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