Re: Snakebite: a forgotten problem
Snake bite is an occupational hazard of farmers, villagers, hunters, and migrating population.(1) Scarcity of health facilities at rural setting majority victims initially attend tantrik and then non–allopathic doctors with no knowledge of standard line of treatment for snake bite. Majority of cases are reported during early darkness (viper, cobra bite) and midnight to early morning (krait bite). During these hours doctors at primary health centers are absent. There is always a short supply of snake antivenin (ASV), emergency medicine and ventilator or ambu bags. Hence many victims are driven to private and relatively equipped hospitals where they will surely go into debt and will have to sell jewellery or pieces of land to pay for bed, consultations, investigation, ASV and ventilators. Because of poor knowledge and experience doctors are not confident regarding outcome.
There should be task force to develop simple protocols for early clinical diagnosis, and management of snake bite.
All basic facilities should be made available at PHC. There should be short training course before appointment regarding management of envenoming for doctors joining primary health centers. ASV should be made freely available at private hospitals too. At least the population at risk for envenoming should be under umbrella of health insurance.
Elisa antigen detection kit should be made available to restrict the excessive use and prevent the crisis of ASV supply(2).
Director of health serivices governmnet of Maharashtra refused and denied reimbursement of tour bill of one author (HSB) for training government medical officers.
Scientists should make an attempt to search out alternate or substitute to ASV ( 3 ).
Prevention is the mother of cure. Instead of killing millions of dollars for ASV, tours abroad, and Meetings, WHO and local government should arrange training for peripheral doctors regarding management of snake bite and provide cots with mosquito net, gum boots and thick gloves to people more prone to snake bite accidents(4).
Himatrao saluab Bawaskar MD
Parag Himmatrao Bawakar MBBS
Pramodini H.Bawaskar MBBS
Bawakskar Hospital and Research Center Mahad raigad Maharashtra India 402301
1- Bhumik S. Snakebite: a forgoten problem British Medical journal2013;346:f628
2- Bawaskar VHs and Bawaskar PH. Profile of snakebite envenoming in western Maharashtra ,India Trans. Roy.soc.Tropical. Medicine Hygiene. 2002;96:79-84
3- Bawaskar HS and Bawaskar PH. Call for global snake bite control and procuremnet funding. Lancet 2001;357:132-33
4- Bawaskar HS and Bawaskar PH.Snakebite:simple steps to prevention and reduction of mortality. Lancet 2010;375:805
Conflict of interest Nil
All authors read the letter and agreed .