Globally, some five million people are bitten by venomous snakes every year, and around 100,000 die. Thirty thousand of those deaths happen in Africa. In fact, the true numbers could be even higher, as many deaths are likely not reported. “Some people come too late and some don’t come at all, so we don’t actually know the full extent of the snakebite burden in the area,” explains Jacob Chol Atem, an MSF clinical officer in South Sudan. “But we do know it is a big problem and that people lose their lives because they can’t get treatment.”
Antidotes priced out of reach
Snakebite envenoming—the medical condition resulting from a snakebite—needs to be treated with antivenom in most cases. But antivenom is expensive and unavailable in many health facilities. Treatment can cost several hundred US dollars per patient—more than a year’s salary for many people, especially those in rural areas where most snakebite victims live. Additionally, governments don’t provide much support for this disease since it predominantly affects those who aren’t in a position to demand attention.
Snakebite is a poor person’s disease, and pharmaceutical companies don’t create medicines for the poor; they create products that will be lucrative. Previously, MSF used FAV-Afrique, an all-in-one antivenom, to treat envenoming from ten different snake species in sub-Saharan Africa. But the manufacturer stopped producing it because of a lack of profitability and the last batch expired in June 2016.
With no equivalent available, MSF had to find suitable alternative treatments. Two years down the line, MSF medical teams are now successfully using two new antivenoms in South Sudan: EchitabPlus and SAIMR-Polyvalent. “Before it was more straightforward: we could give the same antivenom even if we didn’t know which snake the patient had been bitten by,” says Atem. “Now, the treatment has become more complex and we administer antivenom depending on the patient’s symptoms. But overall, it works, and we are glad to have found an alternative.”
While this is good news for MSF patients in Agok, this approach is not the solution for all snakebite victims, as determining which of the two antivenoms to use based on symptoms is difficult for non-specialists. High prices keep antivenoms that are effective against venomous snakes in any given area out of reach of the people who need them most. It is a vicious circle in which countries don’t buy antivenoms for their hospitals because they are too expensive and pharmaceutical companies don’t produce them because so few buyers are purchasing them.
Antivenom is not always enough
Even with antivenom, treatment for snakebite is much more difficult when victims arrive late to hospitals. Delays can cause further damage, including “compartment syndrome,” which occurs when swelling caused by the venom increases pressure within a muscle compartment, to the point that blood cannot supply the muscles and nerves with oxygen and nutrients.
If left untreated, compartment syndrome can cause muscles and nerves to fail and eventually die. Once acute compartment syndrome has occurred, surgery is the only option. In the most severe cases, the damage may be so extensive that patients lose the use of their limbs or need amputations. An estimated 400,000 people globally are maimed or disabled every year as a result of snakebite.
The long road to recovery
Awien has been at the hospital for two months now. She was in critical condition when she arrived and was treated with three doses of antivenom. She was unconscious for the first five days, but eventually she came to and her condition began to improve.
She has since had multiple surgeries to remove dead tissue, as the muscles in her arm were damaged beyond repair as a result of compartment syndrome. Nineteen surgical procedures is an awful lot, but her family did not want her arm amputated and asked the medical team to do all they could to save it. Though the road to recovery has been long and difficult, Awien is lucky. For countless others, treatment for snakebite remains out of reach.