had started ASV infusion even before getting a response from me.
Like hundreds of my juniors who have my contact details after attending my workshop on Snakebite management in various institutions, Dr Rajib also had my number. He wanted my opinion as a confirmation to his diagnosis. So he made use of technology and got in touch via WA.
This incident prompted me to start the “Snakebite Interest Group”. Like any other initiative, this WA group also faced initial problems. Some people liked it, some others didn’t.
In the beginning, I had started this group with 60 people from my contact list. Though most of them were doctors, there were a few from other professions. We were all tied together by one common cause; “Snakebite”. There were junior doctors working in rural health centers and hospitals, a few senior doctors, some researchers and a few social activists who work for the cause of Snakebite mitigation. Two well-known reporters of Bengali daily Newspapers were also a part of the group right from its inception.
One of the reporters, Mr Biswajit Das of the Bartaman published an article on the WA group in his newspaper. This news article created much interest in the WA group and I started receiving requests from various people belonging to different professions to add them to the group. The maximum capacity that can be included in a WA group is 100. There were so many aspirants that I had to start a 2nd group due to popular demand.
Most of the junior doctors are very active in the group. They post Snakebite case details regularly, not only seeking advice from experienced seniors, but also to inform their field experience that comprised of success and failures. One important outcome of these discussions was that doctors at the referral centers were informed instantaneously, even before the referred patient reached the higher center. Such responses are crucial in a life death situation.
We were able to add legendary figures with snakebite treatment experience in our group. Dr Himmatrao Saluba Bawaskar and Dr Dilip Punde of Maharastra are in this group. Prof. Shyamal Kundu, HOD, Medicine Dept of B S Medical College is also an active member of this group.
We have doctors and Snakebite mitigation enthusiasts from six states in this group. Participants discuss not just Snakebite cases, but also Snake rescue, public awareness, mishandling of snakes, ASV quality and other matters pertaining to snakes and snakebites.
Many group members left us in the last 5-6 months, and many more have joined our initiative. I have gathered a lot of experience on human behavior and team management from this group. A few participants were initially very active and repeatedly requested me to retain them in the group; latter on these very people left the group abruptly.
Some advice from my experience of managing this WA group for those who may want to start a similar group; Never add any person on request from another person. Let each and every member join the group sending a request to the group admin.
Lastly, I would like to share a few pictures that were shared by our group members while discussing further line of treatment. The first two pictures were posted by Dr Sk Rajib. It depicts the CK patient having bilateral Ptosis. Second picture is of a Uro bag of a Krait bite patient treated at Basirhat Dist Hospital. Do note the dark colour of the urine. This condition is called hematuria. The third picture is of the Krait snake shared by Dr (Sr) Archana of Chhatrishgarh. The patient in this case suffered from coagulopathy after bite from this specimen.
Written by Dr Dayal Bandhu Majumdar
HallaBol was a war cry used in the past to build up frenzied energy to spill over into the battle field with destructive force. In this day and age the same slogan signifies the intent to wipe out social evils that dog our day to day life.
From Snakebite Healing and Education Society’s perspective: Halla Bol is the rallying cry to fight societal myths around snakes and snakebite and spread awareness to mitigate this highly neglected issue. The various areas to mitigate snakebites are: