: Mouth Piece

How I Became a Snake Rescuer

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.

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Bhima Shankar Gadave, Senior Snake Rescuer from Latur, Maharashtra.

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.

snake release

Releasing a rescued Spectacled Cobra back into the wild

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.

juvenile cobra

Juvenile Spectacled Cobra

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.

The Snakebite educator with a message for safe handling.

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Diana Barr with Dr David Williams at Palais des Nations (UN), Geneva, Switzerland, at the 69th World Health Assembly (WHA), May 2016.

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Fieldwork in Ranthambore, Rajasthan.

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.

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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.

Dastakar Kendra Workshop

Snakebite Awareness workshop with workers of Dastakar Kendra, a local artisan’s initiative.

SHE conducted awareness programs in the local schools, a B.Ed. college, villages and the local cottage industry that promotes regional artisans.

BEd College Workshop

Snakebite awareness workshop with students of Acharya Nanesh BEd College

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

One Million Snake Bites written by Janaki Lenin

I wrote this in 2011 at the request of the film production company that produced ‘One Million Snakebites,’ a BBC Natural World documentary. Wasn’t published then so here it is –
If you are a young farmer in India, your chances of succumbing to snake bite are greater than anywhere else in the world. The country has made impressive strides in several fields of endeavour, including putting satellites in orbit, but in the case of snake bite casualties, we appear to be mired in the Dark Ages.
According to the World Health Organization (WHO) between 35,000 to 50,000 Indians die every year, but in 2008, the Government of India reported a dramatically low 1400 mortalities. Apparently six of the worst affected states never sent their death toll figures.
Finally, a path-breaking project code-named ‘The Million Death Study’ provides a more realistic handle on the impact of venomous snakes. The research team comprises experts from institutions in Canada (the Centre for Global Health Research at St. Michael’s Hospital and University of Toronto), UK (Nuffield Department of Clinical Medicine, University of Oxford) and India (the Registrar-General of India (Delhi), S.C.B Medical College (Orissa), Indian Institute of Health and Family Welfare (Hyderabad), St. John’s Research Institute (Bangalore) National AIDS Control Organization (Delhi) and Madras Crocodile Bank Trust (Tamil Nadu). By a process of extensive interviews called “verbal autopsies”, the study found that as many as a million Indians are bitten by snakes every year while almost 50,000 people die. Indian mortalities are a third of the globally estimated snake bite deaths. In other words, for every two people who succumb to AIDS in India, there is one snake bite fatality!
This is no surprise when you consider that Indians seem quixotically prone to high snake-bite-risk behaviour such as walking barefoot without a torchlight at night and sleeping on the floor, while also creating ideal cover for rodents and snakes in their midst. Once bitten, they further reduce their chances of survival by going to a witch doctor first rather than seeking the only cure, antivenom, from a hospital. There is very little understanding that a venomous snake injects its virulent muscle-eating, nerve-damaging, blood-destroying venom deep into body tissue that no amount of superficially applied ‘black stones’, herbal poultices, or eating bitter roots can hope to counter. For years, Indian herpetologist Rom Whitaker has evangelized to country folk that only an injection can counter the snake’s injection, but clearly vast areas of the country remain to be covered.
Do snakes especially target Indians? Surely our neighbours who share the same farming patterns, life styles, and medical practices are equally doomed. Perhaps there are just too many of us crammed on a land where agriculture is still the majority occupation?
Both India and Sri Lanka have about 300 people per sq.km while Pakistan has 214 and Nepal 200. But Bangladesh blows us all off the South Asian density chart with 1100 people compressed in every square kilometre. It stands to reason that Bangladeshis are more likely to trip over snakes than Indians. And they do. A recent survey reported 700,000 snake bites and 6000 deaths a year.
Across South Asia, the picture-perfect rice fields are highly productive food bowls. Herpetologists such as Rom Whitaker, however, see an ideal snake-rich landscape. The flooded fields are demarcated by raised embankments that are perfect for housing high densities of rodents and snakes. For nocturnal, rodent-eating, farm-living snakes, life can get no better. At dusk, cobras and Russell’s vipers emerge from rat burrows and dense undergrowth to start hunting for prey, just when barefoot farm workers are likely to step on them. It appears that this is when and how the bulk of the snake bites occur.
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In ‘One Million Snake Bites’, an hour long BBC Natural World documentary, Rom Whitaker uses high speed photography to illustrate that despite the bad rap, the cobra doesn’t bite most of the time. It first relies on its ability to make a quick getaway to avoid confrontations. When cornered, the defensive snake sits with its hood spread looking beautifully dangerous. But in take after slow-motion take, every cobra strikes with its mouth closed, its dangerous toolkit safely sheathed, consistently punching but not biting. Now you know why Rikki Tikki Tavi, the mongoose always wins its bouts with Kipling’s hooded death. Whitaker surmises that the cobra is reluctant to bite because producing venom demands a lot of energy, and no snake in its right mind would want to physically tangle with an animal as deadly as a human.
Even the small, feisty saw-scaled vipers and the larger, fat Russell’s vipers are prone to swift departure in some cases. But in others, they open their jaws wide and sink their fangs up to the hilt. All these species of snakes are common to most South Asian countries which heightens to mystery of why India bears such a high burden.
