At least four persons including two siblings died of snakebites in the Kapilvastu district last Monday. Since the temperature started rising, many districts across the country have reported incidents or deaths from snakebites.

The Ministry of Health and Population, however, doesn't have data on the actual number of snakebite victims who perished.

According to the Epidemiology and Disease Control Division, nine deaths from snakebites have been reported in the past one year. This figure is a huge understatement, experts say. Since the beginning of the current fiscal year, 6,047 cases of bites by non-poisonous snakes and 1,037 cases of poisonous snakebites have been reported.

Incidents of snakebites and resulting deaths are common in Nepal, but the issue still remains grossly neglected and experts call it a lurking if invisible crisis.

Of late, cases of snakebite have been rising even in the hills and the mountainous areas. Though a detailed study is yet to be carried out, experts attribute warmer weather caused by climate change to the growing bite incidents in the hill and mountainous areas.

Here is all you need to know about increasing cases of snakebites in Nepal:

2,700 deaths a year

Around 2,700 people, mostly women and children from Nepal’s Tarai region, die of snake bites every year, according to a report titled “Snakebite epidemiology in humans and domestic animals across the Tarai region in Nepal: A multi-cluster random survey.”

The study was jointly carried out in 2018 and 2019 by experts at the BP Koirala Institute of Health Sciences; the Division of Tropical and Humanitarian Medicine, Geneva University Hospital; the Institute of Global Health, Department of Community Health and Medicine, Faculty of Medicine, University of Geneva; the Institute of Environment Science under Geneva University; and the Department of Control of Neglected Tropical Disease, World Health Organisation Geneva. The report was also published in The Lancet, a leading international medical journal.

Data from the Ministry of Health and Population, however, shows only around 1,000 yearly hospital admissions after snake bites.

“Those who die in communities do not get reported in the government records,” said Dr Hemanta Ojha, chief of the Zoonotic Section at the Epidemiology and Disease Control Division.

Snakebite is a life-threatening medical emergency. Survival depends on first aid measures and immediate transport to the nearest health centre with anti-snake venom and supportive care facilities.

Study shows close to 3,000 people die from snakebites every year in the Tarai alone, many before reaching the hospital. Victims do not even get ambulances on time. Even if they do, it is difficult to find the right place for their proper treatment.

According to the aforementioned study, most deaths (40 percent) occur in the villages, 40 percent during transport to treatment centres, while the remaining 20 percent occur in hospitals.

All hospitals do not treat snake bites, as they do not have trained human resources or access to anti-snake venom serums. Doctors say many victims die before getting primary care.

In the first week of June, two siblings from Dudhauli Municipality-1 of Sindhuli district were pronounced dead upon reaching hospital. The boys were rushed to a nearby primary healthcare centre first, but were referred to a hospital in Janakpur, which took them five hours to access. By then, it was too late.

“In snakebite cases, the first one hour after the bite is the golden hour,” said Dr Sanjib Kumar Sharma, rector at the BP Koirala Institute of Health Sciences who is also a snakebite expert at the World Health Organisation. “The more time taken to reach the hospital, the greater the risk of dying. A lot of people bitten by venomous snakes die before reaching hospital.”

Conservative beliefs, neglected disease

The conservative belief of consulting traditional faith healers, snake charmers and shamans, instead of going to healthcare facilities at the earliest, is the primary reason for many snakebite deaths, according to experts.

There are also incidents of deaths of women and children from snake bites while they are confined to the Chhaupadi (menstrual huts) in rural Nepal.

Snakebites are a major public health scare in Nepal. However, there has been little attention in addressing it.

Snakebite incidences are also common among cattle and thousands of farmers are affected every year.

“You could die from a snakebite. It also results in hospitalisation and disability, which ultimately affects their income generation,” said Sharma. “When animals die of snake bites, the farmers also face big financial losses.”

The UN health body has added snakebite envenoming to the list of neglected tropical diseases, highlighting the need for stronger epidemiological evidence in endemic countries such as Nepal.

Women, children and the poor

Of the 25 beds at the general ward of Sukraraj Tropical and Infectious Disease Hospital in Teku, 15 were occupied by snakebite victims on Wednesday.

Doctors at the hospital said most victims are women and children who were bitten by a snake either while working in the field, or while playing in the open. Poor people living in thatched-roof houses are also highly vulnerable to snakebites, as snakes visit such homes in search of rats.

“It is true that snakes do not discriminate between rich and poor, or male and female. But the fact is women, children and the poor are the most vulnerable to snakebites,” said Dr Manisha Rawal, director at the hospital.

Doctors say small children are at a risk of dying from snake bites as they do not inform their parents about having been bitten on time due to their fear of getting scolded for playing in the bushes or outdoors.

Commitments, challenges, climate change

The government has committed to achieving the national target which is aligned with the World Health Organisation’s target of a 50 percent reduction in deaths and disabilities through snakebite envenomation by 2030.

Officials say they have been focussing on strengthening healthcare services and starting awareness drives about the risks. “We have developed a national guideline for the management of snakebites, provided training to health workers, prepared master trainers, and supplied anti-snake venom to health facilities of the Tarai regions,” said Ojha of the Epidemiology and Disease Control Division. “Awareness drives have been launched through all available means about the risks and messages are being sent across in five different languages—Maithili, Abadhi, Tharu, Bhojpuri and Nepali.”

Each year, the health ministry purchases 20,000 vials of anti-snake venom worth around Rs20 million, which are provided free of cost to the victims.

Though a study on the direct link between climate change and rising incidents of snakebites has not been carried out in Nepal, experts say warmer weather is responsible for the rise in snakebite cases. Cold-blooded animals, including snakes, become more active in warm temperatures, they added.

Moreover, venomous snakes have been moving even to the hills and mountainous areas, and warmer weather is helping them survive there, thus making even these areas prone to snakebites.

“Deaths from snakebites have been reported from hilly districts too,” said Ojha, an EDCD official. “Health facilities from hill and mountain districts like Doti and Darchula have asked for anti-snake venom for the treatment of snakebite victims.”

What’s the remedy

Experts say there should be a greater awareness drive on keeping the houses and surroundings clean, prevent children from playing in the bushes and people should avoid walking during the night. If absolutely necessary, they must use torch light while walking in the dark.

“The residents of the Tarai region should use mosquito nets while sleeping, which not only protects from mosquito bites but also from snakes,” said Sharma, the snakebite expert. “Rush the victims to hospitals immediately after a snakebite, using whatever form of transport is available. Don’t wait for an ambulance. Motorbikes, which are widely available, can be an ideal means of transport.”