This is the story of an unfortunate 10 year old boy, Imran S.K. Imran was the son of Moslem S.K., a poor farmer from Sikarpur village, under Bewa Gram Panchayat, Police Station & Block Farakka, District Murshidabad, West Bengal. He had 7 siblings and his father struggled to feed the family from the produce grown on the small tract of land he possessed. Imran was bitten by a venomous snake around 11 a.m. on 15th Oct 2015.
The family elders, being illiterate, resorted to faith healing by a local healer. When it became evident that the child’s condition was deteriorating, Imran’s father took him to the Beniyagram BPHC (Block Primary Health Centre). The staff there referred Imran (without treating him) to Dhuliyan Central Hospital (DCH) (a Central Govt Hospital for Bidi workers) at Tarapur, Shamsherganj, Dist Murshidabad. The child was brought to DCH 24 hours after the bite. His left foot had progressive swelling.
It was 10.30 a.m. 16th Oct 2015. Dr Saswati Naskar was the Medical Officer at DCH and attended to Imran in the OPD (Out Patient Department). She performed the 20WBCT (whole blood clotting time) test. The blood didn’t clot in 20 mins. This was a sign of a viper (hemotoxic) envenomation.
DCH is a hospital only for bidi workers. The general public is not treated there. The hospital also had no facility to treat snakebites. Dr Saswati further referred Imran to Jangipur sub-division hospital where Imran finally got his first dose of antivenom (10 vials) after almost 30 hours after the bite. Doctors at the Jangipur sub-division hospital further referred Imran to Murshidabad Medical College & Hospital at Berhampur, 40 KM from Jangipur. By this time Imran was heading towards renal failure. The hospital had a dialysis machine and conducts dialysis through the Public Private Partnership (PPP) with 10 beds kept for this purpose. Even though the facility was available at the hospital, the staff referred the patient to a Kolkatta hospital. The reason given was that the hospital didn’t have care facilities for children.
Moslem was asked to shift Imran at 10 p.m. in the night. Kolkata is approximately 200 kms away from the Murshidabad Medical College. Moslem SK did not have the finances to afford the trip and treatment. Heart broken, he decided to take his son back home.
Murshidabad is situated on the border of West Bengal and Jharkhand. There was a local faith healer in Talbehera village of Jharkhand. Frustrated at not getting treatment at the Govt hospitals, Moslem SK chose to take his son to this healer. It was evening of 17th Oct and Imran was by now very critical.
Meanwhile Dr Saswati Naskar from the DCH hospital was concerned about the boy not receiving proper treatment. She therefore brought this case to the notice of Dr Dayal Bandhu Majumdar who is the points person in West Bengal for Snakebite Management Training for doctors. Dr Dayal shared this information on the Snakebite Interest group on Whatsapp. This group has doctors, herpetologists and social workers working as a team to mitigate snakebite. Soumya Sengupta, a teacher from Bankura, West Bengal picked up the information and started following up with Imran’s family. Soumya collected the contact number of the BDO (Block Development Officer) of the Farakka Block and requested him to intervene. Dr Saswati called Imran’s family a couple of times as well. The stress of a child being critically ill and people repeatedly calling the family made the family provide wrong status of Imran’s health. In the meantime, the WhatsApp group made all arrangement at NRS Medical College, Kolkata for treatment of Imran.
Priyanka Kadam who runs Snakebite Healing and Education Society got involved at this point and Soumya and she started repeatedly calling Imran’s father to coax him to take the child back to the hospital. Imran was showing signs of renal failure with progressive swelling. By midnight, Imran breathed his last and he was buried as per Muslim custom in the early hours of 18th Oct 2015.
Priyanka called Moslem’s phone at 8 a.m. on 18th Oct and was informed by a relative about the boy’s death. It was a huge failure of the medical system to see a patient being taken out of hospital and back to a faith healer. A poor farmer had lost his child after running to 4 different hospitals in search of treatment.
The State of West Bengal gives Rs 1 lakh as ex gratia payment to the family of a dead snakebite victim (W B Govt Order No. 1561, Dated: 19.8.2009).
However, in this case, no death certificate was issued and no post mortem was conducted. Imran’s family had not even informed the local police of his death due to snakebite.
The Joint Secretary to the Government of West Bengal vide order number 1561 (19) F.R/4P-3/04 dated 19.08.2008, had waived off Post Mortem report for payment of ex-Gratia in case of death due to snakebite. Armed with this order, Priyanka approached the village Pradhan, Smt Munni and the BDO of Farraka to order a police investigation on the cause of death of Imran S.K. and use the report as supporting evidence to waive requirement of post mortem report to apply for an ex gratia payment to Imran’s impoverished family. Imran’s father was afraid the authorities would exhume his son’s body. He therefore avoided any official interference.
