The snake bite emergency

It was a rainy night in August, 50 years ago, in our ancestral village of Balara near the Indian border. Because of the monsoon, our village was surrounded by flood waters. 

I vividly remember my grandmother Sharada Devi picking me up, and putting me to sleep on the bed. Waking up the next morning, I learnt that she had been bitten by a snake, and a porter had carried her in a bamboo basket across the Bagmati to a shaman.

She died on the way.

That bereavement at a young age left a wound that is still fresh. Even after half-a-century, the trauma of snakes has not left me. Many thousands of Nepalis die every year because of lack of timely treatment for snake bites.

The Tarai presents an ideal habitat for venomous snakes, and during the monsoon they come out of their flooded hideouts to enter homes and fields. The monsoon is also when there are more farmers out and about for planting, exposing them to the danger.

Snake bite has been such a clear and present danger to life in Nepal’s southern borderlands that during the many festivals this season, stories are told of people who have survived snake bites because of their devotion. 

There are Maithili folk songs that pray for the welfare of snakes, but also plead for divine protection from snake bites at night, so they can wake up alive in the morning. 

The traditional occupation of the Natuwa people is of snake charmers. They used to travel from village to village blowing on a flute-like instrument, making a captive cobra sway and dance. 

The Natuwa can be Hindu or Muslim, and are also called upon when a venomous snake is found inside the house. Some earned the reputation for being quacks because of their ineffective and fake treatment of snakebites.

Mobarak Miya (below) lives near Simara, and shows a round wooden box in which he used to keep his dancing cobra. 

“Nowadays snakes are a protected species and the law does not allow us to keep them, but we had a charmed life as snake charmers,” recalls Miya, who now does day jobs to earn a living.

For a hazard that claims thousands of lives every year in Nepal, there are no reliable estimates of fatalities from snake bites. Awareness is lacking about distinguishing between venomous and non-venomous snakes, or what to do if bitten. Snake bites are treatable, but health posts lack adequate anti-venom vials.

About 10 people every year are killed by tiger or wildlife attacks, but those get much more media attention than the estimated 40,000 snake bite cases a year in Nepal and the 3,000 fatalities that result from them.   

As with everything else, it is the marginalised communities which are most exposed to the risk. Tarai Dalits, who spend more time outdoors in the fields and live in flimsy mud and thatch houses, suffer disproportionately. 

With federalism, rural municipalities should be taking a more proactive approach to supplying antidotes to their health posts and spreading awareness. But this is not happening.

Statistics from existing health posts that administer antivenom show that many victims are from across the border in India. This proves that northern Bihar also suffers from the same risk and lacks treatment. The role of local FM radio in spreading awareness has transboundary importance because these stations have a considerable listenership in India. 

Tarai families are more exposed to the risk because most of Nepal’s venomous species are found in the plains. But in addition, unsafe housing, flooding, paddy plantation and harvest, grazing livestock, open defecation, and sleeping on the floor are added risk factors.

Researchers at BPKIHS in Dharan showed in a pilot in four Tarai villages that a Motorcycle Volunteer Program to rush snake bite victims to health posts saved lives. There used to be about 500 snake bites per 100,000 population with a 10% fatality rate in the sites, but after the experiment, only 0.5% of the 315 cases were fatal.  

Snakes kill and maim the poorest Nepalis, which may be why the state is not so bothered, and there is a direct correlation with unsafe housing, lack of education, and quality health services. 

The snake bite emergency is as serious as ever. It could be that agriculture, pesticide use, urbanisation, infrastructure has forced snakes out of their habitat. Climate breakdown, heat stress, and floods could be making human-snake contact more probable.   

Whatever the cause, I lost my grandmother and many Tarai households lose family members every year. Nepal has had multiple governments in the past three decades, and two elections under the federal system that were supposed to provide accountable local governance. 

But the menace of snake bites remains an emergency.  

Chandrakishore is a Birganj-based commentator who writes this monthly column Borderlines for Nepali Times.