David Williams grew up in rural Australia among all kinds of creepy crawlies. He kept lizards and snakes as pets, even venomous ones. He has been bitten six times, but that has not put him off research into finding a cheaper and more effective anti-venom to treat bites.
Williams now heads the Global Snakebite Initiative and has been helping in snakebite management in Cambodia and Papua New Guinea. He is in Kathmandu for the first international conference on snakebite in Nepal this weekend, and spoke to Nepali Times.
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Nepali Times: Why hold a snakebite conference in Kathmandu?
David Williams: One of the main reasons the conference is being held here is that Nepal has got a lot of expertise, doctors who are very interested in research and want to fix the problem and initiatives like the motorcycle volunteers. There are many diseases that have no cure or treatment, but snakebite is something that is eminently treatable, nobody should have to die from it. So with a reasonably modest amount of investment by health ministries and supporting organisations, we can solve the problem of snakebite. Nepal has all the elements necessary to tackle its snakebite epidemic, and save lives.
What are the main challenges?
There is a solution to snakebite problems, but it is largely a matter of investment. Production of anti-venom requires putting the money into establishing manufacturing facilities, having a proper quality control and a regulatory agency that is able to provide oversight of manufacturing. The same goes for collecting venom. So it is a matter of commitment, and spending the money to do it in the right way. The things that hospitals need to have in order to effectively treat snakebite patients are often the same types of medical consumables that are needed for a lot of other diseases. So if you have a strong health care system that is functioning well with the right drugs and treatment, then we are likely to achieve better outcomes.
But are these interventions possible in Nepal?
It is a lot easier and cheaper to prevent snakebite than to deal with consequences, so community education and awareness for behavioural change is probably the most important aspect. Another is having sufficient stock of effective anti-venoms. Countries have to ensure that reliable supply, and one way to go about is to ask for World Health Organization (WHO) assistance. The good thing is that there has been some strong research in this area with which Nepal should be able to take an initiative to be able to make anti-venom within the country and not rely so much on India. It is especially important to have addition supply of anti-venom this time of the year, when snakebite becomes an epidemic.
The WHO wants to halve snakebite deaths by 2030. Is this realistic?
It is fairly easy to achieve and there is good evidence to back this up. In Ghana it was found that if you introduce effective treatment, train nurses and doctors who deliver the treatment, and educate the community to come to the hospital sooner, fatalities can be reduced by as much as 80% in a very short period. It took Ghana only 18 months. So I think having 12 years from now to cut the fatality and disability by 50% is quite a reasonable target. At core it is about effective treatment, health workers who know how to give treatment and communities that prioritise getting that treatment.
Is climate change pushing venomous snakes up the mountains?
If the world keeps warming, yes. As the weather warms up here in Nepal with climate change, you will start finding venomous snakes in areas where they were never found before because it was too cold. Another aspect that can contribute is changes in the habitat. For example, with deforestation you create open habitats that a lot of venomous snakes, such as the cobras and the Russell vipers, actually find more conducive to their lifestyle.
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