Snakebite is a neglected ‘disease’ of circumstance, that primarily affects some of the world’s poorest people. Bites are common in rural areas of tropical and sub-tropical developing countries and often affect agricultural workers and children. Antivenoms are essential in the treatment of dangerous snake bites, yet they are expensive and require refrigeration, making them difficult to obtain for the people who need them the most.
Frustrated by the lack of antivenom and medical services, Thea Litschka-Koen and her husband Clifton Koen founded the charity Antivenom Swazi to help victims of snakebite in rural Swaziland. The charity raises funds to maintain a bank of antivenom to provide free treatment to snake bite victims in the country. Thea and Clifton also run educational courses and attend call outs to remove and relocate problem snakes.
I spoke to Thea to find out more about the snakebite situation in Swaziland:
How many snakes do you rescue per year?
We rescue anything between 300 and 550 a season.
Which species do you encounter the most?
The most common is the Mozambique spitting cobra (Naja mossambica) [but they also regularly encounter black mambas (Dendroaspis polylepis) and puff adders (Bitis arietans)]
How many bites would you say occur in Swaziland every year? and what species are the main culprits?
We are still collecting the data but I suspect between 700 and 1200 bites a season. About 75-80% of serious envenomations are from Mozambique spitting Cobras.
Education is key to preventing and treating snake bites but the fact that many people in Swaziland fear snakes (and often with very good reason) must be a huge hurdle in persuading people not to kill snakes. Where do you even start when a family has just lost their child to a snake bite?
It’s a case of never giving up. Say the same thing repeatedly and finally people begin to listen. To be honest, I don’t say much in the instances where I have had to remove a snake that has killed. I’m very sympathetic and when asked, I just say that “don’t worry, I’ll make sure the snake never bites anyone again”. They don’t need to know that I release them in areas where there is very little chance that they will encounter humans again.
How expensive is antivenom? And how much do you spend on it every year?
The cost of antivenom is relative. For people with medical aid, it’s cheap. For people who are on minimum wage, it’s impossibly expensive. The cost of one treatment for a spitter bite is about ZAR15000.00 (£720). That’s 24 months for someone on minimum wage. I spend every cent I get from donations and courses I offer. It’s only about 10% of what Swaziland needs to treat snakebite effectively.
With many bites occurring in remote areas, it must be difficult to get people treated quickly. Do you keep antivenom stocks in different locations to help with this?
People who get bitten in remote areas usually have very poor outcome. It takes too long to get to a hospital. If they are lucky enough to survive, the damage caused by spitters are usually devastating. I have been working with the government for years now. Most of the government hospitals carry some antivenom. It is impossible to equip all the rural clinics as they are not equipped nor trained to administer AV. There are hundreds of clinics and they are staffed by nurses who may not administer AV.
Bites from some species can cause debilitating injuries and aside form antivenom costs, medical bills must be huge. Who pays for this?
The patients are charged a minimum. Although it is very little, many can’t afford it. We help where we can.
During the snake bite season you must have very little time to yourselves. What gives you the drive to keep going?
Desperation, begging, tears, immense suffering… And I’m bloody stubborn…
How can people help you to keep doing the work that you do?
I need a dedicated snakebite hospital so that the little we have (equipment and knowledge) is in one central location instead of being distributed all over the country.
A few ambulances would also be great as well as a bottomless supply of antivenom. Seriously though, we need medical supplies, relevant equipment to assist with the snakebite management and antivenom. We also need mosquito nets and educational equipment (printing of posters and other educational material).