Lives lost for lack of antivenom injection

Every year, there are reports galore on people in rural areas losing their lives from snakebites. Lack of anti-venom leaves the victims and their families devastated and helpless, as they can do nothing but wait for their inevitable death.

Blessed with vast wetlands, fertile plains and a tropical climate, Bangladesh is home to many species of snakes. Among these species, monocled cobra, Russell's viper, banded krait, and green pit viper are responsible for most fatal bites. Approximately 6,000 people die annually in Bangladesh from snakebites, though the actual number may be a lot higher as many cases go unreported. According to the World Health Organisation, snakebite is a neglected health issue all over South Asia.

The fact that these deaths could have been prevented makes them even more tragic. The only effective treatment for venomous snakebites is anti-venom or anti-venin injection. Yet, almost every upazila-level hospital in Bangladesh suffers from a shortage of antivenom, resulting in deaths that were preventable.

The Directorate General of Health Services (DGHS) is responsible for distributing antivenom injection to government hospitals. But the injections are usually supplied mostly to medical college hospitals and some district hospitals, while upazila hospitals are left out. On the rare occasions they get supplies of anti-venom injections, the injections are not in their best of conditions due to a lack of proper storage and handling.

The lack of proper treatment in hospitals leaves people from the countryside with only one option for treatment, which is traditional healers. Traditional healers are local ojhas and kabiraj who use chanting, herbal paste, or even cutting the wound to supposedly cure the victim. What they do is just making the situation worse. A study conducted by the Institute of Epidemiology, Disease Control, and Research (IEDCR) in 2020 found that over 60 per cent of snakebite victims initially sought treatment from traditional healers. Many of them did so knowing the local hospitals lacked antivenom injections.

Climate change has been linked with the increase in snakebite incidents in recent years. Due to changing rainfall patterns, flooding and the destruction of wetlands, snakes are losing their habitats and moving closer to human settlements.

According to public health experts, it is not only about the shortage of antivenom but a systemic neglect. There is no budget allocated for providing antivenom at the district and upazila levels. Medical staff do not receive any training on how to diagnose and treat venomous snakebites. Furthermore, the lack of a national database for snakebites also makes it impossible to plan and allocate resources to address the problem effectively.

Our neighbouring countries have started addressing these issues and made noticeable progress. India, where snakebite fatalities are the most common, has adopted a national protocol requiring all health centres to be stocked with antivenom and trained medical staff. Sri Lanka also developed a well-organised supply chain of antivenom vials that has drastically decreased their snakebite fatalities. Yet, Bangladesh still lacks a proper national protocol on the matter.

Most snakebite victims are farmers, fishermen, and day labourers from rural areas and they are often the breadwinners of their families. Their death or disabilities due to amputation often plunge their families into poverty.

Some urgent steps must be taken to address the issue. Firstly, a reliable supply chain must be established to ensure all upazila and district hospitals receive enough anti-venom. Secondly, medical staff must be trained on the diagnosis and treatment of venomous snakebites. The DGHS should allocate a budget dedicated to ensuring the proper transportation of antivenom injection and training of medical staff. Thirdly, awareness has to be developed in rural communities through nationwide campaigns.

rahmansrdk@gmail.com