A nurse’s journey to treat snakebites

WSNA member Kyla Arama, a neonatal intensive care unit nurse at University of Washington Medical Center, is taking on a major public health problem that affects much of the world: snakebites.

In 2017, the World Health Organization (WHO) added snakebite envenomation to its roster of neglected tropical diseases, which includes rabies, dengue, and leprosy.

Arama, a volunteer in Sierra Leone since a teen-ager, heads up the medical side of Bridge of Hope, a faith-based nonprofit working in Sierra Leone, a country located on the southwest of Africa bordered by Liberia and Guinea

“Whenever the local healthcare teams tell us about a health need, we try to fill that need with sustainability and partnership,” said Arama.

Africa is home to more than 400 snake species, of which about 30 venomous species are known to have caused human deaths, according to WHO. WHO estimates 435,000 to 580,000 snakebites need treatment annually in Africa.

With limited access to effective treatment and a deep reliance on traditional healing methods that are often risky, many victims in Sierra Leone—especially those in rural areas—have suffered severe complications or lost their lives.

Bridge of Hope has been working in partnership with Caring Hands Hospital in Makeni and  the Asclepius Snakebite Foundation to combat snakebite deaths.

Now, their efforts have gone national. 
 
In February, the team invited 53 healthcare providers from across Sierra Leone for an intensive three-day training program. The training Feb. 12-16 was held at the Bridge of Hope compound in Makeni. The goal was not only to educate the providers on identifying venomous snakebites but also to equip them with antivenom once new shipments arrived.

Arama said at first, people were nervous about the team. “They wondered, ‘Who are these outsiders?’ she said.

By the end of the program, the group had bonded, even culminating in a celebratory song about snakebites written by one of the providers (see below).

At the snakebite training in February, the group practices a song about snakebites.

Understanding the danger

Arama said venomous bites can cause three outcomes:

• Cytotoxic bites cause extreme swelling and potential limb loss.
• Hemotoxic bites lead to severe internal bleeding.
• Neurotoxic bites attack the nervous system, leading to paralysis and respiratory failure.

Some snake species possess venom with all three properties, making swift and effective treatment critical. The only solution is antivenom—an expensive and often scarce resource.

In Sierra Leone, access to health centers is hindered by a rainy season that runs half a year and roads that are washed out.

Currently, traditional healers are the primary caregivers for snakebites in Sierra Leone. These treatments include an ancient tradition called black stone that dates back to the 1400s. The black stone is often a charred animal bone or stone, which is secured over the bite to absorb the venom. Healers also apply a tourniquet and cut around the bite to release venom. Unfortunately, when a tourniquet is removed, the venom can surge, causing more damage. And cutting out the venom can lead to infections.

Snakebite survivors may credit these practices with saving their lives because about half of the bites from venomous snakes are dry, with no venom injected, according to Eugene Erulu, a physician at Watamu Hospital in southern Kenya, in an article in National Geographic in 2020.

To combat misinformation, Bridge of Hope and the Asclepius Snakebite Foundation have been working on public outreach. Local physicians have appeared on the radio, educating communities on what to do if bitten by a snake. The team is even developing a curriculum to teach snakebite response in primary schools.

Scaling up the solution

Depending on the snakebite, patients need between two and eight vials of antivenom, costing around $40 each, said Arama. She said her team gets their antivenom from Mexico as a dry powder for equatorial snakes. Then the powder is reconstituted.

Bridge of Hope initially ordered 350 vials and have since doubled their order to 700 to meet growing demand. Arama said.

The next steps are ambitious. Bridge of Hope is applying for grants from the Wellcome Trust and the Sierra Leone Ministry of Health to make the program more sustainable. They are also part of a pilot study on rapid testing and treatment for snakebites, a project that could transform how these emergencies are handled across Africa.

Bridge of Hope started tracking snakebite fatalities after its first training with Caring Hands Hospital in February 2020. With a recorded 298 cases in Makeni since 2020, the fatality rate is just 2 percent.

A little girl saved

For Arama and her team, the fight is transforming so many lives. She recalls one of their first cases—a little girl who was bitten by a mamba in 2020. Late at night, there was a knock on the door, and a family brought the child to the team.

“She was shaking, struggling to breathe,” Arama said. “We used eight vials to save her life. She 100 percent would have died without treatment.”

The fight against snakebite deaths in Sierra Leone is far from over, but real progress is being made.