Aaron Albert Tsatsi Professional Speaker, Conservationist & Professional Snake Handler  To provide the Members of Ntlo ya Dikgosi with knowledge, skills, and the right attitudes necessary for them to correctly identify, control, relocate and conserve snakes in their respective areas. At the end of the presentation, Members of Ntlo ya Dikgosi should be able to: • Explain the relationship between snakes and environment. • Classify and identify snakes • Differentiate between venomous and non venomous. • Ability to safe handle snakes. • Ability to apply first aid skills on snakebites.

Members should appreciate that snakes like any other creature have a positive ecological and social role to play, as well as instill positive attitudes about snakes to their local communities.  In the world. • 3,500 known species of snakes in the world, only 200 are lethal to humans

 Botswana • 67 Species and sub species of snakes, only 7 are lethal to man. These are: Puff adder, Mozambique Spitting cobra, Black Mamba, Cape Cobra, Snouted Cobra, Boomslang and Vine Snake.

 Adders: Adder venom, causes local tissue death. This results in massive local swelling and a lot of pain.

 Cobras and mambas: These snakes have venom which causes muscle paralysis, which means that the person cannot breathe, and their heart cannot pump. The venom usually takes effect within half to one hour.

 Boomslang: This is a rare bite. The venom will cause severe generalised bleeding within 48 hours.

. Snake venom is designed to imobilise or kill the prey, digestion and protection.

. Venom can be injected by bitting or spatting.

. A few precautions can be taken to minimise the risk of accidental snake bites. They include:  Snakes may enter the house in search of food or to find hiding place for a while. Do not keep livestock, especially chicken in the house, as snakes may come to hunt them. Store food in a rat proof container. Do not sleep on the ground. Before looking at ways to prevent snakes getting into the farm, compound or garden you should ensure that the surrounding area is not a haven for snakes to take up residence because they would then be much more likely to make their way into any building you may have. . Long grass is a favoured habitat of snakes so keep yours well mown.  Keep shrubs trimmed round their base and away from the office.  Ensure that branches of trees do not overhang your office or seating areas in your substation.  Stack your fire woods on a suitable platform-such as a pallet-off the ground.  Regularly sweep up leaves and other gardens debris.  Fill gaps, cracks and crevices in brick and stone walls.  Drivers or cyclists should never intentionally run over snakes on the road. The snake may not be instantly killed and may lie injured and pose a risk to pedestrians.  The snake may also be injured and trapped under the vehicle, from where it will crawl out once the vehicle stopped.  The above recommendations for preventing snakebite can be disseminated for national or local use as guidelines, training modules, leaflets, video clips and posters that can be displayed on the walls of hospitals and clinics waiting areas for the attention of patients and their families.  Dramas and wellness events to portray snakebite scenarios.  Media such as TV and radios can be used for health promotions and advantage can be taken of FM radio ins to publicise the problem.  What happens in snake bite?

 About 20 percent of bites by venomous snakes do not result in venom being injected.

 In the rest, the severity of the reaction to the venom depends on many different things:

 The age of the person  The general health of the person  The size of the person

Related to the snake:

 The species of snake  The condition of the venom glands  The condition of the fangs

 The number of bites  The location of the bites  The depth of the bites  The amount of venom injected

The speed and efficiency of the initial treatment of the bite is also important in determining the outcome of snake bite.

Getting the patient to medical help is major priority.

WHAT TO DO:

• Get everyone well away from the snake. • Get medical help as soon as possible. • Try to obtain a clear description of the snake. However, this isn't essential, and you shouldn't waste time looking for it. The symptoms will give the doctor a good idea of the kind of snake (neurotoxic etc.), and the severity of the bite. • Stay calm, and reassure the person who has been bitten. Fear and anxiety cause an increase in heart rate, and thus a more rapid spread of venom throughout the body.

• For neurotoxic and haemotoxic snake bites, it may help to wrap a crepe or pressure bandage firmly around the area of the bite, covering the entire limb (from fingertip to armpit; from toe to groin). Apply hand pressure at the site of the bite until a bandage or strips of fabric can be obtained.

• Keep the person as still as possible and immobilise the affected limb by binding splints (e.g. straight branches) to either side of the limb. Keep the affected area lower than the heart if possible. • If a snake spits into someone's eyes, rinse with large amounts of water, preferably by holding the head under a running tap for about 15 minutes. This will also require treatment at hospital: a drop of antivenom is placed in the eye. • Observe the person closely and record any symptoms and the time taken for them to appear. • If the patient stops breathing, you will need to breathe for them until they can get expert medical help. WHAT NOT TO DO

 Don't use antivenom except in a hospital environment. Some patients react against antivenom and may go into anaphylactic shock, a serious condition that requires emergency medical treatment. Antivenom also needs to be kept refrigerated, injected correctly (into the bloodstream, not the muscle, and not into the bite site), and given in sufficiently large quantities to be effective.  Don't cut and suck the wound, or use suction cup devices or electric shocks

WHAT NOT TO DO

 Do not apply tourniquet

 Do not use ice or very hot water.

 Do not give the victim alcohol.

 Do not inject antivenom randomly.

The majority of patients cannot correctly identify the snake even with the help of pictures.

Because of this Dr Blaylock divided the snakebite victims into the following 3 groups according to the clinical picture at presentation:

• Painful Progressive Swelling (PPS) • Progressive Weakness (PW) • Bleeding (B)

 The management of the cases and the dosage of antivenom will be according to the discretion of the treating physician and the institutional snakebite management protocol.

Venom type Cytotoxic Neurotoxic Haemotoxic

Mozambique Black Mamba, Boomslang, Snake species Spitting Cobra, Cape Cobra, Vine/ Twig Puff Adder Snouted Cobra Snake

First Aid Techniques First aid should be focused upon transporting the patient to the professional medical assistance. Do not try to catch the snake for identification.

Painful Progressive Progressive Dominant Clinical Bleeding Swelling Syndrome Weakness Presentation of Syndrome (B) victim (PPS) Syndrome (PW)

Antivenom type Polyvalent Polyvalent Monovalent  All snakebite victims should be hopitalised for at least 24 hours.  Symptoms and signs of severe local or systemic envenomation occur sooner in children than in adults due to a higher venom concentration.  The same amount of antivenom given to children and adults.  The venom from baby snake is just as lethal as that of the adult snakes.  The severity of the signs and symptoms and rate of deterioration of a victim, depends on the amount of venom injected during the bite and bite site.  The closer the bites to the heart the faster the signs and symptoms will appear.  If the venom is injected directly into the vessel, rapid deterioration in the victim’s condition may be expected.  Snake-bites are well-known medical emergencies in many parts of Botswana, especially in rural areas. Food producers who work on plantations, mines, agricultural farms and children are the most affected. The incidence of snake-bite mortality is particularly high in Northern part of Botswana where there a lot of rains during summer time.  Snake antivenom provides a specific lifesaving measure. The current annual need for the treatment of snake-bite envenoming amounts to 10 million vials of antivenins. Unfortunately, the present worldwide production capacity is well below these needs. This trend needs to be reversed through concerted actions by national, regional and world health authorities and manufacturers and through effective public – private partnership.

. The prevention of mortality and morbidity depend upon availability of antivenom in the health facilities in these settings and their rational use. Mechanisms need to be developed to ensure access to antivenom by all needy patients. The health system needs to respond to this challenge and logistics must be put in place to ensure timely availability of antivenom at the point of use.

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