Strong preparedness is required
The Nepal Weekly 
February 22, 2022
Snakebite is an occupational hazard affecting farmers, plantation workers, herders and fishermen. Open-style habitation and the practice of sleeping on the floor also expose people to bites from nocturnal snakes, with children being at a particularly high risk. In rural Nepal, snakebite is an important public health problem.
The agriculturally prosperous Terai region with hot climate, high seasonal rainfall, lush natural vegetation, high density of rodents, rich reptiles and amphibian flora make an ideal habitat for snake to live and increase availability of marshy land to undergo hibernation. The abundance of snake and human activities, mainly agriculture, increases the human – snake encounter leading to snakebite. Nocturnal snakebite is also common in Nepal due to the sleeping habit. Snakebite is a life threatening medical emergency and survival of the victims depends much on the appropriate first aid measures and immediate transportation to the nearest health centre where the facility to administer anti-snake venom and supportive care is available.
In developing countries where snakebite is mostly prevalent, traditional faith healers, snake charmers and religious practitioner called Dhami treat many snakebite victims. In rural population of Nepal, the doctor population ratio is far from accepted norms and most of the trained health workforce are based in urban areas. Therefore, the people of rural areas often seek health care from practitioners of indigenous medicine. Most of the death related to snakebite occurs before reaching the treatment centre, either during transportation or at the village. Doctors or health workers at primary care level as well as some of the district and provincial level hospital do not treat snakebite, likely due to inadequate training on snakebite management during medical schools resulting in lack of confidence on management of snake envenoming.
Every year, two million people worldwide are bitten by snakes resulting in an estimated 81,000-138,000 deaths.The World Health Organisation has added snakebite envenoming to the list of neglected tropical diseases highlighting the need for stronger epidemiological evidence in endemic countries such as Nepal.
A recent publication of The Lancet Global Health mentions that nearly 3,000 people die every year in the Terai region of Nepal. Out of the number 76% are women. The publication is the outcome of four years study on snake bite problem in Nepal. The study further says that 2018 onwards every year 40,000 persons have been victim of snake bite in Terai of Nepal. The death rate among the victims is 2,386 to 3,225.
Women are more exposed to outdoor jobs like farm work, drudgery, collection of firewood and fodders. Likewise, open defecation is another cause they meet snakes in dark or unnoticed. Moreover, the cause of death may be reduced if treatment was available on time on the spot of within a short time after snake bite.
89 snake species have been recorded in Nepal. Among this great diversity of snakes, we know with certainty of 17 species of snake that are found in Nepal and have the front-fanged type of venom apparatus and thus are considered to be highly venomous and dangerous.
The snakes do not offend humans but to be safe from any possible risks, they attack human or animals, experts explain. Snakes are normally not active in the winter days. They come out after temperature rise and also the rain water makes their nest logged. These are the causes they look for safe shelter and come near human settlements. Their favourite food is rats which they normally find in the farms. The human settlements are another good place for them to find rats. Snake bites also happen unknowingly mostly time of working in the paddy field. The victim knows lately that treatment is not possible.
In addition, in many case, poor facilities and human resource in the health posts and hospitals are not service needful to the snake bite victims. Well prepared ambulance service may save more such victims to rich well equipped hospitals on time. Similarly, people also need to be aware of avoiding snake bites and what to do after incident rather than depending on shamans.
Here we recall that reducing snakebite cases and deaths by 50 percent by 2030 is one of the Sustainable Development Goals and Nepal as the country is a signatory country to meet the target. (By : Ram Dangol)