Is it the quality of healthcare? The Million Death Study found that only 23% of the deaths occurred in a hospital. Perhaps another reason for the very low official snake bite toll figures. Even the Irula tribals with whom Whitaker has had a long collaboration, set great store in their native treatments. In one gory episode in the film, the swollen finger of an elderly Irula lady who had been bitten by a saw-scaled viper is sliced with a broken piece of glass and the whole hand packed with green plant material. Had it been a lethal dose of venom, the outcome would not have been happy.
Clearly, belief in herbal medicine and magic is high, and when the condition of such a patient takes a turn for the worse, he/she is rushed belatedly to a hospital. Doctors have a hard time distinguishing the symptoms of snake bite from complications caused by local treatment thereby losing critical time. This is compounded by people’s poor knowledge of appropriate first aid measures. For instance, wrapping tight tourniquets causes more harm than good.
Bite area (final)
Even if snake bite victims and their families chose to seek treatment from a hospital, not all hospitals stock antivenom. The patient has to be transported over long distances to reach one that can treat him/her. Most doctors know little about snakes and are unable to tell venomous from non-venomous snakes. Some unfortunately rely on anecdotal mumbo-jumbo such as pattern of the bite mark and number of fang punctures to differentiate between venomous and non-venomous bites. Other problems include administration of insufficient doses of antivenom, lack of supportive care such as ventilators (in the case of krait and cobra bites) and dialysis machines (to treat Russell’s and hump-nosed viper bites).
To add tragedy to injury, antivenom manufactured in India is of low potency, and huge doses may be required to neutralize the effects of venom. Whitaker collected a venom sample from one black cobra in Rajasthan that yielded 198 milligrams, while one 10 ml vial of antivenom can only neutralize 6 mg of venom.
To top these challenges, there is an additional whammy: the venom of some species of snakes varies from one place to another. For instance, venom of the Russell’s vipers of east and south India are nerve-affecting in addition to the blood-deranging effects elsewhere in its range. This might mean that the antivenom made using the venom of south Indian Russell’s vipers may not neutralize a bite from the same species in north India.
Besides, antivenom is made from the venom of four of the commonest snake species: spectacled cobra, common krait, Russell’s viper and saw-scaled viper. However, India has four species of cobras, eight species of kraits, two sub-species of saw-scaled vipers and one species of Russell’s viper. We just do not know how effective the available antivenom is against the venom of all these species.
During the course of the film, Whitaker travels across India collecting venom samples from different species of snakes. Collaborating with toxinologists, who work in the laboratory, he hopes to try to answer these complicated questions in order to produce a truly life-saving antivenom that is widely available and is effective throughout the country.
While ruminating over the 50,000 poor souls a year who never make it, I realized this was spread over a very large country. Perhaps the best way of seeing this in the all-Asia context was to break it up into units. India’s 5 deaths per 100,000 people is high compared to the South Asian average of 0.91-2.21. But it appears to be similar to the lower-human-population-density countries of Pakistan and Nepal that suffer 4.8 and 3.5 deaths per 100,000 respectively. Surprisingly, Sri Lanka’s human density figures are almost the same as India’s, but it suffers a mere 0.63 deaths per 100,000 people. [These are back of the envelope calculations based on guesstimates. So please take it with a large pinch of salt.] This kind of comparison is interesting but still needs fine-tuning when better snake bite statistics become available.
The Million Death Study provided another clue to India’s snake bite problem: religion. A Hindu has a higher chance of dying from snake bite because his/her reverence for cobras has fostered a higher degree of tolerance toward the presence of snakes as well as a belief system that sets great store in village cures. But, the Islamic Republic of Pakistan ranks second in severity.
At every turn a poor snake-bitten farmer is conspired against – by his own occupation and behaviour, the snake’s potent venom, and the insufficient medical care delivery system. Solving this, one of the worst public health crises caused by vertebrate animals, needs a radical change in attitude to an age-old problem. It needs large-scale public awareness campaign, clinical training and good quality antivenom.
A public awareness campaign, that employs the best techniques of the advertising industry, should educate people on how to avoid snakes and highlight that antivenom is the only antidote to a venomous snake bite. Wearing adequate covering for the feet and ankles where most bites are inflicted, sleeping on cots and under mosquito nets will greatly reduce the incidence of snake bite. Keeping the immediate surroundings clear of garbage, firewood piles, and straw heaps will discourage both rodents and snakes. Using a torch and being aware of snakes when walking at night would probably halve snake bite mortality.
In Madurai, a group of voluntary snake rescuers provide rapid transport to hospital for snake bite victims. They also counsel patients and help in obtaining prosthetic limbs when a snake bite victim is disabled. In the Nepal Terai, where the road network is rudimentary, volunteer village-based motor cyclists have proved effective in transporting snake bite victims to medical care. Programs like this have to be scaled up to enable victims to live as full a life as possible.
On the medical side, monitoring the incidence, mortality and disability rates is important so improvements in dealing with the problem can be tracked. Rural health workers and doctors not only need training to adequately diagnose and treat snake bites, they also require access to antivenom and a range of basic resources such as ventilators and dialysis machines. Venom and antivenom manufacturers have to raise their standards to those established by the WHO.
We have the knowledge and the technology to make this happen; all the government needs do is push the concerned departments into high gear. In addition, key stakeholders in herpetology, medicine, toxinology, venom collection and antivenom manufacture recently met to form a South Asian Snakebite Initiative, so there is light at the end of this horrendous tunnel.
Written by Janaki Lenin
http://wildlifealmanac.blogspot.in/2016/03/one-million-snake-bites.html

