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Jakarta Post

Poison, venom experts team up to tackle hidden health problem

Up close: The green pit viper is responsible for most venomous snakebites in Java

Ron Lilley (The Jakarta Post)
Denpasar, Bali
Thu, January 24, 2019

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Poison, venom experts team up to tackle hidden health problem

Up close: The green pit viper is responsible for most venomous snakebites in Java. (Photo by Ron Lilley)

What would you do if you were bitten by a snake? The reality for most victims of a snake bite in Indonesia is a deadly game of chance — one of little hope for proper treatment and, potentially, the loss of one’s livelihood, or even one’s life.

According to the World Health Organization (WHO), snakebites are one of the world’s most neglected injuries.

Indonesia, like many of its Southeast Asian neighbors, is home to many venomous snakes, including cobras, kraits and vipers.

Most victims of envenomation, however, are low-income groups like farmers or fishermen who, without affordable access to local medical services, remain vulnerable to harmful encounters with venomous creatures.

Some venoms, such as from kraits and certain jellyfish species, can cause death in under an hour, giving a victim no time to reach a hospital. Because of inadequate treatment, those that do recover may suffer amputations, secondary infections and other health problems.

These injuries can remove someone from the workforce, causing economic hardship to families and communities who are often already living at subsistence levels.

Shortages in funding, expertise and government support have ensured that snake bites and other forms of envenomation remain hidden health issues, concealed among broader poverty. This growing social need, particularly in rural areas, is inspiring a diverse range of figures from the world of science and medicine to collaborate in response.

At the first conference of its kind, the Toxinology Society of Indonesia (TSI), the Malaysian Society on Toxinology (MST) and Indonesia’s Health Ministry recently convened in Yogyakarta for the ASEAN Marine Animals and Snake Envenoming Management (AMSEM) international symposium.

The conference, opened by the Health Ministry’s director general of health services, Farichah Hanum, marked a significant step forward in Indonesia’s efforts to address poisoning and envenomation issues.

People involved came from a range of disciplines, including medical practitioners, biochemists, snakebite specialists and toxinologists (scientists specialized in the study of poisons and venoms from animals, plants, mushrooms and bacteria).

The welcome address was delivered by TSI founder Tri Maharani, who is a leading light in the effort to improve snakebite treatment in Indonesia by providing snakebite management training for medical staff in hospitals throughout Indonesia.

She contributed the first-ever snakebite records for Indonesia to the WHO and is now having the WHO snakebite management guidelines translated into Indonesian for use in medical training facilities nationwide.  

Of the 728 cases of snakebite, only 4.5 percent were recorded as fatal. However, as the majority of hospitals and clinics have not yet provided data, these figures are certain to be unrepresentative and a huge underestimate.

Anecdotal evidence suggests over 150,000 bites occur in Indonesia each year, resulting in hundreds of deaths and thousands of permanent disabilities.

Traditional medicines and remedies for snakebite are used widely throughout the archipelago, but experts maintain that there is no effective treatment for snakebite except by the use of an appropriate antivenom. A swathe of issues surrounds the administration of antivenom in Indonesia, however, from limited availability to inadequate training of medical staff in its use.

Antivenom produced in other countries can be imported for treating bites from certain species, but current import regulations make it extremely costly. Local production would reduce costs significantly, but the costs of production, research and testing are high, while research may take many years, with low prospects of finding an effective and marketable product unless the government agrees to subsidize purchases and distribution.

The conference hosted speakers from 10 countries and underlined the need for partnerships between actors across sectors and regions, which will have a significant impact on efforts to treat snakebite and other kinds of envenomation.

Research indicates that, besides causing injuries and death, some components of biotoxins also have potential to be used in treating a wide variety of illnesses, including cancer.

Experience in other countries shows that the linking of snake specialists and medical professionals is vital in the process of pinpointing areas where bite incidences are especially high, and ensuring accurate identification of the snakes responsible so that appropriate treatments can be given.

As the WHO points out, snakebite is primarily a disease of the poor, and unless governments are prepared to subsidize treatment costs, people who are among the poorest of global society will continue to suffer the consequences of envenomation.

The recent AMSEM meeting indicates that efforts are finally being made in Indonesia to acknowledge this widespread problem, as a first step toward remedial action. Experts hope the Health Ministry will acknowledge the social and economic problems caused by snakebite and other types of envenomation, and use its power to support necessary improvements, including antivenom production, training in hospitals and public education, which will save many lives and significantly reduce economic hardships.

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— Ron Lilley is a herpetologist living in Bali. He gives talks to schools and the public in Bali on snake identification, snake proofing and how to avoid snake bites.

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