Tuesday, August 19, 2014
Guest Post: The Danger of Snakebite and the Search for Solutions | Family Economics
My name is Mike Reddy and I am a program officer and Gates Fellow with the Bill & Melinda Gates Foundation Malaria team. I have a background in public health entomology and mosquito-borne disease ecology and epidemiology. I’m currently working with the SC Johnson BoP team on malaria prevention in the Greater Mekong sub region. I was thrilled when they asked me to contribute to the Better Lives Blog. This work is so critical to the global malaria eradication effort. My post today isn’t about malaria, but rather another issue that plagues many of the same communities – venomous snakebites and the devastating burden of this most neglected of neglected tropical diseases.
Death and disability caused by venomous snakebite represents a tremendous health burden amongst disadvantaged agricultural communities in the tropics. It is estimated that up to 94,000 deaths annually are attributable to venomous snakebite to envenoming, or poisoning, while another 200,000 to 300,000 people are permanently disabled. Young, economically-important workers are at disproportional risk by virtue of their contact with snakes in the forests and fields while farming. This is particularly so in rural Mon State, Myanmar where I recently spent a week in the field with our partners from the SC Johnson BoP team working to develop mosquito repellent products designed to protect migrant farm workers and their families from mosquito-borne diseases such as malaria and dengue.
One of our tasks was to document the daily routines of tenant farmers and their families. In doing so, we asked about hardships and health burdens experienced as a consequence of their work and living conditions. The fear of snakes and snakebite arose repeatedly during our focus group discussions. Throughout the course of a week spent in the villages, we heard of at least two locals who had been hospitalized after being bit. Much to our surprise, such events were not viewed as unusual; rather, snakebite was viewed as an occupational hazard for migrant laborers working in the nearby plantations.
In the course of our interviews with farmers, snakebites were cited far more frequently than either malaria or dengue as a major health concern of migrant laborers and their families. Poor access to transportation also was cited as a key issue as the nearest hospital was nearly an hour away by car. Depending on the species of snake and dose of venom received, the time between when a bite occurs and when anti-venom is administered can mean the difference between life and death. In comparison, malaria is viewed more as a disruptive inconvenience than a potentially fatal event. This may be due, in part, to the fact that most respondents know that effective anti-malarial drugs are available through local clinics and pharmacy kiosks, however, no such treatment for snakebite is currently available in villages.
Preventative measures are limited to thick rubber boots that are cumbersome and uncomfortable to wear in the tropical heat. Some plantation owners provide such boots to their workers while many do not. Without adequate protective equipment, timely administration of anti-venom remains the only treatment available. Anti-venom is snake-specific and must be given within minutes to hours post-envenoming in order to be effective. Further, current anti-venom formulations require refrigerated storage and a trained medical professional to administer, both of which are in scant supply in the rural, tropical communities where most venomous snakebites occur. This presents a fundamental challenge to efforts designed to curb the risk of snakebite. Currently, there is no comprehensive strategy to address the global burden of snakebite and very few global health resources dedicated to the prevention and treatment of snakebite in among populations living at the base of the economic pyramid.
The first step toward addressing snakebite as a global health concern is to document and share the experiences of the people who live with this threat on a daily basis. Personally, it has been an eye-opening experience to learn first-hand the tremendous problem snakebite represents in rural Myanmar. I hope that by sharing these observations from the field, it will stimulate others to learn more about this most neglected of neglected tropical diseases and to advocate on behalf of those afflicted by snakebite.