A crusade to prevent snakebite casualties

There is nothing quite so green as a green pit viper, so distinctively designed as a banded krait or so exquisitely patterned as the scales on the hood of a spectacled cobra. Despite the chilling beauty of these ancient creatures, for centuries snakebites have caused thousands of deaths and continue to do so.

Living in the wild jungles of Chitwan and Bardia, we rarely saw any snakes except during the monsoon off-season when they were flooded out of their homes, so mishaps were minimal. Alerted by the vibrations of our stomping footsteps, keeping well out of the way is every snake’s preferred option. But for us any close encounter triggers an instinctive frisson recoil, no doubt inherited from ancestors and honed by deep-rooted survival mechanisms. 

In Nepal we have a specially complex relationship with our serpent brethren. They are heralded in mythology, revered as powerful protective deities, valued for medicinal properties and feared as potentially lethal. They are diligently worshipped during Nag Panchami and their venom compounded into lifesaving drugs. But snakes are generally destroyed at any opportunity, even though most species are harmless and make valuable contributions to Nepal’s natural ecosystems. Of the 89 varieties found in Nepal, only 21 species are venomous.

These harmful species of vipers, cobras and kraits annually kill mainly farmers, children and villagers from rural communities in the lowland Tarai, and particularly during the hot wet summer months. In Nepal, an estimated 40,000 persons are bitten and more than 3,000 die from snakebites every year, not all of them officially reported. Worldwide, WHO estimate 5.4 million people are bitten with 1.8 to 2.7 million cases of envenoming each year.

The tragedy is that these fatalities are preventable and caused by a lack of understanding by those afflicted, often the poorest of the poor. Thousands of lives can be saved by spreading awareness about the venomous snake species in Nepal, how accidents can be prevented and the immediate steps to take when someone is bitten.

Chief of the GoN’s Epidemiology and Disease Control Division, Hemantha Chandra Ojha is a softly spoken man with a lush moustache and an infectious passion for his subject. He explains that despite a network of snakebite treatment centres supplied with antivenom, “Over three quarters of victims die before they reach help by not acting fast enough, being delayed by jhankris, lacking transport or having to travel too far.”

It was this confluence of avoidable catastrophes that first caught the attention of my colleagues at the Rotary Club of Kathmandu Mid-Town. Our member Isabella Khadka seized the opportunity to really make a difference. She has tirelessly cajoled, rallied, fundraised and inspired by leading the Rotary Snakebite Prevention Project in a four-year crusade 2022-2026 to reverse this lack of knowledge, and address this desperately neglected and preventable public health issue.

“We aim to eliminate the myths,” says Khadka. “We are using high tech social media and communication solutions country-wide to tackle an age-old problem. No one should die of snakebite in Nepal.” 

Less than two years since inception, the Rotary initiative has already reached over 25 million listeners with radio spots on 41 local FM stations, Radio Nepal and Kantipur FM discussion programmes, outreach meetings, local champions, and orientation sessions for teachers, health workers and journalists. The range of knowledge products feature vibrant Maithili artwork using five colour-coded languages (Nepali, Pashimi Tharu, Awadhi, Bhojpuri and Maithili), and include posters, social media, Facebook, YouTube action clips, training videos and the bilingual website www.snakebitenepal.org. 

Khadka has assembled a strong team to prepare the Rotary campaign, secure an international grant, and co-opt partners that include the BP Koirala Institute of Health Sciences in Dharan and Snakebite Research Centre with Prof Sanjib Kumar Sharma, Epidemiology and Disease Control Division, National Health Education Information and Communication Centre, World Health Organisation and WWF Nepal, amongst others. The implementers are Digital Broadcast Initiative Equal Access.

In 2019 a major High Level Meeting and Workshop on Snakebite was inaugurated by President Bidya Devi Bhandari in Kathmandu to seek consensus on best practice methods to tackle this issue for Nepal. Experienced global practitioners from Oxford, Frankfurt, Melbourne and India, as well as Nepal’s many expert herpetologists, endorsed the need for increased public awareness. 

Since then, collaboration has been secured from government, embassies, development agencies and NGOs as well as medical institutions, civil society and local communities. Awareness events have been conducted throughout Nepal and abroad, and most recently on 22 February 2024 in the Armed Police Headquarters in Kathmandu to update diplomats and donors. Ongoing training is given in all seven Provinces to health workers on the management of anti-snake venom and the improvement of snakebite treatment centres.

The key messages being communicated in the national awareness campaign are not complicated. They resonate from my jungle days even though I was thankful never having to cope with a snakebite emergency. Reading this might save your life, or someone else’s. 

PREVENTION STRATEGIES

- Keep your surroundings clean – snakes hide in tall grass, rubbish and firewood

- Snakes are attracted to food storage – and hidden rodents

- Beware while walking around at night - use a torch and tap the ground in front of you

- Beware while working outdoors (e.g. in fields) - use a long stick to tap the ground

- Stay away from areas where snakes might hide

- Sleep under a mosquito net to help deter snakes – and avoid sleeping on the ground

- Snakes are an important part of the natural environment.

FIRST-AID 

- Help snakebite victims stay calm - don’t panic or move the bitten part

- Do not feed the victim anything 

- Quickly transport victim to health care facility - on a motorcycle between driver & pillion rider 

- Don’t play with or touch dead snakes – take a photo to show health workers

- Use tables on the website to locate closest antivenom treatment center

- Don’t have transportation? Use website to find a health worker to advise over phone.