 

Loss of life can never be compensated!

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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

  1. Should have a minimum 50 vial stock of lyophilized (powder form) ASV to ensure safety of their ground staff and folks living in the buffer zones and periphery of the forest.
  2. Should have an experienced snake handler and 3 sets of snake handling equipment.
  3. Should be affiliated to some NGO for capacity building and workshop to understand the snakes in their region and how to handle a man-animal conflict.
  4. Should have the information on the health centers / hospitals closest to their location and names & numbers of doctors they can immediately call in case of emergency.
  5. Should monitor hotels in the buffer zones and ensure they follow snakebite first-aid protocol.

For hotels especially resorts in the buffer zones and the periphery of reserve forests

  1. A downloadable chart of the snakebite first aid protocol should be displayed.  Snakebite first-aid management should also be included in the staff training. Given below is a link to the protocol. Please scroll down to locate the downloadable versions in local languages like Hindi, Marathi, Gujarati, Bengali, Kannada and Malayalam. http://www.she-india.org/snakebite-first-aid/
  2. Every hotel or commercial place of stay should have 20 vials of Lyophilized (powder form) ASV as a part of their first aid kit. This can be provided to the nearest health care center doctor to administer in case of a venomous snakebite. (Please note: ASV cannot be induced by a non-medico).
  3. The staff should know to identify the medically significant (venomous) snakes found in their region.
  4. Every commercial establishment should have a set of snake handling equipment.
  5. They should have the information on the health centers / hospitals closest to their location and names & numbers of doctors they can immediately call in case of emergency.

