Charles C. Hofer - Snakebite!: Antivenom and a Global Health Crisis

Venomous snakes live all over the world, and their deadly bites kill thousands of people each year, especially in regions such as sub-Saharan Africa, Southeast Asia, and South America.

On a hot August night, three medical doctors settle in for a relaxing dinner after a long days work. American physician Dr. Leslie Boyer and two colleagues have spent the day visiting a small hospital in Tanguita, a small village in the African nation of Benin.

At dinner the three doctors talk about the days events and the work that lies ahead. They have come to Benin to train local medical workers and to help solve a health crisis that is ravaging this part of the world. The epidemic is snakebite, a health crisis that strikes young and old alike, killing tens of thousands each year across sub-Saharan Africa. This large, tropical region stretches across the continent south of the Sahara, the worlds largest hot desert. The region includes the nations of Ethiopia, Nigeria, and Rwanda.

People in Benin and other African nations experience hundreds of snakebites each year.

A cell phone rings. I know you were just here all day, says a frantic voice on the other end. But a little boy has just arrived, and hes desperately sick! Within minutes the three doctors abandon their meal and are back in their Land Rover, lurching over the endless bumpy dirt roads that crisscross the sprawling Benin countryside. The journey back to the hospital in Tanguita will take an hour, and every second counts.

The doctors arrive shortly before midnight. Hospital workers swiftly escort them to a ten-year-old boy curled up in a small hospital bed. He is bleeding from his eyes, and he is going into shock, a medical emergency that causes basic bodily functions such as breathing to shut down. The boy is unable to talk or hold himself up. His abdomen is swollen too, suggesting that he might be bleeding from the inside.

To Boyer and her colleagues, the cause of the symptoms is obvious: the boy was bitten by a venomous snake. Such snakes use a dangerous biological chemical known as venom to ward off perceived threats. The venom can be deadly to people and other animals. In talking with the boys family, the staff knows that the boys bite occurred less than fourteen hours ago. His condition is getting worse with each passing minute. At the location of the bite, near the boys ankle, the skin has turned dark. His ankle has puffed up with swelling. The snakes venom is spreading rapidly, coursing through the young boys body and attacking it from the inside.

Small cuts on the boys leg near the bite indicate that a family member or local healer tried traditional healing methods before bringing the boy to the hospital. These methods often involve cutting the wound so the snake venom will leak out with the blood. However, this causes an additional loss of blood and delays proper medical attention. The only lifesaving treatment for a venomous snakebite is antivenom. The medicine is created from the deadly venom itself. If doctors dont take action immediately, the boy will die before sunrise.

Dr. Boyer ( left ) of the University of Arizona in Tucson, Arizona, and a local doctor examine a snakebite patient in Benin. The boys foot and ankle are dark and swollen, common symptoms of a snakebite.

The hospital has already given the boy the only two vials of antivenom they had. But the medicine did not slow the effects of the snakes venom. Luckily, one of Boyers colleagues has brought a personal supply of effective antivenom with him. Will this be enough? The clock is ticking, and the venom already has a significant head start.

The doctors carefully administer the medicine, using a needle to inject the boy with a higher dose and at a faster rate than is typical for antivenom. Its a dangerous way to deliver the medicine, but they have no other options. Time is running out.

The team steps back to watch the boy as the antivenom goes to work. If it doesnt work, nothing more can be done.

In less than an hour, the boy stops bleeding. His breathing returns to normal, and he sits up in bed. My leg itches! he exclaims. Everyone in the room breathes a sigh of relief. The boy is well on his way to recovery.