Odisha Review April - May - 2014 A Way to Solve Snakebite Problem in Odisha and India Dr. Indramani Jena Odisha is one among the snakebite prevalent states of India : total 600,000 to 1600, 000 cases of with large number of fatalities. Here, not only the bite and 11,000 to 25, 000 deaths due to snakes. rural and agricultural preponderance contribute This is due to tropical climate, agricultural and to high mortality, but the lack of prompt forest based profession and many social factors. ambulance service and loss of golden period of The American Society of Tropical Medicine and treatment is spoiled by resorting to traditional Hygiene are quoting still very high figures from methods. Technically, major burden of the India: 46,000 people dieing every year from problem can be solved by 108 ambulance services snakebites against the official figure of only 2,000.3 for transport and Anti Snake Venom used Lack of direct statistics of snakebite is due to judiciously in time, but inherent delay in multitude of factors like biting snakes, transporting the victim due to prevalent predominance of night time bites, hesitation of sociological milieu is a hurdle in this direction. people to notify a bite. There is necessity of motivation in snakebite But it is a fact that snakes and snakebites prevalent areas through health education by regular are reducing in number due to pesticide use, health workers, PRI representatives and voluntary urbanization and deforestation. Evidences of agencies. Time, transport and therapy will snakebite attendance in medical centres at present remarkably reduce the alarming incidence of and revealed figures given by newspapers now a snakebite in the tropical environment. day are definitely reduced to some extent Let us examine the feasibility of this idea compared to figures of a decade back. The faster from technical angle. urbanization and deforestation is a way definitely to reduce snakebite substantially, yet total Introduction: reduction cannot be thought of in such a tropical climate. Exact figures of snakebite and snakebite deaths are not known in Odisha and India. It is Certain Issues estimated that 2500 to 6000 cases of snakebite HIGH INCIDENCE: occurs in Odisha and out of them, 400 to 900 cases die (around 1000 snakebite deaths per Snake scare stalls Odisha Assembly. 4 annum in Odisha)1,2 . Similar figure is seen in whole Peculiarly, the Odisha Legislative Assembly came 60 April-May - 2014 Odisha Review to the horror of harbouring a snake, when it was with another species of cobra, called Monocled suspended for some days and started functioning Cobra (Tampa Sapa in Odia). These are very under vigilance of Snake Help Line, Bhubaneswar dangerous snakes as they have a habit of residing and with presence of an emergency physician with around human habitations, paddy fields, bushy enough stock of antivenom. The appearance of forests both in rural and even urbanized areas of snakes has recurred time and again in Odisha Odisha. Legislative Assembly even in present year. Every monsoon turns Bhubaneswar into a ‘city of The pathetic story of cobra is its venom snakes’ and large population of cobras (Naga capacity and killing capacity. A single bite of cobra Sap) exist in surrounding areas of residences in contains venom capable of killing 15 to 20 the capital city. 5 Raj Bhavan officials were on their persons. When 13 mg of venom is fatal for an toes, when a rat snake was found in the VVIP average weight man, it can inject 12 to 20 times suite which was to be occupied by President such dose and that is why serious cobra bite cases Pranab Mukherjee during his second visit to may not reach hospital within one hour. But luckily Odisha on September 6. 6 such cases are very few and may be 2-3 %. Krait bites often outnumber cobra bites and krait can Capital Hospital in Odisha is a figurative inject larger than fatal dose in successful bites. hospital like S.C.B. Medical College for good Banded Krait (Rana Sap in Odia) bites rarely and catchment of snakebite case. There are 4-5 it is to be noted that Indian antivenom has no snakebite predominant coastal districts. Presently neutralizing effect in this snakebite. Large number Capital Hospital7 records a number of snakebite of Russell’s Viper (Chandan Boda Sap in Odia) cases. bite cases come with severe local pain at site of BITING VENOMOUS SNAKES OF bite with bleeding from the site, with bleeding from ODISHA1: gum margins. Sometimes the non-poisonous snakebite (Pond snake and Rat snake bites) Common Indian Cobra (Naga Sapa in causes alarm reactions in a patient like palpitation, Odia) is found in large numbers in Odisha along restlessness and fear, but this is of no significance on mortality point of view. Table showing details of Biting Snakes in Odisha1 Snake Fatal Dose Venom Symptoms and Later Complications Deaths Variety of venom store time