Lack of antivenom compounds Kitui snakebite menace
By Lilian Kaivilu
Josphene Syombua Salee limps slowly towards her main house in Kavindu village in Nuu area of Kitui County. A white prosthetic leg is the first thing I notice on her as she bends slowly to pick up a broom from her two-roomed house.
This is the mark of a venomous snakebite that Syombua bears since July 11, 2015. Three years later, the 36-year-old is still living with the consequences of what she terms as a near-death experience.
Following the snakebite, the mother of three was admitted at the Mwingi Level 4 Hospital for three months, accumulating a medical bill of Sh30,000. “We were in the farm with other community and family members harvesting when I was bitten by a snake. I immediately lost consciousness, only to wake up in the hospital two weeks later.
To Syombua, the snakebite changed her life as she ended up with an amputated leg. HeR case is just one among the 400,000 people across the world who remain with permanent disabilities every year as a result of snakebites, according to the World Health Organization (WHO). “When I woke up for the first time in the hospital, I was given a form to sign, consenting to the amputation of my leg,” Syombua remembers. “Niliamua nikatwe mguu badala ya kupoteza maisha (I chose to have my leg amputated rather than lose my life.)”
Today, the mother of three says she cannot walk as fast as she used to. As a result of the snakebite, Syombua cannot do farm jobs as she used to. Consequently, she depends on her husbad for upkeep.
In the larger Nuu ward at least one case of snakebites is reported every week during the rainy seasons.
Saturdays are the busiest days at the Nuu Sub County Hospital. On this particular day, Nduki Munzyu, 30, joins the queue at the facility’s waiting area. On her back, the mother of four has strapped her one-and-half year old son. The young boy is due for regular post natal clinics at the health facility. On one hand, she holds the hand of her 14 year-old-daughter while on the other she carries an envelope with some hospital documents.
For Munzyu, this is the most appropriate day to bring her children to the hospital. It is the local market day hence more convenient to access means of transport to the health facility.
On this particular day, Munzyu is bringing her daughter for a regular check-up at Nuu Sub District Hospital. She has already missed school the last one week due to some pain from the wound on her left leg. The daughter was bitten by a venomous snake as she walked home from a relative’s place on the night of May 26, 2018. She is a Class Eight pupil at Mutulu Primary School.
Joseph Mbithi Maundu, a clinical officer at the Nuu Sub County hospital says children under 15 years are the most affected by snakebites. Majority of the patients, he adds, get the bites at night. “This means that they report in the hospital at night when there are no adequate staff members. This is a challenge because we only have two clinical officers at this health facility.” According to him, stockouts of the antivenom is also a challenge sometimes, a situation that forces them to refer the patients to Mwingi Level 4 Hospital.
Maundu narrates how they lost a patient due to lack of antivenom at the facility. “In January 2018, we received a patient who has suffered a snakebite. On that particular day, we did not have antivenom in our facility. We thus referred the patient to Mwingi Level 4 hospital. Unfortunately the family took the patient to a traditional healer and that is how the patient succumbed to the fast spreading venom.”
Besides the challenge of antivenom stock outs, Maundu cites religious beliefs by some local sects as a challenge to treating not only snakebites but also other diseases. “Kavonokya (a religious sect) members do not believe in taking medicine, even in the case of snakebite. In such cases, all we can do is sign the ‘Against Medical Advice form’ to indicate that the patient refused medication,” he explains.
Hezekiah Abuga Ondiko, head of heath commodities and technology division in Kitui Countysays the county receives antivenom every quarter from the Kenya Medical Supplies Agency (Kemsa). He, however, revealed that there is slow uptake of the commodity because of resistance from some patients. “We procured 70 vials for each of the big hospitals (Kitui County Referral Hospital and the Mwingi Level 4 Hospital),” said Ondiko.
Depending on the type of snake that bites a patient and how one reacts to the snakebite, a patient can use upto two vials of the snake antivenom. Each vial costs Sh5,800. According to Ondiko, puff udders and cobras are the commonest snakes in this region and children and men are the most affected. Although snakebites are mainly recorded in poor homes, Ondiko says the county has set up waiver committees in the hospital in order to intervene when patients cannot raise the bill.
Kitui East, Kitui South, Mwingi North and Kitui rural record the highest number of snakebites in Kitui County due to their rocky terrain as proximity to the Mui basin.
Joseph Kamundulu Mbuke, a community health volunteer at Nyaani Community Unit in Nuu ward, Kitui county says poor road network and lack of skills in handling snakebites is the main challenge in the area. “In 2018 alone in Nyaani community unit, there were three deaths as a result of snakebites. As community health workers, we need training in handling snakebites,” he says.
Ondiko says there is need for advocacy during public barazas to advise locals where to get help in case of a snake bite. In order to address this concern, Health Action International, through its Snakebite Programme in collaboration with the Global Snakebite Initiative and the James Ashe Antivenom Trust at Bio-Ken Snake Farm. is providing communities with information and tools to learn how to prevent snakebite and provide effective first-aid and treatment for it.
In Kitui County, there are 14 health facilities that can treat snakebites. In each of them, there is a medical officer. However, Ondiko says poor road network harbours timely access to these facilities. Currenly, the county has 30 ambulances and plans to buy 24 more.