The problem of snakebite

“Can we find out more about snakes?” That request from our physician consultant started me on an unexpected journey. After extensive research including interviewing over 34,000 people in the community, we now understand much more about human–snake conflict. Most importantly, we have learnt that snakebite requires a wholistic response.

A public health perspective
South Asia has approximately 70,000 snakebite deaths per year; there are approximately 100,000 deaths worldwide. Other impacts of snakebite include disability due to limb damage, social and mental health issues, and crippling economic costs from the loss of healthy income earners. In 2018, the World Health Organisation recognised ‘snakebite envenoming’ as a neglected tropical disease, enabling more funding and planning for prevention and better treatment.

A scientific–medical perspective
We need to understand the chemical actions of venom and the medical symptoms of snakebite. We also need to develop diagnostic tests and antivenom that are safe, effective and affordable.

An environmental perspective
Many people’s first suggestion is to kill snakes. This would lead to more rats, which eat more grain, leaving people without food. Understanding snakes’ place in the environment can help us modify interactions more appropriately. Snakebite is primarily a rural problem. Tropical regions are most impacted, with snakebite cases mainly coinciding with the monsoon season. In our area, bites tend to happen in the cool of the evening; snakes come out to hunt just when people are also more active outdoors. Lighting and torches will help people to see and avoid standing on snakes.

Understanding the geographical distribution of snake species is crucial to providing the relevant antivenom. Environmental management has a place in decreasing the incidence of snakebites. Advisors recommend sleeping with a well-tucked-in mosquito net; properly disposing of waste and securing grain storage to decrease rat and snake populations; and establishing buffer zones between grain crops and housing.

Personally, I have come to appreciate the amazing design of snakes. Their scale patterns are remarkably consistent within a species and some designs and colours are quite eye-catching.

An economic perspective
There is an inverse relationship between a country’s Gross Domestic Product (GDP) and the incidence of snakebite deaths: lower GDP = more snakebite deaths. Rural areas usually have a weaker political voice and fewer health resources: antivenom is costly to produce and requires well-trained health workers to administer; protective footwear is expensive; ambulance services are deaths of farm animals cost farmers dearly.

A spiritual perspective
In South Asia, 70–90% of snakebite victims first present to a traditional healer. Many would not kill a snake because snakes are worshipped, and many believe a snake will only bite you if the gods allow it. Others believe the snake’s death will cause the snakebite victim to also die. This spiritual perspective has both religious and cultural aspects. Hindus, Buddhists, Animists and Christians all have snake-related beliefs.

The Bible has many literal and analogical references to snakes, and they are not all negative. Most often people think of the Genesis 3 serpent and its connection to Satan in Revelation 12, but we also have the bronze snake of Numbers 21:4–9 which people could look to and be healed. Then, John 3:14–15 says, “Just as Moses lifted up the snake in the wilderness, so the Son of Man must be lifted up, that everyone who believes may have eternal life in him”. These verses, which occur just before John 3:16 in Jesus’ discussion with Nicodemus, need further exploration in parts of our world where snakes and snakebites are common and their connection with the spiritual is pervasive.

“Your kingdom come”
Often when we pray the Lord’s Prayer, I get to this and stop: “Your kingdom come, your will be done on earth as it is in heaven”. What does God’s kingdom look like for human–snake interactions? Snakebite is a huge problem where I can only ever make a small impact. When I look at it from the perspective that God has given me an opportunity to be part of His Kingdom work, then I press on with the task He has given me to do.

Amelia has served in South Asia for more than 15 years, as a nurse, PhD student, and in building local
research capacity.

Name has been changed.