sequence (mg) (mg) Cobra 15 150-300 Small local swelling Local necrosis and 50 % [Naga at site of bite; within sloughing of skin SapTampa two hours drooping taking months to heal Sap] of eyelids, salivation, air hunger, confusion, delirium and respira- tory failure 61 Odisha Review April - May - 2014 Common 10 5-20 Negligible local Negligible 40 % Indian mark; develops Krait[Chiti drooping of eyelids, Sapa] salivation and air hunger; terminally respiratory failure Banded 10 35-50 As Common Indian Negligible ~ Krait[Rana Krait Sap] Russell’s 42 120-250 Local swelling and Prominent local 3-% Viper bleeding, Bleeding swelling and usually [Chandan gum, blood in sputum it heals after one Boda Sap] and urine; kidney is or two weeks; affected and urination rarely local sloughing stopped. seen Rat 0 0 Scratch only Nil 0 % Snakebite [Dhamana Sap] Pond 0 0 Scratch and local Nil 0 % Snakebite injury only [Dhanda Sap] The following are snakes of medical importance in Odisha, 95 % of deaths due to snakebite are due to these species1. Spectacled Cobra (Naga) Monocled Cobra (Tampa) 62 April-May - 2014 Odisha Review Common Krait (Chitti) Banded Krait (Rana) Russell’s Viper (Chandan Boda) Russell’s Viper (Chandan Boda) Pond Snake (Dhanda, not poisonous) Rat Snake (Dhamana, not poisonous) 63 Odisha Review April - May - 2014 FATAL COBRAS: TIME RESTRAINT : Fatality in cobra bites is astonishing. Time is a great factor in the cure of Cobras abound in rural as well as urban areas. In snakebite. The largest venom dose of any snake the city of Bhubaneswar, this species is can be neutralized by antivenom. Simply to encountered frequently. Severely envenomed illustrate, it can be said that injection of a mix of cases are few among such bites, very short time this venom and equivalent antivenom has no effect at hand due to very quick spread of venom in on experimental animals. Then, where is the human system and affecting nerve mechanism of difficulty in curing a cobra bite? respiration and rapid onset of death debars cases People spoil time in reaching the hospital. in receiving treatment. Cases with moderate and They spend minutes in ignoring the gravity of mild envenomation can avail benefits of therapy. snakebite, search a local traditional healer; even The author has encountered at least 10 cases of today, rural people carry the victim to Lord Siva’s cobra bite, where the patient succumbed within temple to pour water on the head. 45 minutes of bite where reaching at nearest hospital was not possible after known cobra bite. All methods of first aid have been proved Few cases, which were alert from the moment of to be ineffective in snakebite except cobra bite, could be saved with right treatment in immobilization of the victim, i.e. minimum time. movement of the bitten part so that venom will be confined to the local site of bite longer than if the FATAL KRAIT : part is moved or patient walks or runs when blood Krait bite is frequent in villages and danger circulation will hasten venom entry to blood and for residents of thatched houses. Common Indian brain. Krait (Chiti Saap) lives very close to human FALSE BELIEF THAT A SNAKEBITE habitation and beyond our imagination the CASE DIES DUE TO FEAR : innocent looking krait of the day becomes active, agile and aggressive bites viciously in winter nights. Snakebite is quite alarming, never kills a The bite is small, a man in sleep cannot trace and person due to fear. This blind belief often reduces signs of fatality appear when the person awakes. the gravity of poisonous bite and allows undue delay in deciding whether to rush to hospital or SERIOUS RUSSELL’S VIPERS : make dilly dally by consulting a local traditional Typical Russell’s viper bite occurs by healer. walking over the snake and this poisoning is CULTURAL PRACTICES IN RURAL associated with bleeding and thinning of blood ODISHA : resulting in bleeding disorder. Occasionally the snake spontaneously bites without provocation. Number of cultural practices enhance This snakebite is easy to grade, follow up and snakebite mortality. Any movement or exercise cure compared with treacherous krait bite and of the victim after the bite is very harmful. I am dangerous cobra bites due to slower process of shocked to say that some snakebite victims are envenomation. Blood can be tested in simple forced to swim, if they are capable, to cure manner hourly. Venom that enters slowly from snakebite. This is extremely dangerous and will site of bite to circulation and consumes clotting land in fatality quite early. Any delay in reporting elements can be neutralized by antivenom. at treatment centre is a technical crime. Worship, 64 April-May - 2014 Odisha Review making a phone call to somebody who will pray of ambulance is a great asset to think of god, pouring water over head of the victim in front transporting a victim to treatment centre in time.