By Henrylito D. Tacio
While dengue fever, measles, polio, diphtheria and other infectious diseases are hogging the headlines last year, there is one disease that is not even mentioned nor given much attention although it is existing: snakebites.
“Snakebite is one of the neglected tropical diseases,” says Dr. Patrick Joseph G. Tiglao, board of director and secretary general of Philippine College of Emergency Medicine, Inc. “In the Philippines, the problem seems not to exist because of lack of awareness and lack of formal data.”
The Philippine Statistics Authority states there are about 300 documented deaths annually from snake bites. “(The figure) does not include those undocumented and improperly documented ones,” Dr. Tiglao laments. “Snakebite incidences alone may reach to thousands if data are gathered throughout the Philippines. It’s just the tip of the iceberg.”
One reason why the total figure is hard to come by is that most of those who die from it are from rural areas where reporting is almost nil. “Mainly because snakebites are happening in the outskirts, in the community where most of the patients would rather go to the traditional healers than consult with physicians,” Dr. Tiglao says.
“It is also bothersome to note that this is a disease of the poor,” he continues. “Those inflicted are farmers and mountain inhabitants who do not have access to immediate medical care. That’s the reason why it is not properly documented and underreported. It is not even part of the reportable cases. With lack of data or documentation, presto, the disease does not exist.
Rural incidents
According to Dr. Tiglao, snake bites occur mostly in rural areas as it is an occupational disease. “It mostly affects people from the farming industry,” he says, adding that there are also fishermen who are bitten by sea snakes.
Science Daily reported that the number of people who die of snakebites is “comparable to that of AIDS (Acquired Immune Deficiency Syndrome) in some developing countries.”
As in the case of the Philippines, the true incidence of venomous snake bites all over the world is difficult to ascertain as it is often underreported. However, the Geneva-based World Health Organization (WHO) estimates about 5.4 million victims per year, with an estimated 80,000 to 130,000 deaths. There are also 400,000 survivors but most of them suffer from permanent disabilities and other after effects.
Snakes have existed since time immemorial. In fact, snake figures prominently in the Garden of Eden. For successfully convincing Eve to eat the forbidden fruit from the Tree of Knowledge of Good and Evil, God punished the snake.
In Exodus, a snake made its appearance when Moses turned his staff into a frightening reptile. Moses also made a bronze snake on a pole that when looked at cured the people of bites from the snakes that plagued them in the desert. “Anyone who is bitten and looks at it shall live,” God told the prophet.
In medicine, a snake is also used as a symbol. “Snakes are sometimes perceived as evil, but they are also perceived as medicine,” Hollywood actor Nicolas Cage was quoted as saying. “If you look at an ambulance, there’s two snakes on the side of the car. The caduceus, or the staff of Hermes, there’s the two snakes going up it, which means that the venom can also be healing.”
Home to deadliest species
There are over 2,900 species of snakes and they can be found on every continent except Antarctica. “Most of the species of snakes in the Philippines are harmless but the country is also home to some of the deadliest snakes in the world that is why venomous snake bites still represent an important, albeit largely unpublicized, health hazard in the country, especially in the rural areas,” Dr. Eduardo M. Gonzales wrote in his Manila Bulletin column.
Being a tropical country, the Philippines is blessed with the most ecologically unique and fascinating wildlife on the planet. The ecosystems on both land and sea are prime habitat for many snake species. Most of them prefer to live in moist areas like rivers.
While most of the snake species are harmless, the best advice is to treat all snakes as potentially dangerous. About 19 venomous snakes have been identified in the country, but they are classified into four categories: cobras, pit vipers, coral snakes and sea snakes.
Cobras are recognized by the intimidating hoods that extend on both sides of their heads. “Bites by cobras are immediately painful and tender to touch,” factsanddetails.com states. “When biting, these cobras tend to hold on and chew savagely. Specific symptoms of cobra envenomation include drowsiness, difficulty in speaking, drooling, blurred vision, shortness of breath, and loss of consciousness. These symptoms occur within one hour after the bite. Respiratory arrest can occur within minutes.”
In Samar, spitting cobras are common. They do so due to their nervous personality and when they are cornered. While the spray of venom (which can reach up to 2 meters) “is not especially harmful to intact skin, these cobras aim for the face and eyes, and it can cause blindness if not flushed and treated right away,” the website of Uncharted Philippines stated.
Pit vipers, on the other hand, are brightly-colored snakes which dwell in trees. One special feature about these types of snakes is that they give live birth to their young instead of laying eggs.
“Pit vipers possess a very sophisticated venom delivery system,” factsanddetails.com says. “Large tubular fangs are placed in the front of the mouth and they are hinged, allowing them to be folded back when not in use. Their venom is primarily hemotoxic and all of the lanced-headed vipers of the Philippines are capable of inflicting a dangerous bite.”
Although sea snakes are completely marine creatures, they are air breathers and must surface to breathe. “Generally, sea snakes are not aggressive,” says factsanddetails.com. “They are not thought to strike humans unless provoked, nor do they typically actively pursue swimming prey.”
There are some sea snakes whose venom is several times more toxic than the cobra’s. “Fortunately, only small amounts of venom are usually injected, so fatalities are rare,” factsanddetails.com says. “The most serious bites involve multiple serrated-edged lacerations which may result in death from respiratory, heart, or kidney failure.”
Coral snakes are different from sea snakes. “Coral snakes are identifiable by their markings, which consist of multicolor bands or stripes,” writes Alexander Harris for animals.mom.me. “Primary nocturnal, coral snakes avoid dry areas and populate scrub jungles and monsoon forests. They avoid human contact and are for the most part docile.”
How snakes do it
Snakes inject venom through their fangs. “Snakes that inject venom use modified salivary glands,” the WebMd.com explains. “Venom is a modified form of saliva and probably evolved to aid in chemical digestion. Varying degrees of toxicity also make it useful in killing prey.
“During envenomation (the bite that injects venom or poison), the venom passes from the venom gland through a duct into its snake’s fangs, and finally into its prey,” the website adds.
Snake venom, the United Nations health agency says, can “cause paralysis that stops breathing, bleeding disorders that can lead to fatal hemorrhage, irreversible kidney failure and tissue damage that can cause permanent disability and limb loss.”
Preventable
“Filipinos must be aware that snake bites are preventable,” says Dr. Tiglao, who is a member of the Remote Envenomation Consultancy Services (RECS), which do volunteer consultations for those inflicted with snakebites. “It is also curable when properly managed.”
In an exclusive interview, Dr. Tiglao shares the following first aid measures to prevent further harm: reassure the patient to keep calm and avoid panicking; immobilize the extremity or part bitten; and get to the appropriate hospital immediately.
The patient must tell the doctor the details pertaining to the bite (events prior to being bitten, symptoms, first aid done, location of the bite, snake characteristics or picture of the snake).
“Filipinos should be aware that we have three species of cobras and all are being treated with one antivenom,” Dr. Tiglao says. “The antivenoms are limited to specific hospitals, mostly government institutions. For other species of snakes, we do not have antivenom for them. So, if you are bitten by a pit viper, no antivenom is available in the country.” – ###
