By Esther Ntiyaduhanye | 13 September 2024
Snakebite Victims: How much suffering is enough to act?
Have you ever been bitten by a snake or know someone who has? There are typically two ways this story could unfold. Either the snake wasn’t venomous, and there’s no cause for alarm, or it was venomous, and in that case, every second counts. The victim needs urgent medical care, where time truly becomes the difference between life and death.
In an ideal world, if someone is bitten by a venomous snake, several things would be readily available: transportation to a hospital, an ample supply of antivenom, trained medical staff who can swiftly intervene, and, crucially, the ability to afford the treatment. However, this is not the reality for many snakebite victims in Rwanda.
The Reality in Rwanda
Rwanda, a low-income country in Sub-Saharan Africa, is home to several highly venomous snakes, including puff adders (Bitis arietans), Jameson’s mambas (Dendroaspis jamesoni), and black-necked spitting cobras (Naja nigricollis). Most of Rwanda’s population lives on less than a dollar a day, relying on subsistence farming. Snakebite victims in the country frequently face long-term complications, such as permanent disabilities, blindness, or amputations, some might even lose life, yet, the extent of the snakebite problem remains under-researched, limiting the government’s ability to take comprehensive action.
One study conducted by the University of Global Health Equity (UGHE) aimed to fill this gap. It surveyed 390,546 people across 763 villages in the Eastern Province, where snakebites are believed to be more common than in other parts of Rwanda. Community health workers were trained as enumerators, going door-to-door to gather data on snakebites and victims’ healthcare-seeking behaviors.
Startling Findings
The study found that 4.3 out of every 1,000 people had been bitten by a snake per year. Shockingly, only 13% of these individuals sought formal medical care, with the majority turning to traditional healers, family members, or friends. This makes one wonder, why would someone choose to avoid medical care after such a life-threatening event?
The reasons are, unfortunately, clear. Of the 1,098 victims who went to hospitals, only 24 received antivenom. This is because of frequent antivenom shortages, or hospitals stocking antivenom that is ineffective against African snake species. Furthermore, medical staff often lack proper training in diagnosing and treating snakebite envenomation (SBE). In some cases, healthcare workers even recommended dubious treatments, such as using black stones or seeking help from traditional healers. Even when victims did receive treatment, they faced several hurdles, such as being told to return home for documentation, waiting in long queues, or being refused care until their symptoms worsened.
Given these challenges, it’s not surprising that many snakebite victims resort to unsafe, alternative measures. Some burn the bite site, tie ropes around the wound, or attempt to suck out the venom. Others drink herbal remedies provided by traditional healers, who also claim to offer spiritual protection against future snakebites. Traditional healers are often preferred over hospitals, as they provide home visits and offer flexible payment plans. However, their treatments have not been proven effective, and victims still suffer from the long-term effects of snakebite, sometimes even leading to death.
One study participant expressed his frustration:
“At the hospital, I paid them, and they treated me. If someone is bitten by a snake, I’d advise him to go to the hospital and not to traditional healers, because I paid them a lot of money and they failed to help me.”
The Underreporting Problem
Rwanda is known for its people-centered policies, so one might wonder: Why not launch a nationwide campaign to raise awareness about snakebite prevention and improve hospital care? The problem lies in underreporting. Rwanda’s current surveillance system only mostly captures cases reported by hospitals, leaving out the majority of victims who seek care elsewhere. While the Rwanda Biomedical Center conducted a door-to-door survey to assess cases on a household level in 2023, the results were not reported. This means the true scope of snakebite is largely still unknown, making it difficult for the government to develop effective intervention programs.
With the Ministry of Health aiming to reduce snakebite deaths and disability by 50% before 2024, there is an urgent need for a more robust system to track cases, regardless of where victims seek treatment.
Preventive measures such as community education on snakebite risks, training healthcare providers, and improving antivenom availability must be prioritized.
How to prevent snakebites
Preventing snakebites in rural areas is also crucial. Simple precautions like wearing shoes, using a flashlight at night, sleeping under well-tucked mosquito nets, and properly storing food to avoid attracting rodents can help reduce snake encounters. However, the UGHE study found that many victims lived in homes with poor lighting and infrastructure that made it easy for snakes to enter. Only half of the respondents took any measures to control rodent populations.
The lack of awareness around prevention and the reliance on myths, such as believing that killing snakes reduces the risk of bites, only worsens the problem. International recommendations, like those from the 2015 Hinxton Retreat, emphasize the need for community campaigns on snakebite prevention and proper first aid techniques.
A call to action
Snakebites are a neglected public health issue in Rwanda, but the suffering of victims should be enough to prompt action. There is a clear need for community-based surveillance, public education on care-seeking behaviors, and improved case management at healthcare facilities. Without urgent and comprehensive efforts, Rwanda’s goal to reduce snakebite deaths and disabilities by 2024 may remain out of reach.
It’s time to ask ourselves: How much suffering is enough before we act?
Esther Ntiyaduhanye is a research associate at the University of Global Health Equity, working on neglected tropical diseases, with a particular focus on snakebites; and advancing One Health policy in Rwanda. With a master’s degree in Global Health delivery/One Health track, Esther plays a key role in projects aimed at improving health outcomes and addressing complex global health challenges. She is passionate about research, writing, and engaging in thought-provoking conversations that foster innovation and drive transformative change in global health.