When there is no drug to treat the Venom

By Ronald Orachwun

Pimer Joan, a mother of four and resident of Olyeko cell, Nebbi municipality awoke around 6 am one Friday morning to fetch firewood. She tied a few ropes round her waist, armed with a machete and filled her 5 litre jerry can with clean and safe water.
That Friday in June 2020 began like any other day in Pimer’s 11 years of marriage as the sole responsibility of fetching firewood lied on her and sometimes her 7 year old daughter.
In the company of two of her other married friends in the neighborhood, they snacked on roasted cassava that she had prepared the previous day, enjoyed the cool morning air and melodious songs coming from the birds.
After about 50 minutes later, they arrived at Jukia Hill, close to 1km away from home and she began checking the pile of wood she had cut some two weeks back.
As she pushed her hand under the pile of wood, she felt a sharp pain which sent her reeling. Soon blood oozed from two puncture wounds on her hand. Below the pile of wood a thin grey snake with lighter scales round its head, presumed to be a black mamba slithered from view.
Her other friends, yelling from the bush for help with no one in sight frantically carried her back home. She was unconscious by the time they reached home.
“About two hours later due to the delay, she started vomiting”, her husband Orom John recalls. Even the colour of her eyes changed. We tried to rush her to Nebbi general hospital which is some 2km away but she died soon before we could step at the gate of the hospital”, he said.
Pimer’s story is one of those many tales that are told by survivors of snake bites in West Nile region.
Brenda Eyokia, a resident of Adalafu in Arua city is among those who live to remember the pain of being bitten by a cobra. For her had it not been for the quick rush for medical attention in the shortest possible time, she would have not lived to tell her story.
“I was bitten by a cobra. The pain was so enormous. The poison compelled me to vomit but even the vomiting was very impossible, until I was given contents of fresh eggs and cooking oil to take. They helped me to vomit with ease. Good enough I was staying near Oli Health Center IV and my parents rushed me for injections and after three injections, I came back to life”, she narrates.
Unlike Eyokia who tried both the traditional and medical assistance to recover from the snake bite, many of those bitten by snakes in West Nile prefer traditional assistance to recover from the poison.
This can be seen from the health center three levels where no statistics is computed of snake bites as victims do not want to open up. Medics believe that much as the home remedies may be helpful, seeking medical care is more paramount for the isolated snake bites. The district health officer Arua Bishop Paul Drileba has this observation.
“Anyone who has been bitten by a snake we would recommend that they go to the health facilities and then that’s where they can be referred for more help. But the community members seem to suggest by their actions that they are better managers of snake bites than any of us and that they have herbs, you have to drink milk or they give you eggs to give you relief from the venoms. But you see at the side of the snake bite there may be skin infections, which need to be handled professionally because it can lead to more infections and infections going into the blood and perhaps eventual death and the after effects of the venoms”, he said.
To the district health officer of Maracha, Dr Paul Onzubo, seeking for a better care at a health facility is the way to go. He also discourages the home remedies to snake bites.
“Those traditional remedies cause more problems to the victims. Let alone the black stones that people apply to the site of the bite. Or even tying the coin at the site of the bite as well. If it’s the leg or the arm people tend to tie the coin at that same spot. Now if a poisonous snake bites you, you will only concentrate the snake on that part which was bitten and now there is a possibility that that part will die. And now assuming that the person was bitten at the neck, will you also tie the neck of that person? That is the biggest question people will never give us an answer when we ask”, he said.
A study by the Health Action International and Coalition for Health Promotion and Social Development HEPS in April 2018 found that snakebite and snakebite envenoming was a serious public health problem in 144 health facilities.
A total of 12,479 cases of snakebites were registered in one year though experts thought the study’s findings were an underestimate.
Arua and Yumbe in West Nile, Gulu, Kampala and Mubende are the most affected with snakebites.
Another study by Makerere University School of Public Health showed that out of 1,080 households enrolled, 341 had had a case of snakebite. Among the 6,600 members in the 1,081 households, 441 had ever been bitten by a snake.

Who are at risks?
Most African snakebite victims are farmers who work in remote fields barefoot or in sandals, making them particularly vulnerable. Once a venomous snake strikes, a race against the clock begins. Transport to the nearest hospital can take hours, even days. By then it may be too late.
The venom of elapids, a family of snakes that includes mambas and cobras, can kill within hours. Their neurotoxins rapidly paralyze respiratory muscles, making breathing impossible. The venom of vipers, however, can take several days to kill, interfering with clotting and leading to inflammation, bleeding, and tissue death.
Once the victim is at a treatment center, survival depends on two vital points: Is a reliable anti-venom available? And if so, does the medical staff know how to administer it? Often in sub-Saharan Africa the answer to both is no.
Some people aren’t taken to a hospital at all. Families may seek help instead from a traditional healer, who may apply leaves or ash from burned animal bones, or tie a tourniquet around the bitten limb, which can dangerously restrict blood flow.
Some botanical treatments do ease pain and reduce swelling, but they can’t save a victim’s life.

First aid for snake bites
It should be emphasized that black stones have no place in the medical management of snake bites. The primary aim of first aid is to delay the absorption of the venom into the body, and to prevent life-threatening complications.
It is also important to note that 70 per cent of the bites are by non-venomous snakes. Another 50 per cent of these bites are described as dry bites, meaning that they do not have poison in their fangs.
Therefore, when a person is bitten by a snake, the affected area should be immobilized, and the victim taken to a health facility as soon as possible. Traditionally, first aid includes making incisions on the affected are, sucking venom out of the wound, and using bandages around the wound.
However, health experts say these should be discouraged because they have not been proven to be of any health benefit.
Also, any interference with the wound introduces infection, causes bleeding and also increases absorption of the venom. It would be helpful if the snake that inflicted the wound is also carried to the hospital, as this will aid the health workers to choose the most effective antidote.

Hope of any anti-venom?
According to experts, lack of anti-venom production in Uganda leads to absence of safe, affordable and effective anti-venom for snakebite management at the health facility level.
Availability of anti-venom in Uganda is highly ineffective. Besides, a vial costs around 800,000 shs, making it very difficult and expensive to afford proper treatment, which usually requires at least a minimum of six vial, costing around 4.8 million shs.
In 2017, the World Health Organization recognized snakebite as a neglected tropical disease.
In Sub-Saharan Africa, over one million people are bitten by snakes every year, with the vast majority of these concentrated within the rural settings, where access to health care services is limited.

Sigh of relief.
Government through the Ministry of health has already developed a snakebite prevention and management strategy to address snakebite envenoming in Uganda. The aim is to halve the number of deaths, mobility and cases of disability caused by snakebite envenoming.
Dr. Alfred Mubangizi, the assistant commissioner in-charge of vector control Ministry of health while presenting the strategy during a multi-stakeholder forum in Kampala recently said the strategy will address the challenge of snakebites in the country.
It has four main objectives; empowering and engaging communities, ensuring safe and effective snakebite treatment, strengthening health systems and increasing partnership, co-ordination and resources.

COVER PHOTO: Snakebite first aid. Experts warn against unnecessary movement when bitten by snakes.