For Snake rescuers / Field Biologists / Herpers / Trekkers / Nature Enthusiasts

  1. Always move around in pairs.
  2. Carry snake handling equipment if you are going to handle / relocate a snake in a conflict situation.
  3. Carry 10 vials of lyophilized (powder form) ASV in your first-aid kit.
  4. Carry a card with your basic details like:  a) Full Name, address and contact details. b) Who to contact in an emergency situation (name & number). c) Blood group. d) Details of any allergic reaction you may have to food, medicines or any other substance.e) Details of Snakebite expert doctor (name & contact number for the ground doctor to seek guidance in a venomous snake bite situation)

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

 

 

The Rescue Paradox by Kedar Bhide

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.

rescueparadox

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 –

 

1 Nandu Dixit Krait Pune
2 Ravi Korphate Cobra Pune
3 Usmad Madari Cobra Pune
4 Bashir Khan Cobra Nagar
5 Sanjay Khandagale Krait Narayangoan
6 Tandale Krait Pune
7 Sonar Russell’s Viper Bhor
8 Madhu Nitnavare Krait Pune
9 Vishal Mormare Cobra Pune
10 Sunil Ranade Cobra Mumbai
11 Vikrant Nar Cobra Chiplun
12 Rajan Kakade Russell’s viper Deorukh
13 Shantaram Pol Cobra Pune
14 Vadbule Cobra Rahu
15 Adam Jamadar Cobra Ichalkaranji
16 Tiwari Namhe Cobra Pune
17 Amol Vayal Cobra Pune
18 Kailas Pokale Cobra Pimpalwadi
19 Rahul Kambale Cobra Neral
20 Sunil Ingawale Cobra Ichakaranji
21 Pappu Yadav Russell’s viper Morgaon
22 Pawan Upadhye Cobra Loni
23 Kishor Wadkar Cobra Pandharpur
24 Narayan Pujari Cobra Pandharpur
25 Raja Kokare Cobra Pandharpur
26 Rahul Suvarnkar Russell’s viper Latur
27 Dhanajay Cobra Jalgoan
28 Tukaram Favare Cobra Mandangad, Dapoli
29 Durvesh Goware Cobra Uran
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  1. Many people want to become snake friends. It’s so easy, just start catching snakes, and there you become a snake friend. Is there any need to catch them? How do you do it? What precautions do you take? What you do with the snakes after they’re rescued? How many times do you handle it to show off? Nothing matters, except that if you are able to catch a snake you become a ‘snake friend’ (sarp mitra).
  2. Such an easy friendship!
  3. Please take a look at the list above, the magnitude of responsibility it carries to become a snake friend can be clearly seen.
  4. ‘Rescue’ by definition (here) means saving an animal from an adverse situation and rehabilitating it back into its natural environment. Unfortunately most ‘rescues’ do not fit this definition. In several/ most cases, the snake is just moved from one stressful situation to another, or (often) an area outside its original ‘home range’.
  5. When we talk about ‘rescue’ we really should be thinking about what’s good for the snake and not us.
  6. Do you think taking a snake from one environment where it is actively foraging/ living and dumping it into a new environment is rescue?????
  7. Do you think capturing a snake from an adverse situation and then using it for live shows for ‘education’ is rescue?????????
  8. Do you think handling, kissing snakes and showing off your images on social media is rescue??????
  9. If you answer all the above questions in positive, then, are we really doing snake RESCUE????????
  10. That’s where the shift needs to take place in our minds and we should rethink the term ‘rescue’ and use it so as to suit the welfare of the snake.
  11. Around two decades back there was a dire need to create a positive image of snakes in our community and during those days there was a lack of digital media for communication, which is available today. Therefore, during those days, showing off your snake handling images or doing live snake shows had a positive impact to create a whole line of people who started conserving snakes and making efforts to get this group of animal kingdom to a respectable level.
  12. In today’s world, our snake conservation efforts should move away from snake handling, snake shows and catching them to creating a society for co-existence, reduction of snake bites and fatalities and more focus on researching about the species.
  13. One simple SOP, which you can follow for snake rescue work, is given below. There can be an inclusion of more points depending on the situation.
  14. What I’m writing below are the ‘least’ or minimal things to follow –
  15. Identify the need for rescue  – Rescue only when unavoidable.
  16. Get acquainted with safer bagging techniques.
  17. Always work in pairs when possible.
  18. Minimize the handling of a snake; twice per snake only– once while bagging and once while releasing.  Avoid all       unnecessary handling.
  19. In case of injuries to snakes or transfers to another bag/ box, handle with care and again do it only if absolutely necessary.
  20. If the snake is fit for release, then do it without any delay (ASAP).
  21. Keep records of rescue (bagging to release) – Submit it regularly to the Forest Department.
  22. Get acquainted with First aid, and always carry a ‘SAFE SNAKES’ card which has information about the nearest hospital, relative’s number and personal details like           blood          group, past history of bites (any anti-venom   sensitivity) and if possible, contact number of some expert medical professional for guiding doctors about the latest treatment    protocol, nearest Forest Department office number & Police station’s number.
  23. To attend regular refresher’s course in identification and  rescue  techniques  (once a year – which can be     organized by inviting experts).

