Action plan to boost rural hospitals in India's snakebite crisis

Despite the infrastructure advancements rural hospitals are still struggling with a critical gap that includes a lack of trained medical personnel and medical infrastructure to manage snakebite emergencies Snakebite still remains a silent yet deadly public health crisis thus affecting rural populations The recently launched National Action Plan for Snakebite Envenoming NAPSE aims to change this by prioritizing medical training referral systems and infrastructure improvements to ensure timely lifesaving treatmentA paper titled Primary Health System Strengthening and Systemlevel Interventions for tackling snakebite envenoming in India by Priyanka Kadam Stuart Ainsworth and Bhupeshwari Patel was published by Transactions Journal of the Royal Society of Tropical Medicine and Hygiene before World NTD neglected tropical diseases day on 31st JanuaryPriyanka Kadam PhD Hon President and Founder of Snakebite Healing and Education Society Member of WHOs roster of experts on Snakebite Envenoming said India reports the highest number of snakebite deaths annually with 58000 lives lost each year surpassing other countries with high snakebite burdens As a result snakebite has been designated a notifiable disease and included in the National Health Program Timely treatment at Primary Health Centres PHCs can significantly reduce this burden However PHCs face numerous challenges including high staff vacancies inadequate infrastructure and a lack of skilled personnel to handle medical emergencies such as snakebites To address this it is crucial to allocate at least 2537 of the countrys GDP to enhance the medical facilities at governmentrun health centres across IndiaAccording to the research paper Snakebite envenoming is classified by the WHO as a priority neglected tropical disease and it presents a significant global health challenge inflicting substantial morbidity and mortality India bears the highest snakebite burden with approximately 58000 deaths reported annuallyFor the past 13 years the Snakebite Healing and Education Society of India operating within the civil society sector has been dedicated to mitigate the impact of snakebites through both grassroots interaction extending to the remotest regions across 12 snake bite endemic states in India and through national and international advocacyAs snakebite envenoming is a medical emergency prompt treatment which includes antivenom administration is crucial in obtaining positive outcomes In other global snakebite endemic regions that experience a high snakebite burden lack of antivenom is often cited as a primary cause of high mortality India has five major antivenom manufacturers ensuring ample availability of antivenom which is provided free of charge in government hospitals Although the efficacy and availability of antivenoms available in India may vary it is their experience that these issues are not primary factors in contributing to high snakebite mortality in India Instead the high number of snakebite deaths is primarily attributable to delays and barriers in snakebite victims accessing healthcareThe research paper also states that the rudimentary facilities and lack of knowledge in appropriate snakebite management in many PHCs make handling medical emergencies such as snakebite a daunting task This results in frequent referral of snakebite victims commonly without primary treatment or stabilisation to higher district hospitals which are often located some distance away in major population centres further delaying critical treatment and intervention and so increasing the likelihood of poor outcomesOften these patients are transported privately by the family with little to no medical support often resulting in patients dying en route In discussions with SHEINDIA during districtlevel Doctors and Nurses capacitybuilding workshops clinicians who are familiar with the treatment of snakebite in India listed 10 common reasons why snakebite patients are referred from PHCs to other hospitals A lack of trained medical personnel capable of managing snakebites An absence of antivenom and necessary supportive drugs Inadequate respiratory support equipment Apprehension about anaphylaxis following antivenom administration Cases where the snake responsible and the physical signs and symptoms of envenomation are unusual or atypical Insufficient beds available for patient admission at PHCsPatient families being uncertain about the treatment provided at PHCs Concerns regarding potential violence from the patientrsquos family if the condition worsens Absence of a pathological laboratory for diagnostic purposes especially for viper envenomation and Lack of a blood bank investigation facility and dialysis machine or qualified technician in PHCsThe list above demonstrates areas in which interventions could be put in place to mitigate the referral of snakebite patients from PHCs to higher level hospitals states the paperIn conclusion the paper clearly states that over the past two decades there has been significant proactive investment in infrastructure development across India with a primary focus on building roads bridges railways and hospitals However hospitals in many areas still face challenges related to the availability of medical personnel with appropriate knowledge of snakebite care and the associated medical infrastructure in which to manage it We hope that the recent publication of the NAPSE with a focus on education and training for proper emergency snakebite care and referral practices alongside improving infrastructure will lead to a wholesale change over the next decade towards more frequent positive outcomes for rural populations exposed to snakebite in India