Re: Snakebite: a forgotten problem
2 February 2013
I read with interest Dr Bhoumick's article (1) on one of the most important and neglected public health problem in India; snake bite. Million death study has shown us how the importance of snake bite was underestimated by state.
Although policy paralysis about less glamorous (unlike AIDS) health issues like snake bites and organophosphate poisoning is responsible for the current state of affairs, apathy from medical fraternity in the teaching hospitals is also at fault. While half of the residency time is spent by trainees attending to tropical health problems like snake bites, malaria, dengue, leptospirosis, diarrhoea, organophosphate (OP) poisoning etc; these get hardly any representation in the final assessment exams which principally revolves around cardiovascular diseases, strokes etc. Some of the students trained in Mumbai who later join primary health centres in rural areas ( which usually is the last career option) may not have managed a single case of snake bite.
In spite of the experience of many years in treating these conditions several important issues like correct dose of antivenin(2,3) PAM in OP(4) poisoning etc remain unanswered. Therefore no formal treatment protocol exists leading to many times unwarranted use of antivenin therapy.
There are many clinicians who are working on snake bites in their own limited private set ups. Dr Bawaskar, known for his work on scorpion envenomation, took an initiative last year to arrange for an informal meeting of clinicians with Dr Warrel at his own hospital. Not funded by any pharma industry or state support this was a unique medical gathering. This six hours meeting led to interesting debates, discussion and many interesting hypothesis were conceived in the end. Dr Punde; clinician from the interior of Maharashtra is exclusively treating snake bites and has an experience of treating over 3000 bites over last 10 years. Most of his work remains unpublished.
Public health infrastructure should me made more conducive for researchers who are interested in these issues and such projects should be generously funded.
Government should collaborate with these people working in the field to formulate treatment protocols (which may not be evidence based but practically proven) and involve them in training health care professionals in primary care in rural areas and in medical colleges.
1) Snakebite: a forgotten problem.BMJ 2013;346:f628
2) HS Bawaskar. Snake venoms and anti venoms. Critical supply issues.JAPI 2004; 52:11-13.
3) Vijeth SR, Dutta TK, Shahapurkar J and Sahai A . Dose and frequency of anti-snake venom injection in treatment of Echis carinatus ( saw -scaled viper ) bite. JAPI 2000;48:187-92.
4) Kirti S Pawar et al. Continuous pralidoxime infusion versus repeated bolus injection to treat organophosphorus pesticide poisoning: a randomised controlled trial. The Lancet 2006;368:2136 - 2141.
Competing interests: None declared
Dept of Nephrology, Seth GS medical college, KEM hospital, Parel, Mumbai, Parel, Mumbai, India
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