Thanks to the Assam model of the Venom Response Team (VRT), two West Bengal women in critical condition, one of them pregnant, were saved after snakebites in the past seven days.
Talking to The Statesman, Dr Dayal Bandhu Majumdar, member of national snakebite management, said, “Nandita Das, 30, of Raghunathganj in Murshidabad, was treated by a trainee nurse using ambi bag providing artificial ventilation and respiration, while Borojora’s Rinku Kumbhakar was saved by her family and ambulance assistants using the same model during her long journey to the hospital.”
The VRT Assam model has been popularised by ‘Snake Man’ Dr Surajit Giri, an anaesthesiologist at the Community Health Centre (CHC) of Demow in Sibsagar district, who conducted his 150th awareness programme on Saturday. “As per the model, members of every block primary hospital voluntary organisation should be trained to use ambi bags. The patient is put on portable ventilator after reaching the hospital,” said Majumdar.
The women were reportedly bitten by poisonous snake Krait. It is very difficult to detect Krait-bite marks due to its very small teeth, but the venom is neuro-toxic and becomes fatal if not treated immediately.
THE SNAKE MAN
Weekends for Dr Giri are hectic, as the doctor needs to move into communities to create awareness on snake bites and insist on urgent medical treatment. “In 2008, when I was working at a private hospital in Sibsagar, a snakebite patient came to us. She had the anti-venom dose, but we couldn’t help her as we didn’t have the protocol or equipment. She moved from one hospital to another. Finally, she died on her way to Assam Medical College, Dibrugarh. This struck me hard. We were helpless as we did not have adequate information. So I formed a team and started community awareness in 2008. It was a journey to dispel all myths about snakebites,” he said.
According to Devajit Moran Tinsukia, district convener of Assam Snake Rescue Network, incidents of snakebites are on the rise owing to rapid deforestation, incessant rain and sudden rise in temperatures.
In one instance, in 2010, a young doctor had to take on a patient and his entire family to persuade them to take the anti-venom. They would go to faith healers. After one hour of coaxing, the patient with the cobra bite agreed and was cured.
“I realised that if we treat patients at private hospitals, we will never win the war. Most of the snakebite patients are poor. They have an inherent fear of medical treatment and ICU cost. A dose of anti-venom costs Rs 450 and a patient needs at least 10 such doses. We knew we had to treat them at the CHC without the ICU,” said Dr Giri.
CHC GETS SNAKEBITE ROOM
In 2018, the Demow CHC was a two-storey building with the operation theatre (OT) on the first floor. The anti-venom and other medicines for snake bite were kept in the OT, while the patients were brought to the outdoor emergency. “We lost time. I was the first one to treat snakebites at the CHC. I could not be available 24 hours, so I trained other doctors and nurses. We still lost 45 minutes of the golden hour as medicines and requisites were not available in a designated room,” added Dr Giri.
Taking the need for quick treatment into account, a ‘Snakebite Room’ was started at the Demow CHC on October 16, 2020. The room is equipped with two beds, all essential medication as per protocol and trained doctor and nurses. Pictures of snakes endemic to the region were put up on the walls so that a patient could identify them and doctors could arrange the treatment protocol. The SOP for treating snakebite was hung on the wall.
From 2018 to 2022, Dr Giri has treated 760 snakebite patients at the CHC with no death and 100% success. Since the start of his career, he has treated more than 1,200 snakebite patients. In 2021 alone, Dr Giri treated 464 patients at the CHC.
“With the experiences, we started a unique initiative, the VRT. A leader was selected from the community awareness programme and included in a specialised WhatsApp group which goes by the name Snake Group. The members are snake rescuers, doctors and citizens. Pictures of the snake bite patient transferred to the hospital are uploaded on the group. Pictures of the snakes too are uploaded if possible. We give our suggestion for the treatment protocol on the group itself. We are included in the project of health volunteers by the Deputy Commissioner of Sibsagar. We now provide the anti-venom and treatment for free.”
A Fast Response Team (FRT) was also started for snake bite treatment. It’s a common group where treatment protocol is discussed.
A patient bitten by a Pit Viper did not respond to 55 anti-venom doses, even though there was no coagulation of blood. “We administered magnesium sulphate with glycerine which worked. The patient was saved and till now we have treated 100 Pit Viper bite patients without the traditional anti-venom,” Dr Giri said.
This is a major protocol and Dr Giri collaborated with the Tezpur Central University on this. It has been published in a peer-reviewed journal on toxicology.
Recently, the Odisha government approached Dr Giri, as statistics show between 2016 and 2019, of the total 6,228 deaths due to various calamities, snakebites accounted for 2,217, surpassing casualties due to cyclones, floods, lightning, fire accidents and boat tragedies. The government provides Rs 4 lakh to the families of the victims.
In June 2022, Tinsukia district alone registered 10 such deaths. In Demow CHC, 17 patients have been treated in June so far.
Dr Giri, who has written on his experience to Prime Minister Narendra Modi in the Mann Ki Baat in February, has requested the PM to form VRT, FRT and Snakebite Room in every rural hospital.
Dr Majumdar said, “Let us try to spread the concept throughout the country.”