The Little Flower Hospital, Angamaly, Kerala is organizing a conference with assistance from the Medical Council of India with snakes, venom and snakebite as the theme. The conference is scheduled for the 20th and 21st of September.

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The annual mortality worldwide related to snakebite stands at about 100,000 per annum. Of this it is estimated that roughly half occur in India (nebulously estimated as between 30,000 to 50,000).Snakebite is as big an issue in our neighboring countries of Sri Lanka, Myanmar, Bangladesh, Nepal and Pakistan. The rich biodiversity of flora and fauna aided by weather conducive to their sustenance in a part of the globe which is exceedingly densely populated makes conflict inevitable. The rich biodiversity also reflects in the various species of snakes accounting for the varied symptomatology in bite victims both inter species and intra species, region to region.

Snakebite is predominantly a rural phenomenon in the agrarian setting. As man build higher, digs deeper and increasingly forages deep into the air, water and sea conflict with Mother Nature is but inevitable. This could only lead to an increase in conflict between mankind and the wild. Reports of venomous snakebite from the heart of busy cities are not uncommon. An average bite victim is a farm laborer in a village a good hundred kilometer away from the nearest hospital which has the stock and the will to treat snakebite. The victim is also likely to be male, bitten some where on the lower extremity and during the evening hours. He is also unlikely to have seen the snake leave alone identify it and would most likely have sped back home to apply some emollients to the bitten part. As also unless symptomatic he would tend to wait and watch at home for symptoms to appear. And when symptoms do appear he would rush to the local healer for treatment. Precious time is lost thence.

The other scenario is when victims are brought to hospital early enough and are triaged in the emergency- envenomation being confirmed from a serial WBCT (Whole Blood Clotting Time), wherein blood drawn is allowed to stand and clot. The failure of blood to clot would confirm haemotoxic bite. The other test used for triage is the Single Breath Count which like the WBCT is repeated at 30 minute intervals or till seen as abnormal. The failure to take into account other signs and symptoms of envenomation and to allow a single test (theWBCT) to decide on the further course of treatment is intrinsically flawed. The WBCT comes abnormal only after the venom has already fixed to tissue which is already a bit too late. What other parameters taken in conjunction with the WBCT could help us decide the further course both earlier and with consistency is the unanswered given the unavailability of Venom Detection Kits in the mentioned countries.

This and endless list of questions are left to be answered. What do we do to improve on the level of care provided such as to be able to match the snake bite mortality of the United States and Australian which is in the single digit annually?

A large body of work on venom research and characterization, development of detection kits has already been done. How do we translate it into a product to help the victim of snakebite as also in utilising venom fractions in our fight against other diseases.

The treatment of snakebite has stopped at the ASV ( Anti Snake Venom ) for more than four decades now. What are the other modalities that need to be explored especially with plant extracts? In there any substance to the traditional system of treatment which has been bequeathed us with our folklore? And more importantly will it withstand the exacting standards of controlled clinical trials ?

There are a whole lot of questions pertaining to the standardization of ASV as also the venom pool being used for its manufacture. Does the ASV from different manufacturers have the same efficacy in different regions of our country and the neighbourhood. Do we need to extend the pool of venom drawn on for manufacture of ASV.

It is of utmost importance that every clinician consistently be able to identify the Big 4 and their look alike. The fact that we use polyvalent ASV should not prevent us from taking the pains to examine and identify the offending snake.

We plan to address all these issues during the course of the conference.

We have an august list of speakers drawn from the fields of herpetology, biochemistry & biotechnology and clinicians. We look forward to an honest and fruitful interaction.

Sincerely Jaideep