You have to love an article with the line: "this is very good news not only for the horses but for human patients".

Is there an opportunity to focus snake bite prevention and treatment to areas of the country where the need is greatest?

Jamie

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Australia brings snake bite expertise to Myanmar
Ron Corben
February 25, 2017

BANGKOK -- Snake bites kill hundreds of people every year in Myanmar and leave thousands more with lifelong disabilities. Many could be saved if anti-venom treatments could be delivered faster, especially in rural areas, say experts. But decades of decline in the country's vital health infrastructure must first be reversed.

The scale of the problem reflects the shape of Myanmar's economy, in which agriculture, especially rice production, accounts for 40% of national output. About 60% of the nation's 55 million people are economically dependent on farming. But paddy fields and rice stacks draw rats and mice, luring dangerous snakes such as Russell's vipers and cobras into close contact with humans.

Myanmar's official figures put the annual toll at 13,000 cases of snake bite and at least 600 deaths. But the true total may significantly bigger. "Official figures are not perfect all the time," said Dr. Chen Au Peh, a renal specialist at Australia's Royal Adelaide Hospital. "We wonder if the real figures may be somewhat higher than that -- but we are not sure of the facts."

Peh leads an Australian team with $2.3 million Australian dollars ($1.8 million) in funding from Canberra for programs to improve Myanmar's snake bite treatment record as part of a four-year partnership with Myanmar's ministries of industry and health.

Another team member, Dr. Afzal Mahmood, a senior lecturer in public health at the University of Adelaide, said the project followed earlier involvement by Australian medical professionals called in by the Myanmar government to help rebuild the infrastructure surrounding anti-venom treatment.

"When we started working three years ago on this issue, we came to know that the snake bite for rural [people] and the farmer has a huge family economic burden," Mahmood said.

Victims often face long periods of hospitalization, he said, leaving families with medical bills amounting to many months of earnings for hospital and transport expenses, even after government subsidies. "Everything adds up, [and] people go further into poverty with these public health issues."

Peh said he became aware of Myanmar's high rate of renal failure during earlier visits to the country. Snake bite victims often face severe kidney failure, which is "one of the most feared complications of the bite from the Russell's viper," he said. "It is true that even to this day, something like 70% of patients with acute kidney failure in [Myanmar] [have suffered] a snake bite. It is an enormous problem."

Other complications can also arise, said Mahmood. In cases where first aid is poor and tourniquets are applied, blood supply to affected limbs can be damaged, resulting in amputation. "This affects many people. Psychological issues post-bite are not only [a matter for] the person but the family ... suffers. It's a very life changing experience," he said.

The Australian project is aimed at creating a sustainable project model that is capable of duplication throughout the country.

The focus has been on Mandalay, in central Myanmar, where the Australian health professionals are working with one of the largest divisional hospitals -- the Mandalay General Hospital. The region faces about 700 to 800 snake bite cases a year and is intent on building on guidelines, protocols and standard operating procedures for the health sector.

"We have produced revised guidelines for the doctors [and] some diagnostic tests and the training of some 200 health care providers," said Mahmood.

The crucial goals are to shorten the time that elapses between bites and emergency treatments, and to ensure the availability of anti-venom at local clinics, the first call for most snake bite victims. Locally produced anti-venom has been in short supply in recent years, and imports from other countries in the region are often less effective.

Farmers in distant fields may be some distance from the nearest clinic or hospital. "Six or seven miles [10km-11km] of dirt road, with lots of holes, will take several hours to travel. So all these factors accumulate to a long delay between bite and the administration of anti-venom," Peh said.

Anti-venom also requires storage by refrigeration. But electricity supplies are often interrupted, especially in rural areas. To overcome this challenge Australia has supplied an initial 30 solar powered refrigerators for use in areas with frequent snake bite cases where electricity supplies are irregular.

"It's a small gesture but it means that for those patients and farmers who live around those areas [who] so unfortunately get bitten, if there is anti-venom in these refrigerators they can get help immediately, rather than have to wait for a truck or motorbike or an ox cart to drive them ... to the next hospital," said Peh. He added that this allows patients to be stabilized immediately, and then transferred to bigger hospitals, "so they have a better chance of survival."

The project is also about horses, which act as the "production factory of anti-venom antibodies," as Peh put it. Myanmar's economic decline in recent decades has undermined anti-venom production and veterinary practices. The Australian team initially discovered high mortality rates among 350 horses used to produce the serum, with at least 50 horses perishing each month.

Peh said poor nutrition, anaemia, and infections linked to the venom immunization program were among the main reasons for the high mortality rate, which fell by 80% after Australian veterinarians were called in to assist local workers. "In the last 10 months the average horse mortality is something like six or seven per month -- compared to 50 per month. And this is very good news not only for the horses but for human patients who may need the anti-venom," Peh said.

Production of anti-venom has risen from 60,000 vials a year to 100,000 vials. "The more horses that survive the month, the more vials of anti-venom you can produce," he said.

Key to the project's success, according to Mahmood, is to ensure it remains sustainable when the Australian team leaves. Myanmar vets have been visiting Australia to observe best-practice care, and snake handlers have been trained to ensure that venom drawn from the snakes for anti-venom production is of high quality.

"So the snake bite incidence is decreased, and ... we are going from community to community and empowering the people so they stay [to provide support] -- even when we have left," Mahmood noted.

http://asia.nikkei.com/Life-Arts/Life/Australia-brings-snake-bite-expertise-to-Myanmar