JIST

Snakebite awareness as a part of social toxicology: a long way to go

Dr Anand Mugadlimath, Dr Mandar R Sane

Monsoons (June-July) are the time when snakes come out - to play, hunt and mate. Their dens being flooded, they seek refuge in dry patches where often the reptiles’ cross paths with humans, resulting in snake-human conflict & a season of fatal snakebites every year. This is on one side; on another side, snakes are needed to maintain biodiversity and save our grains from the ever-increasing rodent population in the agricultural field. 

With 2.8 million snakebites a year, under-reported and inadequately treated, fatalities in India are estimated at close to 50,000 a year, the world's highest. Around 1.2 million snakebite deaths occurred from 2000 to 2019 in India.[1] Out of these, very small proportion of snakebite cases were managed at government hospitals as the majority of the patients were attended by traditional faith healers.[2] Rampant myths, superstitions, loss of post-bite time at traditional faith healers and lack of awareness of snake bites are the potentially preventable causes of fatalities due to snake bite. Similar death occurring due to myth related to snake calls for the discussion on occasion of International Snake awareness day.

Recently, on 24^thJuly 2021, to be specific, a postmortemexaminationwas conductedon 24 yrs old male hailing from a rural area with an alleged history of snakebite. On examination, multiple bite marks were seen on his left forearm;an enquiry about the incident following history was given. According to the relatives, the deceased was said to possess mystical powers due to the presence of "Garuda Rekha" (eagle sign) in his hand, and they believed that snakes don't bite him, even if bitten venomcan't act on his body. Corroboratively, he has helped to move away from snakes on a couple of occasions, merely by his presence as per the villagers. 

In the present incident, when the snake didn't move despite his presence, due to peer pressure (everyone assured him as he has garuda rekha, it won't bite, even if bitten venom can't act on his body), he caught the snake with bare hands and wanted to throw it quickly. However, in that fraction of a second, the snake coiled around his forearm and started inflicting multiple bites, somehow he managed to throw the snake, which was later killed by others.  Few learned persons in the village warned him to go to hospital and get treated immediately, but the deceased outrightly rejected the request and went to his field for work, only to be discovered by the neighbours in gasping condition after a couple of hours.

From the above, we can say that antidote availability is not the only solution to snakebite envenomation but creating awareness about the snakebite and human-snake encounters is more important, especially in the rural setup. We can add a new frontier in toxicology, that is, Social-Toxicology to deal with educating laypeople about the basics of any toxicological emergency and to alleviate the myths related to toxicology, the effect of which are more toxic than the toxin itself.

Following are the list of myths and misconceptions related to snakebite related to first aid & treatment.

Myth: Persons born with "Garuda-Rekha" have inborn immunity towards snake venom, and snakes get scarred by their presence.

Fact: There is no such protection; every human being is equally susceptible, snakes are very reticent and shy away when anyone (apparently with or without garuda-rekha!) approaches them.

 

Myth: Worshiping snakes or keeping fast in the name of snakes protect humans from any

deleterious effect of snake bite/venom.

Fact: On a lighter note, these practices might save a person from non-venomous snake bites, not venomous ones!

 

Myth:  In the case of snake bites, visiting local traditional healers helps inavoiding the ill effect of venom, and this must be done before taking to modern medicine, otherwise it won't act.

Fact: All the traditional remedies are useless, and golden hours should not be wasted running behind these.

 

Myth: Mongoose is immune to snake venom because they eat some leaves & roots of a specific tree to safeguard themselves fromthe lethal effect of snake venom. Humans can also develop such immunity by eating special leaves & roots.

Fact: This is false; the mongoose is safe because it avoids getting bitten bya snake in a close fight due to its inherent quick & swift reflexes.

 

Myth: Snake does not bite persons with leprosy/ vitiligo; the venom does not affect if a bite occurs

Fact: Only humans can make such discrimination. Snakes act at the spinal level and don't make such differentiation.  

 

Myth: Applying 'Nagmani' (Snake-gem) or rubbing extract of some herbs at bite place

has anti-venom action.

