Snakebite Epidemic

Snakebites kill tens of thousands of Africans a year

SIMON ISOLOMO AWOKE around 5 a.m., said goodbye to his wife and seven children, and climbed into his dugout canoe. That Tuesday in December 2018 had begun like many others in Isolomo’s 30 years of fishing in the province of Équateur, in the Democratic Republic of the Congo. Paddling on the Ikelemba River toward his fishing camp with a couple of friends, Isolomo, a 52-year-old French teacher, snacked on kwanga, a popular manioc dish, and enjoyed the cool morning air.

Three hours later they arrived at the camp, and Isolomo began checking the fishing lines he’d set up the day before. Feeling resistance on one, he thrust his hand into the murky water.

A sharp pain sent him reeling. Blood oozed from two puncture wounds on his hand. Just below the surface, a yellowish snake with black rings—probably a banded water cobra—slithered from view.

Isolomo’s companions helped him into the canoe and paddled frantically back to their village of Iteli. By the time they arrived, about three hours after Isolomo was bitten, he was slipping in and out of consciousness.

“His eyes had changed color, and he was vomiting,” his wife, Marie, recalls, starting to cry. After a traditional healer applied a tourniquet, they set out by canoe for the hospital in Mbandaka, the provincial capital, some 60 miles away. But before they arrived, Isolomo stopped breathing and died.

Isolomo’s story encapsulates the global snakebite crisis: Bitten in a remote area, hours from the closest hospital, he didn’t have a chance. As many as 138,000 people around the world die from snakebites each year, according to the World Health Organization (WHO), and roughly 95 percent of those deaths occur in poor, rural communities in developing nations. Another 400,000 people survive with amputated limbs and other permanent disabilities.

One of the worst-hit locations is sub-Saharan Africa, where up to 30,000 deaths from snakebites are believed to occur each year. But some doctors and snakebite experts say the true toll may be double that. A major factor is a severe shortage of the only medicine that can neutralize the toxins of dangerous snakes: antivenom. Complicating matters is that many victims, for lack of money or transportation, or because of distrust of Western medicine, don’t go to hospitals—or don’t get there in time. Staff at many health centers are insufficiently trained to treat snakebites, and even if the drug is on hand, it’s too expensive for many victims. Additionally, most of the more reliable African antivenoms need to be kept refrigerated to stay stable and effective. With frequent power cuts, even in cities, keeping them cold can be nearly impossible.

To draw attention to the snakebite crisis and to attract funding for research and treatment, in 2017 WHO added snakebite envenomation to its roster of neglected tropical diseases, which includes rabies, dengue, and leprosy. In 2019 it announced a goal of slashing the number of annual deaths and disabilities from envenomation by 50 percent by 2030—an undertaking that could cost nearly $140 million.

Most African snakebite victims are farmers who work in remote fields barefoot or in sandals, making them particularly vulnerable. Once a venomous snake strikes, a race against the clock begins. Transport to the nearest hospital can take hours, even days. By then it may be too late.

The venom of elapids, a family of snakes that includes mambas and cobras, can kill within hours. Their neurotoxins rapidly paralyze respiratory muscles, making breathing impossible. The venom of vipers, however, can take several days to kill, interfering with clotting and leading to inflammation, bleeding, and tissue death.

Agile and arboreal, the eastern green mamba is one of four African mamba species. Mamba strikes can release a neurotoxic venom that acts quickly, paralyzing respiratory muscles and causing death by asphyxiation.

A puff adder, one of Africa’s most dangerous snakes, basks on a warm rock in Guinea. In 2017 the World Health Organization added snakebite to its list of neglected tropical diseases, spotlighting this health crisis to attract funding for research and treatment.

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