SM NAJMUS SAKIB
Amid a steady rise in death reports due to snake bites, the country's preparedness to fight against the menace looks inadequate with poor facilities in the government hospitals at Upazila headquarters and lack of trained physicians.
Though not enough, there is a stock of anti-venom in the country but cannot be used for the lack of facilities in the hospitals of the most affected areas, mainly rural areas.
The doctors in those hospitals also apparently lack training required to be able to provide the treatment, experts said, unveiling the country's weaknesses in snake-bite treatment.
They suggested developing facilities in the affected areas so that treatment can be provided to the patients immediately after the snake bites, and said it would substantially reduce casualties.
Due to lack facilities, around one-third of imported anti-venoms in the country mainly due to poor storage facilities and shortages of trained doctors in local hospitals
Of the limited stock of the anti-venom the country maintains, a third of it expires as those are not used for a long time.
Doctors in villages and upazilas are allegedly reluctant to apply anti-venoms to patients of snake bites or treat them for lack of necessary training and supporting facilities.
As many as 95 per cent of snake bites happen in rural areas with the majority during the rainy season starting from June in a situation where only government hospitals provide treatment to snake-bite patients, said officials and experts working in the field.
The situation came to light against the backdrop of the reemergence of Russell's Viper, locally called Chandrobora, this year in as many as 27 districts of the country.
Rajshahi district Civil Surgeon Dr. Abu Syeed Mohammad Faruk told the FE that they don't have storage facilities for anti-venom. "When we get such patients, we provide them with initial medical support and refer to Rajshahi Medical College Hospital (RMCH) for treatment."
The Upazilas of the district don't have anti-venom of Russell's Viper despite being the most affected areas by the venomous snakes.
During the period from 2013 to 2024, the RMCH treated 235 patients (125 from Chapainawabganj), and recorded a total of 69 deaths, according to Chattogram-based Venom Research Centre.
It says Russell's Viper reaches Padma basin and then Meghna basin to Chandpur.
According to the Directorate General of Health Services (DGHS), five people died out of 16 bitten by Russell's Viper in Rajshahi this year.
"We often report snake bite patients," said Dr Faruk, adding that a demand note of anti-venom has already been sent to the DGHS for immediate release of the drug.
Pioneer snake researcher in Bangladesh and President of the Toxicology Society of Bangladesh Prof Dr. M Abul Faiz told the FE that there is no separate or dedicated government programme to look into snake mapping or snake bites.
"Therefore, we don't have an exact figure of snake bites or fatalities," he added.
Since it (snake bite) is a reportable disease, according to the World Health Organization (WHO), "we only get the number after people have reported snake bites", he explained.
"We have never produced anti-venom. And, the possibility of private production is less as it wouldn't be profitable," he explained, suggesting a fast move to develop local anti-venoms.
"On the other hand, what we procure we cannot use. One third of it expires due to non-use. Doctors in upazilas are not trained to use snake anti-venom. But anti-venom can be used even after expiry with following some WHO-guided procedures," he added.
Admitting the situation, DGHS line director Dr. Md. Robed Amin told the FE that so many upazilas are found to be disregarded to send demand notes of snake anti-venom.
"They are reluctant as this treatment requires high medical support and special training which are not available for many of them," he explained.
Dr. Amid, however, termed the news reports on Russell's Viper exaggerated.
Of the total fatalities by snakes, the contribution of Russell's Viper is still little, says DGHS, urging people not to get panicked and to be aware of it.
More than 400,000 people are bitten by snakes every year. Among them, some 7,511 people died. And, 95 per cent of these people who were bitten by snakes are from villages, according to a DGHS survey last year.
There are 82 species of snakes in Bangladesh. Out of which, 28 species are venomous.
Reemergence of Russell's Viper
Russell's Viper was reportedly extinct from the country. However, a report of its resurface was confirmed in 2012 after a man was bitten in Chapainawabganj and maimed due to the venom.
"Being a riverine country and agriculture-driven economy, Bangladesh's atmosphere allows a fast spread of snakes, certainly Russell's Viper. This nature produces sufficient food and accommodation for the reptiles. Furthermore, Russell's Viper gives birth new offspring with as many as 40 at a time," Dr. Faiz added.
He strongly suggested farmers wear gumboots while working on crop fields and take other safety measures to cope up with the situation.
Climate change is one of the major causes of resurfacing and spreading of Russell's Viper in Bangladesh, according to scientists, who have found recently that the rise in temperature will cause some snake species to be extinct while some others will spread in new places for survival, including Bangladesh.
East Asia and Africa will be their (snakes) new places in next few decades, Dr. Faiz explained.
"But it started happening so early; Bangladesh's case (return of Russell's Viper) evidences it," he said.
Anti-venoms imported from India claimed to be less effective
Bangladesh mainly imports anti-venom from India which, experts claimed, is less effective against the local varieties of snake venom. It would be around 60 per cent effective, they suggest.
The DGHS is in a procurement process of 20,000 vials of anti-venom under the arrangement of local companies from India and another 10,000 vials under the arrangement of the WHO.
However, it has received 3,000 vials and the rest is expected to arrive in phases. Two vials are required for a single dose of anti-venom.
"We have already distributed most of the stock of 3,000 vials to district offices and will get 4,000 more soon," said Dr. Amin of the DGHS.
"The anti-venoms can be applied up to 15 years after getting expired scientifically. However, some hospitals are not comfortable to use expired antidotes fearing its side effects. Thus, we send them to medical colleagues for further use and research," he continued.
However, DGHS doesn't have data of how many vials expired as it doesn't have an automation system.
"Our system of preserving drug information is not scientific. We don't know how many of them (anti-venoms) expired immediately due to lack of automation," he said.
Dr. Abdullah Abu Sayeed, assistant professor of medicine at Chittagong Medical College (CMC) and co-investigator of Venom Research Centre, told the FE that the anti-venom that Bangladesh imports from India is mostly effective against four local venomous snake species.
"And, there are different species of Russell's Viper alone in India. So, we don't have a study of which variant is close or effective for the species that is found in Bangladesh," he added.
The DGHS said they will examine the anti-venoms, including for Russell's Viper, imported from India to determine its effectiveness against local varieties.
"We have one kilogram of venom collected from the local varieties of snakes along with a small amount of anti-venom, which is under active process for sending to the WHO headquarters for research and development of anti-venom," said Dr. Amin.
Govt working on developing anti-venoms
WHO also suggests developing anti-venom by using snake venom of source country for proper effectiveness and the venom centre is working in this regard, according to Dr. Sayeed.
"We have a reserve of Russell Viper venom in our venom centre. We are working to develop anti-venom by applying those to chickens and goats," he said.
However, collecting venom and developing anti-venom are long processes, he added.
"In the last few years, snake bites have become increasingly common across the country, certainly in villages. Therefore, we have started the mapping of snakes which will take time. And, for proper action and research, we need sufficient financing," he added.
Dr Amin of the DGHS said that they have received a fund of 200,000 euro from a German University on anti-venom research.
© 2024 - All Rights with The Financial Express
