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The Hidden Wounds of Snakebites: A South Sudanese Story

2022-09-19T03:37:47.274Z


Every year, more than 5 million people are attacked by these animals, making it a neglected global health crisis.


Mark McNicol, an MSF doctor.

If you are bitten by a snake in rural South Sudan, several things can happen to you:

you could die

Children are especially vulnerable and it is a long way to reach health care in these parts of South Sudan.

Depending on where you live, it can take more than a day to walk to the nearest health center.

Many people die from a snake bite before they can get help.

You may live close enough to a health center to walk, or to be taken by relatives for treatment: antivenin, wound care, painkillers, and antibiotics.

If the health center you arrive at does not have antivenin or it has expired, you can lose your life.

You might also survive without treatment.

You will experience pain, swelling, and other major symptoms.

You may be left with a chronic wound from the bite itself, or it may heal.

There may be a scar, but you'll still be alive.


As a superstition, in South Sudan it is customary to hang dead snakes on trees to prevent them from coming back to life.Pierre-Yves Bernard (Pierre-Yves Bernard/MSF)

The Médecins Sans Frontières (MSF) hospital where I have worked is in the small town of Lankien, in Jonglei state.

It is one of the very few health centers in the area.

One would expect to see fewer snakebite injuries in more urbanized areas, but the truth is that we regularly receive patients with these types of injuries.

However, during my mission, I did not see a single case where someone came to the ER immediately after a bite.

What we did see was people coming to the hospital months after the event;

often when the less visible consequences of the bite finally came to light.

I remember the case of a woman who came to the hospital.

She had been bitten on the ankle four or five years ago.

The first thing I noticed was a strong characteristic odor of infection.

Before I saw her ankle, I knew she would be wrong.

When a snake bites you, one of the injuries it can cause, apart from those caused by the venom itself, is a very deep puncture wound.

And through it, bacteria (perhaps from the snake's fangs or your own skin) are injected almost deep into the body.

“While superficial wounds are healing, bacteria can multiply, causing infection and eroding bone.

It may be the case that, while superficial wounds are healing, bacteria can multiply, causing infection and eroding the bone.

This is something we also see in conflict zones, in patients with gunshot or shrapnel wounds without access to proper treatment.

Over time, the deep infection can spread to the point where it breaks through the skin again, causing an open wound.

This does not happen in all cases of untreated snakebite, but patients with this problem do come to Lankien.

The woman with the infected ankle was one of the worst cases I have ever seen.

Bone infection is treated with antibiotics, but when it is especially severe, patients need surgical debridement, which means that the infected tissue is removed or even, if necessary, amputated.

Our hospital does not have an operating room, so we use telemedicine to consult with fellow surgeons from other MSF projects.

It was clear that antibiotics were not going to be enough for the woman, and we raised the issue of amputation.

It was a difficult decision, as it meant that he would have to rely on crutches in an area where almost all travel is done on foot, sometimes involving long distances and difficult terrain.

But without the amputation, the infection would spread and get worse.

She had suffered for years, and the strong smell of the fabric caused her to also suffer from the stigma of the community.

In the end, the woman and the team agreed that amputation was the best option.

My colleagues took care of transferring her in our small supply plane to another MSF hospital, where they have the necessary facilities and personnel to carry out the operation safely.

Snakebites are a neglected health crisis, and an ambitious approach is required to tackle it

Snakebites are a neglected health crisis, and an ambitious approach is required to tackle it.

Around the world, MSF works with governments, health services, donors and communities to try to bring about change for affected people.

The answer is as much about access to affordable, good-quality antivenom as it is about greater investment in community awareness, first aid and bite prevention.

The woman's operation went smoothly, but the impact of the injury will accompany her for the rest of her life.

It is necessary to ensure that fewer people have to face the consequences of this forgotten problem, which puts their lives and livelihoods at risk.

Mark McNicol

is a member of Doctors Without Borders.

He has just returned from a mission in Lankien, a remote rural area in South Sudan. 

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Source: elparis

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