It took many calls to motivate the people on the ground to help with filing the request for ex-gratia payment. The application was filed in Nov 2015 and finally came through in June 2016. The collective efforts of Dr Saswati Naskar, Dr Dayal Bandhu Majumdar, Soumya Sengupta and Priyanka Kadam ensured the distraught family got some relief from their debt ridden existence.
This is a small victory against the challenges that the snakebite mitigation issues face regularly at multiple levels. Unless the Health & Welfare Ministry recognizes this as a tropical disease with a serious health care concern, many more Imrans will die of a condition that could be easily treated at a BPHC (Block Public Health Center) level where treatment is available free of cost for all in WB.
To sum up, a simple calculation may encourage Government officials to feel the importance of “Treating a Snakebite case at a BPHC level” – ten vials of ASV, which costs five thousand rupees at Govt rates, at Beniyagram BPHC could have saved the Govt Rs One Lakh which was given as ex-gratia payment. Most importantly, a precious life got snuffed leaving the victim’s family distraught.
The efforts of all concerned in this story is to ensure a timely treatment of all snakebite victims. We aspire for a stage when no one has to claim ex-gratia for a dead family member.
Written by Priyanka Kadam (with inputs from Dr Saswati, Dr Dayal Bandhu Majumdar and Soumya Sengupta).
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
Joydev Mondal, resident of Basanti, Canning Sub Division,South 24 Parganas district of West Bengal was a snake rescuer representing the Juktibadi Sanaskritik Sanstha (JSS), Canning. He died of snake bite on 18 April 2014 at the Gosaba Village Health Centre. He was thirty-five years old, married with two children – a son and a daughter. The younger child was barely two years old when he died.
Joydev was a popular figure locally. He had worked with the JSS for twelve years and had saved the life of many a snake bite victim by taking them to hospitals and not letting them go to local faith healers. This includes an incident when he had taken two children who were snake bite victims to a hospital, something which had endeared him to the entire community.
On 17th April 2014, a day before his death, Joydev had rescued 2 Juvenile Spectacled Cobras (Naja naja). On the fateful day, he was bitten while showing the snake to a forest official. He had caught one of the juvenile snakes by the tail and being small in size it turned back and bit him. Inspite of being an expert Joydev had committed a fatal error – he had forgotten that a juvenile snake being small in size can easily reach near its tail area. Initially Joydev ignored the bite as it was a slight scratch. On the advice of a few well-wishers, he proceeded to the Gosaba Health centre which was on the other side of the river. Precious time had elapsed as he had to wait for the local ferry etc. On arrival, Joydev was administered 20 vials of ASV. A supporting drug, Neostigmine which is supposed to be supplied by the government to every govt hospital and costs somewhere around 10 to 14 rupees was out of stock.
Members of JSS collected Neostigamine from Canning hospital and hurried to Gosaba. But before they could cross the river to Gosaba, news came in of Joydev’s death. As per newspaper report, Dr Samar Roy from Canning hospital and Dr Dayal Bandhu Majumdar both snakebite expert doctors in West Bengal claim that if Neostigmine had reached on time Joydev’s life could have been saved as it would have helped reverse the neurotoxic symptoms (nerve paralysis) due to the Cobra bite.
Point to be noted here is that a Govt. Hospital located at may be the most snakebite prone area of West Bengal did not have the essential drug. The doctors on the ground did not check on this essential life saving drug inventory. According to Dr Majumdar the total cost of vials of ASV used in this case was Rs 8,000 (Rs Eight Thousand) but the Neostigmine injection costed a mere Rs 14 (Rs Fourteen). To add to this, the health care personnel were not able to intubate Joydev and he finally died due to airway obstruction with mucus secreted from the respiratory tract. If Joydev was resuscitated with an ambu bag or life support system at that point, he would have had a better chance of survival.
At the end of it all we have the sad case of a young man dying in the prime of his life due to an act of carelessness on his part and highest level of inefficiency of the government rural health centres who do not take the treatment of snake bite with the seriousness that is needed. An ambu bag which is an affordable equipment and can be manually operated or a portable life support system could have helped save Joydev’s life.
His wife must wonder every day whether it was that difficult to save her husband. Joydev’s children lost their father as toddlers. A whole family’s life changed forever due to this unfortunate incident.
Written by Dev Kumar Vasudevan & Priyanka Kadam with inputs from Dr Dayal Bandhu Majumdar, Dr Samar Roy and Prabhudan Haldar (A retired school teacher from Basanti, WB).