Benedict Moran: In this hospital in eastern Nigeria, doctors are receiving the first patient of the day. 19-Year-old Pwagrida Samson was bitten in the foot by a carpet viper. It’s a small, aggressive and highly venomous snake that is common in this part of the country. 

Pwagrida Samson: I was in the field and walking to go to the toilet and I stepped on a snake and was bitten. Now I’m having a lot of pain where the bite is.

Benedict Moran: This hospital isn’t an ordinary one. It deals exclusively with victims of snakebites. And Samson is a typical patient in typical danger. Venom from a carpet viper prevents coagulation, and without treatment, he could bleed to death. Samson first treated his injury at home in his village, using traditional remedies. But after two days, the bleeding continued, so he travelled more than 100 miles over difficult roads to come here. Now, his foot is severely swollen.

Dr. Agom Dauda Ibrahim: There is swelling already so the tissue is compromised so if there’s an infection, the infection can set in rapidly much more than in a normal tissue.

Benedict Moran: This is the only hospital of its kind in sub-saharan Africa. Demand for its services is strong.

Benedict Moran: We’ve only been here at the Kaltungo Snakebite Hospital for about thirty minutes and within that time three patients have been admitted here.

Benedict Moran: Globally, around 120,000 people a year die from venomous snakebites, according to the World Health Organization. To put that in perspective, in 2018, more people died of snakebites than were killed in war. India and neighboring countries in Asia have the highest number of fatalities. In Africa, the highest caseload is in Nigeria. At least 10,000 people a year here are bitten. One in five of them die. Many more deaths and injuries go unreported. So says doctor Abdulrazaq Habib, of the research coalition known as the Global Snakebite Initiative.

Dr. Abdulrazaq G. Habib: Only about 8 percent of victims of snakebites go to a formal hospital, meaning over ninety percent are faceless, no one knows them, no one has seen them. If we are not aware of them, how can we speak for them.

Benedict Moran: Habib says snake venoms can contain numerous proteins, enzymes, and toxins that not only prevent blood from coagulating, but can also destroy cells, or cause blood pressure to plummet. They also can disrupt signals in the nervous system, causing muscle paralysis. The WHO recently moved snakebite poisoning to the A-list of neglected tropical diseases targeted for elimination.

Dr. Abdulrazaq G. Habib: In contrast to the rest of the neglected tropical diseases, snakebite is the greatest killer, many of them they maim, they may leave you disabled, you may be diseased, you may be ill but really they don’t kill, you know, and snakebite is the one that really kills and it kills within a very short period of time.

Benedict Moran: Here in Nigeria, farming is the main source of income.

Benedict Moran: Snakes are often found in fields just like this one, places where families are also cultivating. That’s why snakes are so dangerous, especially for children.

Benedict Moran: In the fields just behind the hospital Marlon Dela shows us where the small but dangerous carpet vipers live.

Marlon Dela: The smaller ones are more dangerous than the big ones and have more venom in them, to make antivenom we use a lot of the small ones.

Benedict Moran: Antivenom is the only effective therapy against a venomous snakebite, and it’s important to use it quickly. Delay can be deadly. The Nigerian government usually supplies antivenom to Kaltungo Hospital for free. But doctors here say they are overwhelmed by patients, and the hospital’s supply has run out. A representative from the state ministry of health told us that its budget for antivenom isn’t big enough to meet demand. That means the patients have to buy it themselves, at a private pharmacy nearby. Each vial costs around 100 US dollars and the standard dosage for successful treatment is two vials. That’s a huge expense when half of the country's population survive on less than two dollars a day. There’s also a worldwide shortage of anti-venom. The WHO says only half of the anti-venom needed globally is currently being produced. Adding to this problem, several pharmaceutical companies have recently stopped the production of antivenoms specifically intended to treat some kinds of snakebites found in Africa. The reason? Snakebite victims are mostly found among the rural poor, which means there’s not a lucrative market for those producing an antidote. Mwele Malecela is the WHO’s director of its department of control of neglected tropical diseases.

Mwele Malecela: There were groups producing antivenom in the past. But then the motivation to produce it, given the market base, made it impossible for them to continue doing so.

Benedict Moran: Across africa, faced with a lack of affordable, accessible anti-venom, victims often try home remedies. In South Sudan, 10-year-old Awien Maguor is having surgery at a hospital run by Doctors Without Borders. She was bitten by a Puff Adder, another deadly snake, while sleeping. Her uncle says they tried a wide assortment of traditional treatments. 

Athian Akol Madut: They told us to give the child a raw egg. Then they cut half a frog and put it in on the wound to stop the venom spreading in the blood. We also gave the child a potion made of ground seeds and leaves. We tried all these things but there was no improvement.

Benedict Moran: Nearby is Nyandeng Goch. The 60-year-old was bitten while farming. She too first relied on traditional medicine.

Nyandeng Goch: The wound was bleeding and I called my relatives to come and help me. They came, and they dug a hole and I put my foot inside the hole for two hours and they buried my foot with soil.

Benedict Moran: Dr. Habib says these remedies don’t work against venomous snakebites. 

Dr. Abdulrazaq G. Habib: If anything it’s harmful. Delay is a major predictor of dying, if you delay either in seeing a traditional herbalist or through some other means or you are using some local remedy, that delay could be adverse, it could lead to more complications or even death.

Benedict Moran: But often people have no choice. Nigeria doesn’t produce anti-venom. The country lacks the expertise, production facilities, and funds. Instead, it buys it from companies in the United Kingdom and Costa Rica, which create it through a process that includes injecting sheep and horses with venom and harvesting the antibodies the animals create. Back at Nigeria’s Kaltungo hospital, head nurse Abba Abese is monitoring patients closely. 

Abba Abese: We are telling them the position they will maintain for treating the patient. They should not lie on the affected leg because it adds pressure and it’s always painful and the swelling will increase. 

Benedict Moran: One of her patients is 12-year-old Abubakar Dahiru, who was bitten while tending cows. He’s been in the hospital for seven days. His parents are worried after nurses administered an unusual amount of antivenom. He has needed more than the usual two vials.

Abba Abese: On arrival he had this antisnake venom given to him. The following day it was repeated, the following day it was repeated again, this is the fourth one.

Benedict Moran: Dahiru’s bite won’t stop bleeding. So he also had several blood transfusions.

Abba Abese: Because of the open wound, the bleeding is everywhere the anti snake venom will not be enough for him too, it’s over-diluted and is oozing out so he has little in his body and cannot contain it so another one has to be added again. So like that, like that, because of the continuous bleeding. There is a sign of improvement now compared to when I came early in the morning.

Benedict Moran: The World Health Organization recently labeled snakebites an epidemic and made helping snakebite victims a high priority. It has launched a roadmap to cut in half death and disability by snakebites by 2030. It includes a push for more research on snakebite treatments and funding to help countries stockpile anti-venom.

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