By Chloe Vasquez | 03 September 2024
Eduardo was weeding the coffee plants when he felt the prick in his wrist, like a bee sting. The 43 year old farmer inspected his wrist and saw two puncture wounds beginning to ooze blood. A coworker rushed over and tied a tourniquet around his upper arm, cutting off the blood flow in an attempt to prevent the spread of the venom. After a tense walk to town, Eduardo’s nephew rushed him to the hospital. As the doctor sliced through the tourniquet, Eduardo felt his breathing become difficult.
When Eduardo arrived at the hospital in Tapachula, there was no antivenom in stock; “That’s when my breathing stopped,” Eduardo recalled. He was quickly transferred to a regional hospital, but again: “there was no medicine there either.” Was there antivenom in the hospital in San Cristobal? Yes, the doctor said, “but by the time the medicine gets here, you’ll be dead.”
Desperate now, Eduardo’s family left the hospital to search for antivenoms in pharmacies around the city of Tapachula. They taxied from pharmacy to pharmacy across town, with no luck. Finally, they found a veterinary center with antivenom, which they bought for 3,500 pesos–about $200–per vial. In the end, Eduardo’s family paid more than $1,500 for treatment.
I met Eduardo (not his real name) in 2023 while trekking through the lush mountains of Chiapas’ Sierra Madre mountain range. I was there to interview snakebite victims and learn more about what people did after an encounter with a venomous snake; did they use homeopathic remedies, see a traditional healer, or go directly to the hospital? As I report in a new co-authored article in PLOS-Neglected Tropical Diseases, I knew snakebites were common in these agricultural communities, but I was shocked to find significant and abundant barriers to snakebite care. As Eduardo experienced first-hand, many health facilities across South Mexico are understaffed and hard to reach, antivenom is scarce, and high treatment costs prevent timely and effective care.
Venomous snakebites are the world’s deadliest neglected tropical disease, annually killing more people than dengue and rabies combined. Many of these deaths are attributable to poor healthcare access. Snakebites occur mostly in rural, low-income communities in tropical countries where clinics are sparse, understaffed and understocked. In Mexico, only two private companies currently produce antivenom for snakes. Most common are two products from Instituto Silanes: Antivipmyn, which is effective for bites from any species of pit viper, and Coralmyn, which is effective for any coral snake bite. The antivenoms are effective, but the distribution of antivenoms is a more complex issue. In some rural regions of the country, where snakebite is most common, finding antivenoms can be a significant challenge.
For one, many victims live far away from clinics and hospitals. Often, farmers are bitten while working in agricultural fields, and must walk back to the town to reach transportation. Snake venom acts quickly, and urgent treatment plays a key role in saving lives and limbs. Experts quip that “time is tissue,” such that delays in antivenom treatment can leave victims permanently disabled. Yet, most of the snakebite victims I spoke to had no personal transportation. In the absence of reliable ambulance systems, victims had to wait for a taxi to pass by their remote communities, or ask neighbours, friends or bosses for a ride.
I met Martin, a coffee grower in the Sierra Madre mountains of Chiapas who suffered a viper bite in 2022.
“I could barely bear the journey back to the town. It’s two hours walking, and I came quickly. I was shaky. I said, ’I’m going to die here,”- Martin said.
This sense of urgency presses many victims to use traditional medicines as an intermediate treatment to resist the venom while they search for the antivenom.
Martin’s friends chimed in: “When one of us gets bitten, we have to work together to find a traditional remedy, so that they survive the trip to reach antivenom.”
Researchers have pointed to traditional medicine use as a cause of treatment delays, however the long travel times seem to discourage victims to the point where they prefer to stay in their communities and stick to traditional medicines.
“If the snake is large, you’ll die before reaching the hospital. So, it’s better to stay put and not move… Chili and alcohol are the best cures for neutralizing venom. That’s what saves people’s lives here, because there’s not enough time to reach the hospital“, – said Agustin, a coffee farmer bitten in 2021.
While most victims reported a familiarity with and preference for antivenom and hospital treatment, we found that only 48% of victims reached healthcare facilities.
On average, victims reported almost 3 hour commutes to reach a medical facility. Following the long, sometimes terrifying journey to a clinic or hospital, victims often discovered that antivenom was out of stock. Shortages left victims with no choice other than to seek antivenoms outside of the hospital, or attempt to reach the next closest hospital in hopes of better luck.
In the hot and humid lowlands of Oaxaca, I met Daniela, a corn farmer bitten by a viper in 2013. She was frustrated by the scarcity of antivenom and the need for money to afford treatment.
“They should have the antivenom in all of the clinics. When [a snakebite] is serious, we go to [the hospital in] Valle or Tuxtepec, and you better have money because if not they won’t take you. The snake antivenom is expensive,”- Daniela said.
Eduardo, too, emphasized his exasperation with the treatment landscape.
“There’s no way to save ourselves… We had to go into debt to survive this. It would be useful to have antivenoms around here, because we’re at high risk here in the countryside”, – Eduardo said.
In Southern Mexico, antivenom is expensive and hard to reach. Barriers to timely and effective healthcare are leaving people vulnerable to disability and death. By listening more closely to victims’ accounts of their treatment journeys, we have a better understanding of why people might choose traditional remedies for snakebite. Many snakebite-related health failures are systemic; health systems in Oaxaca and Chiapas need to prioritize ambulatory services, rural health infrastructure and clinician training. To improve snakebite management specifically, hospitals must begin keeping track of antivenom availability, and regularly ordering new batches. In the meantime, communities should have an “emergency snakebite kit,” a minimum dose of antivenom that they can take with them to the hospital, preventing complications due to stock outs. Medical curricula must include snakebite management in their training, especially as doctors conduct their “servicio social” in rural communities.
Until hospitals begin reliably stocking antivenoms, snakebite victims in Southern Mexico will likely continue to seek intermediate or alternative solutions to the recommended antivenom treatment, losing lives, limbs and livelihoods as a result.
Chloé is a recent undergraduate student learning about snakebite management around the world. When her mother survived a Bothrops asper bite in 2020, she decided to dedicate her career to ensuring all people have access to quality snakebite information and treatment. At the moment, Chloe is interning at the Madras Crocodile Bank in South India, learning about snakebite management.