Mark McNicol, MSF doctor.
If you get bitten by a snake in rural South Sudan, several things can happen to you:
you could die. Children are particularly vulnerable and it’s a long road to reach healthcare in these parts of South Sudan. Depending on where you live, it can take more than a day to walk to the nearest health center. Many people die from snakebite before they can get help.
You may live close enough to a health center to walk or to have relatives take you for treatments: antivenin, wound care, painkillers and antibiotics. If the health center you arrive at does not have antivenin or it has expired, you could lose your life.
You can survive without treatment. You will experience pain, swelling and other main symptoms. They can leave a chronic wound or heal from the bite itself. There may be a scar, but you’ll still be alive.
As a superstition, it is common in South Sudan to hang dead snakes on trees to prevent them from coming back to life.Pierre-Yves Bernard (Pierre-Yves Bernard/MSF)
The Médecins Sans Frontières (MSF) hospital where I worked is located in the small town of Lankien, in the state of Jonglei. It is one of the few health centers in the region. One would expect that there would be fewer snakebite injuries in more urbanized areas, but the truth is that we regularly receive patients with these types of injuries. However, during my deployment I have not seen a single case where someone was taken to the emergency room immediately after being bitten. What we saw were people hospitalized months after the event; often when the less visible consequences of the bite finally came to light.
I remember the case of a woman who came to the hospital. She had been bitten on the ankle four or five years ago. The first thing I noticed was a strong characteristic smell of infection. Before I saw her ankle I knew it would be wrong.
If you are bitten by a snake, one of the injuries it can cause, aside from those caused by the venom itself, is a very deep puncture wound. And this injects bacteria (perhaps from the snake’s teeth or your own skin) almost deep into the body.
“While superficial wounds heal, bacteria can multiply, cause infection and erode bone.
As superficial wounds heal, bacteria can multiply, causing infection and eroding the bone. We also see this in conflict zones, with patients suffering from gunshot wounds or shrapnel wounds without access to proper treatment.
Over time, the deep infection can spread to the point where it breaks through the skin again, causing an open sore. This does not happen in all cases of untreated snake bites, but patients with this problem come to Lankien. The woman with the infected ankle was one of the worst cases I’ve ever seen.
Bone infection is treated with antibiotics, but when it’s particularly severe, patients will need surgical debridement, which means the infected tissue is removed or even amputated if necessary. Our hospital does not have an operating room, so we use telemedicine to consult with other surgeons from other MSF projects.
It was clear that antibiotics would not be enough for the woman and we raised the issue of amputation. It was a difficult decision as in an area where almost all travel is on foot he had to rely on crutches, sometimes over long distances and difficult terrain. But without the amputation, the infection would spread and get worse. She had suffered for years, and the strong odor of the substance caused her to suffer from community stigma as well.
In the end, the woman and the team agreed that amputation was the best option. My colleagues took care of taking them in our small supply plane to another MSF hospital where they have the necessary facilities and staff to carry out the operation safely.
Snakebite is a neglected public health crisis that requires an ambitious approach to address
Snakebite is a neglected public health crisis that requires an ambitious approach to address. Around the world, MSF works with governments, health services, donors and communities to try to bring about change for those affected. The answer relates to both access to affordable, quality antidotes and greater investment in community awareness, first aid and bite prevention.
The woman’s operation went smoothly, but the consequences of the injury will accompany her throughout her life. It must be ensured that fewer people suffer the consequences of this forgotten problem that is putting their lives and livelihoods at risk.
Markus McNicol He is a member of Doctors Without Borders. He has just returned from a mission in Lankien, a remote rural area in southern Sudan.
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