Preventing venomous snakebites – the barriers to adoption
Updated: Jul 27, 2022
Harrison Carter is an MSc student supervised by Dr Kimberly Hockings and Dr Ana Nuno, working in collaboration with Madras Crocodile Bank to research social factors affecting the adoption of snakebite preventative measures in the Southern Indian state of Tamil Nadu. You can follow him as @wildharrison on Instagram or via his website www.wildharrison.com.
Carrying out a routine health check on a rescued Spectacled Cobra (Naja naja) in Sri Lanka (2016)
Following a Passion
Various lockdowns throughout 2020-21 provided many with the chance to reflect on life, and lock-on to misplaced dreams. I was no different. Battling 12-hour working days as a Management Consultant for the Department for International Trade, I spent this period delivering remote trade negotiations to improve commercial relations overseas post Brexit. It was exciting and fulfilling work, but it wasn’t my dream. Not even closely related. After all, I was a reptile fanatic, and whilst there are plenty of snakes in London, I preferred my reptiles with scales.
From tracking King Cobras across the mountains of Bali, to rescuing hundreds of venomous snakes from rural communities in the island of Sri Lanka, by 2020 I had worked hard to develop technical skill outside of academic accreditation. But that was just it, I had no academic background in biology or conservation. The second lockdown in 2021 proved to be the biggest turning point for me.
Reflecting on the divergent nature of Management Consultancy from reptile conservation, I decided to return to University and undertake my MSc in Biodiversity and Conservation at the University of Exeter.
Arriving in Penryn it was clear that my passion for reptiles could pose challenges for my MSc. I heard on various occasions that a pre-set species focus, and an odd one at that, would make it hard to find an aligned research project. It felt like the dark city clouds from London were following me southwest, but as it would turn out, there was a silver lining. It forced me to think broader and to find a spot for my unique interest within a bigger question. For me, that question was human-wildlife conflict, or co-existence as progressively preferred. Labelled a neglected tropical disease by the world health organisation in 2017, snakebite deaths continue to carry astronomical impacts on human life. Every year 140,000 people die from a venomous snakebite across the world and 500,000 more are left with permanent disabilities (1). Snakes are the most deadly terrestrial vertebrate for humans on earth, killing more of us than the next 28 animals combined. This was real co-existence friction, real conflict. But what do solutions look like? With limited funding, research on snakebite management is surprisingly limited (2).
It begs the question, ‘How do we prioritise our limited conservation capital?’ One assumes that human life would have been awarded first prize, but this is not the case.
I became fascinated with this issue and spent the first weeks of the term becoming familiar with the management approaches employed.
A typical paddy field setting in Tamil Nadu, the most likely destination for a venomous snakebite – photo by Harrison Carter
There are two ways of managing venomous snakebites: prevention and treatment. Anti-venom is the only effective treatment for venomous snakebites. An incredibly effective product, the global provision of accessible anti-venom would be a landmark milestone to save the lives of thousands of people bitten by snakes. This all sounds great, but there are a few hiccups when applying theory to practice. Especially in the tropics where nearly 100% of fatalities occur. Anti-venom is incredibly expensive (can cost USD 10k per vile), must be refrigerated or ruins, and is hard to medically administer where rapid access to treatment is critical. For application in the tropics, anti-venom is generally not fit for purpose. By contrast, preventative measures are more accessible and aim to mitigate the risk of snakebites all together. Currently employed measures are broad and fairly abundant, with most tropical nations adopting WHO guidelines; including the use of torches at night and wearing of rubber boots in agricultural fields.
There is no question that such measures are theoretically effective, so why does the annual death toll from snakebites remain painstakingly high? It was a big question, and one that drew attention to role of adoption in prevention efficacy.
A large Russell’s Viper found in scrubland in Chennai during my first week of fieldwork, one of India’s ‘big four’ snakebite threats– photo by Harrison Carter
For me, Sri Lanka was the obvious choice for research given snakebite mortality figures and my previous working experience. Having traveled to the island over 10 times prior in the capacity of snake rescuer, I thought it would be easy to establish a project for my MSc research. Juggling the demands of other modules during term 1, I was off to a strong start having found an NGO to collaborate with research and convinced my supervisors of project feasibility. I even had a couple of research assistants in the pipeline and was able to find a good working balance between project planning alongside term responsibilities. It was all going to plan. That is, until term 2.
Seemingly overnight, I was facing challenges left, right and centre. Some expected and others a painful surprise. Research assistants scouted became unavailable, I contracted Covid-19 with heavy symptoms and MSc module work was increasing at a rapid rate. It felt like I was learning to ride a bike without stabilisers, just managing to keep peddling to avoid a painful fall. Then, just two months before I was set to travel to Sri Lanka, civil unrest broke out on the island. I could feel my dream slipping away, now I understood why people opted away from self-generated projects. Regardless, I was determined to make the project work and began to think about other options, other collaborators, even other countries. Fortunately, it appeared that even this cloud had a silver lining.
A Spot of Good Luck
I have long been an admirer of Romulus ‘Rom’ Whitaker, the owner of Madras Crocodile Bank. American by birth, Rom has lived in India most of his life and developed a unique perspective of human-snake coexistence.
