THIRUVANANTHAPURAM: Stocking antivenom alone has not resolved the snakebite crisis in government hospitals. Many facilities struggle to follow the mandated monitoring protocol, leading to accusations of medical negligence from victims’ families.
The root of the problem lies in staffing. India’s National Action Plan for Prevention and Control of Snakebite Envenoming (NAPSE), updated and launched by the Ministry of Health and Family Welfare in March 2024, requires continuous monitoring of snakebite victims. Doctors must check vital signs every 15 to 30 minutes after admission, then hourly, and maintain close observation for at least 24 hours depending on the severity of the bite.
In government hospitals, where a single official often handles afternoon duties, that standard is nearly impossible to meet. “A single doctor has to balance critical bite victims with routine outpatient care and anti-rabies vaccinations. People waiting in the queue get irritated when the doctor goes back and forth to monitor the snakebite victim,” said Dr Sunil P K, president of the Kerala Government Medical Officers’ Association (KGMOA).
Kerala records up to 45,000 snakebite cases annually, of which around 3,000 are classified as critical. But protocol demands continuous monitoring for all cases—critical or otherwise.
The most intensive supervision is needed at a specific and dangerous moment: when anti-snake venom (ASV) is administered. ASV is a foreign protein and the body can react violently to it. Studies indicate that anaphylaxis, a potentially fatal allergic shock, occurs in 13 to 43% of cases, with roughly half of those reactions being severe. Children face higher risk.
Severe reactions can escalate rapidly into respiratory distress or cardiac arrest, requiring immediate access to ventilators and other life-saving equipment. This is where the gap between supply and infrastructure becomes critical.
While government hospitals are generally well-stocked with at least ten vials of ASV, the facilities needed to manage a serious adverse reaction are far fewer. In Ernakulam, only the General Hospital in government sector is equipped to handle such emergencies.
“The first principle we have learnt is: do not harm the patient,” said Dr Sunil, underscoring the risk of administering ASV in facilities unprepared for its consequences.
The directorate of health services has responded to the rising snakebite burden by rolling out training programmes for doctors and casualty staff.
KGMOA noted that it had run similar initiatives with expert faculty. However, the association’s demand for additional resources, more staff, better equipment, upgraded facilities, has gone unanswered.
Norm vs reality
Doctors must check vitals of bite victims every 15 to 30 mins after admission, tahen hourly, and maintain observation for at least 24 hours based on severity
This standard is impossible to meet as most govt hosps have just one med officer handling noon duties
Directorate of Health Services has responded to rising snakebite burden by rolling out training for doctors and casualty staff
The most intensive supervision is needed when the antivenom is administered, as it can lead to severe, sometimes fatal, reactions