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Another aspect we are working on is based on the growing availability of ambulances reaching rural India. Once people realize that a venomous snakebite is a medical emergency, as much as a heart attack or grievous injury, they will opt for speedy ambulance service. We are encouraging ambulances to stock antivenom, train the attendants in snakebite first aid and management and have a respirator on board, a life-saving device for neurotoxic krait and cobra bites which commonly cause respiratory paralysis. Rom



Thanks Pamela, you have put your finger on a couple of the major issues of the snakebite problem here in India. Antivenom is often not available at rural clinics (called Primary Health Centers), one of our projects is to map the distribution of the medically important snakes to prioritize equitable supply and distribution of antivenom to where it is most needed. And these PHCs most often have no doctor in regular attendance. Antivenom must be administered intravenously and since it is horse serum with a potential for acute allergic reaction and as Health is designated a "State Subject", a nurse or paramedic may not be permitted to give an IV injection.
We are therefore working with government bodies such as the Indian Council for Medical Research to make much-needed changes with advice from Dr. David Williams, head of the Global Snakebite Initiative. He has been working in Papua New Guinea for the past decade where a snakebite patient in a remote area may have access to a hospital and doctor only by an airlift, so nurses and other paramedics have to be instructed by phone.
Indian antivenom is the cheapest in the world, at about USD 15 per vial (compared to about USD 1000 in the USA). Unfortunately, the titer of Indian antivenoms is very low and as many as 50 to 100 vials may be needed to save a patient. So, the answer to your question is, no, antivenom is not affordable to rural people. In addition to this (solvable) problem, there is considerable geographic variation in venoms within the same species and since almost all the venom used for making antivenom is from the Irula Snake-catchers Cooperative here in southeast India, clinicians are routinely reporting a lack of effectiveness in the products. One of our projects is sampling venoms from across the country to research this very important part of the big picture. Rom