As the leading authority on snakebite management in India, a nation with similar human-snake coexistence friction, Rom was top of my list for collaboration. By pure coincidence, committee member Xavier Glaudas, had recently finished a telemetry project with Rom and was able to introduce me via Zoom in March. It was an incredibly exciting opportunity, both to meet a childhood idol, but also keep my dream of MSc field work alive. We spoke for over an hour and my note taking had become indecipherable to the naked eye. At least one thing was clear, we agreed that prevention measures were the immediate solution to curb snakebite deaths and that adoption posed our greatest challenge. This isn’t a new issue within coexistence literature, but to our surprise, limited research has explored the adoption of snakebite preventatives. There was a gap to explore and to my immense relief, Rom was excited to collaborate on the expedition. I made the difficult decision to cut ties with partners in Sri Lanka and change study focus to India at the 11th hour. Carrying the highest annual snakebite mortality figures of any nation on earth, India was a fantastic alternative and we began to narrow down our study site.
A photo with Thiruvarur District (Tamil Nadu) Government, having secured local permission for research.
Study Site Specifics
Approximately 50,000 people die of venomous snakebites in India each year, that’s roughly a third of global snakebite deaths coming from one nation. The top three most impacted states, all in rural agricultural communities, are Andhra Pradesh, Uttar Pradesh, and Bihar. Only a couple further down the list, thought to contribute roughly 10,000 deaths each year, was the Southern Indian State of Tamil Nadu (3). Substantially impacted by snakebite mortality, Madras Crocodile Bank had a pre-existing research permit for Tamil Nadu and I had my foot in the door. For a second time during a crazy two-week period in March, I had a confirmed study site and was set to overcome the necessary admin hurdles. Research ethics, risk assessments and visas had to be re-submitted. I also had three wider MSc module deadlines that took my attention, but it was okay, I was moving in a purpose-driven direction.
By mid-May I found myself field side, local permissions in writing and sun cream applied. We were ready to go, ready for the field and ready for our trial week.
Armed with a mixed-methods approach inspired by the Health Belief Model (HBM), we went to battle. The battle against preventable snakebite deaths and injury. Widely used in health literature, the HBM identifies critical perceptions that influence our likelihood to adopt disease prevention measures and key sociodemographic factors that drive variation of the former. Popularly used to enhance the management of emergent diseases, including Covid-19, the HBM is rarely applied in conservation literature and has never been applied to the issues surrounding human-snake coexistence. Our trial week held valuable lessons for application. It was clear we would need to both broaden the scope of questions and re-frame others where literacy capability was unaligned.
An interview with local agriculture in motion conducted by research assistant Selwin– photo by Harrison Carter
The Present Day
As I sit here now, writing this blog, my assistants and I have collected 200 survey entries with an ambition to cover 400 more before the end of June. Fieldwork is in a good place, but this too has had it’s ups and downs. I was expecting two assistants from week one, but a motorcycle accident and other blockers had left me with just one for the first 3 weeks. A data malfunction during week 2 risked the loss of two full days of work and the variable nature of concrete plans continues to provide a layer of general stress in the most idyllic situations. Dynamic leadership and interpersonal relationships have held the key to success. In particular, the relationships I’ve developed with my assistants have been vital to sail through rough waters. More than translators, their patient approach with participants and observations will inform important discussion points in the final write-up. Alas, as excited as we are about the prospect of 600 survey results in 6 weeks, we know this work will merely scratch the surface of this neglected tropical disease. Instead, we simply hope it highlights a surface worthy of further exploration.
The outcomes of this research will help us to understand local perceptions of snakes, perceptions of snakebite risk and prevention methods currently suggested by the WHO.
A developed understanding of root causes for adoption barriers will help iterate prevention plans, products, and governance communication to improve adoption. In turn, higher adoption will lead to more efficacious prevention that can reduce lives lost to snakebites. Excitingly, Rom has shared visions of replicating this research across the other Indian states and the district government in Thiruvarur is keen for the study findings to inform a district snakebite mitigation policy. It appears there is scope for this research to continue and I just hope to remain in the story as it continues to unfold.
In-situ with a local agricultural community, just taking five minutes for another ‘selfie’.
Snakebites will likely remain a great threat to human life for years to come, but prevention is the key to rapid declines in the tropics. Critical to prevention success is adoption and so factors influencing adoption are underpinning. This is not just true for snakebite prevention, but all preventative measures designed to soften the friction of human-wildlife coexistence. For me, this has been my biggest learning.
Integrating my species-specific interest within the larger question of human-wildlife coexistence has allowed me to both follow my passion and build on the learnings of different species applications.
I have ended up exploring snakebite prevention, but hope my findings have insight for others interested in the coexistence conundrum.
If you are interested in following my research, the best way is via Instagram (@wildharrison). Equally, I will be speaking at the World Extreme Medicine conference in November and virtual tickets are available here. 1. Chippaux, J.-P. (2017). Snakebite envenomation turns again into a neglected tropical disease! Journal of Venomous Animals and Toxins including Tropical Diseases 23. 2. Malhotra, A. et al. (2021). Promoting co-existence between humans and venomous snakes through increasing the herpetological knowledge base. Toxicon: X 12, 100081.
3. Samuel, S.P. (2020). Venomous snakebites: rapid action saves lives—a multifaceted community education programme increases awareness about snakes and snakebites among the rural population of Tamil Nadu, India. PLoS Neglected Tropical Diseases, 14(12), p.e0008911.