TO BE STRICTLY AVOIDED –

  1. Keeping live snakes in captivity  (except  for  medical treatment under notification to DCF, Wildlife Office of the respective area)
  2. Live snake shows for whatever purpose.
  3. Handling snakes when not needed.

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

http://kedarbhide.com/?p=1483

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.

Effective Snakebite Management in Himachal Pradesh

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.

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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%).

Doli ambulance in Uttrakhand pic2

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.

Boat ambulance in Assam pic3

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

Dark fairy tale stories by Ashok Captain

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.

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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:

Bungarus-which-one

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.

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Rajasthan

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.

Echis-which-one

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

Snakebite Interest Group on WhatsApp

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

 

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Chhatrisgarh1

“Halla Bol” penned by Priyanka Kadam

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:

  1. Learn to live with the elements (snakes) instead of going on a killing spree. This can be done by creating scenarios that can minimize the risk of a venomous snakebite. Eliminate micro habitats that can attract and house rodents, lizards and snakes. Avoid having shrubs in the garden close to the house, potted plants in the patio, gunny bags filled with food grains, twigs and dried cow dung cake piles(used as fuel in the villages), garbage bins and basically all things stored close to and inside houses that can be used as temporary dwellings for rodents, lizards and snakes.
  2. Reach out to the communities in the villages, towns and cities and create awareness about the venomous snakes found in their region. Discuss their natural tendencies like which part of the day / year they are most active.What is their prey base?  When do they mate as this is the time the snakes are up and about in search of a potential mate. Knowing basic facts about these reptiles can keep us out of danger.
  3. Avoid sleeping on floors
  4. Use mosquito nets that can help not just prevent malaria but also keep away snakes, scorpions, centipedes and spiders.
  5. Look before you reach out to pull out or store things in a corner. Be aware of where you put your hand and feet especially after dark.
  6. Use of torches / lanterns while venturing out after sun down.
  7. Use of proper footwear to prevent bites.
  8. Eliminate all snakebite myths plaguing the masses with science based rationality and logic.
  9. Spread the message about Snake Anti Venom (ASV) being the only treatment to cure a venomous snake bite.
  10. Spread the importance of taking a snakebite victim immediately to the nearest hospital. The first hour of the bite (referred to as the golden hour) is the most crucial in the survival and recovery of the victim.
  11. As a care giver to a snakebite victim, staying calm in a snakebite situation is important and helps the victim to relax. Do not accompany the victim to the hospital as a large group. Allow the treating doctor to work effectively and refrain from creating an emotional ruckus that can scare the doctor and refer the patient to a higher hospital. Time is of immense essence in a venomous snakebite situation. Snakebite can be managed at the tertiary hospital provided the doctors are given the space and opportunity to treat the patient.
  12. As a doctor, have confidence in your ability to treat a snakebite victim. In a scenario where the condition of the victim is deteriorating; do connect with Snakebite Healing and Education Society at 9820523297. We will connect you to an expert doctor who can provide guidance on phone. Do not refer patients without trying the first line of treatment at your hospital. In a scenario, the patient is serious and difficult to manage without life support, always prepare the referral card for the victim’s family to take along to the next hospital.  Please treat all snakebite cases on priority to ensure commencement of immediate treatment as every second matters. Treat every patient as your own and be a life saver.