Fact: As told earlier, it's futile to make such conclusions. Appropriate first aid and early hospitalization is going to save person’s life, and notany such activities

 

Myth: Branding with a red hot iron at the bite place is best first aid, or anal opening of the chicken can be applied to the bitten area; it can suck venom from the tissues.

Fact: Branding is a not only useless but extremely harmful practice to do. The second myth in this is hilarious of all and equally illogical as other myths.

 

Myth: In case of cobra bite, victims should not be allowed to close their eyes; they must be kept awake by any means (including arranging folk-dance and orchestra!)

Fact: Victims of cobra bite suffer from drooping eyes, which should not be confused with sleep or drowsiness. The best way to save at this time would be to shift the patient to a tertiary care hospital at the earliest, where ASV & ventilators are available.

 

Myth: A person bitten by a snake feels that neem leaves or chillies taste sweet. One must go to a hospital if the bitten person eats green chillies like cucumber or carrot!

Fact: There is no way a person would eat chillies like cucumber/ carrot in case of a venomous snakebite. One should not waste valuable time in such ridiculous experiments.

 

Myth: In the case of a snake bite, the snake must always be killed and presented to the treating doctor for identification.

Fact: ASV is like a universal antidote irrespective of the type of snake in the Indian scenario, and there is a high probability of secondary victims when the snake is being killed. Moreover, snakes are protected as wild animals under various schedules of the Wildlife (Protection) Act, 1972. Illegal killing and possession of such protected snakes/their body parts/venom are punishable offences under the act.

 

Myth: If there was more bleeding at the site of the snakebite, it was considered as venomous snakebite compared to no bleeding which was considered as non-venomous snakebite.

Fact: Bleeding at the site of snakebite is commonly seen in Viperine snakebites. It is not always necessary that bleeding will be present at the site of snakebite. Snakebites due to Cobra or Krait may not show bleeding through site. Sometimes, fang marks may not be visible or difficult to demarcate.

 

Myth: Prevention of snake in household by sprinkling of Dichlorodiphenyltrichloroethaneand Thimet powder around their houses.

Fact: It is not known whether such sprinkling of insecticides will keep away snakes; however, it is very likely that such sprinkling of insecticides may be harmful to residents of the household.

 

Myth: Use of tamarind seeds as a first-aid measure for snake bite.

Fact: Such unproven methods was associated with increased risk of bite wound infection.

 

Belief in a snake god, the perception that snakes will not come out during thunderstorms, change in taste sensation, the ability of tamarind seeds or magnet to reduce the venom effect were some of the superstitions reported byChaaithanya IK et al.[3]

Most of the abovementioned mythsare responsible for adverse outcomes in snakebite cases, and sometimes these proved to be fatal, as seen in the case cited above. Anti-snake venom is proven agent to prevent snake-bite fatalities; however, snake-bite fatalities occurring due to myths & superstitions associated with snake-bites can be prevented by creating public awareness. Every year 16^th July is celebrated as International Snake awareness day,and this opportunity should be used to spread snakebite awareness to divulge scientific and evidence-based information to reach rural areas, which bear the maximum wrath. Various platforms should be used to spread the correct information related to snakebite, as a part of social toxicology.

 

References

1.        Suraweera W, Warrell D, Whitaker R, Menon G, Rodrigues R, Fu SH, et al. Trends in snakebite deaths in India from 2000 to 2019 in a nationally representative mortality study. Jit M, Franco E, editors. eLife. 2020; 9: e54076.

2.        Majumder D, Sinha A, Bhattacharya SK, Ram R, Dasgupta U, Ram A. Epidemiological profile of snake bite in South 24 Parganas district of West Bengal with focus on underreporting of snake bite deaths. Indian J of Public Health. 2014; 58(1): 17–21.

3.        Chaaithanya IK, Abnave D, Bawaskar H, Pachalkar U, Tarukar S, Salvi N, et al. (2021) Perceptions, awareness on snakebite envenoming among the tribal community and health care providers of Dahanu block, Palghar District in Maharashtra, India. PLoS ONE 16(8.