Snake attacks are an under reported public health concern in many tropical countries, and Cambodia is no exception. According to a WHO report released last September, an estimated 3 million victims all over the world are bitten by snakes annually.
“Amongst the victims of snake bites, between 81,000 and 138,000 people die from snake bites each year, and amongst the survivors, about 400,000 are left disabled by snake bites,” it said.
Snake venom predominantly affects women, children and poor farmers in remote rural areas of low-income countries, with the biggest problem being that there is not enough access to antiserums in those areas, it added.
The WHO is urging all countries to work together to halve the death tolls and disabilities caused by snake venom by 2030 through the “Snakebite envenoming” forum.
Through this forum, information and data can be accessed and downloaded in both real-time and real-world situations, which can greatly improve the chances of survival of for snake bite victims in remote areas.
No specific data is available on deaths or disabilities caused by snake bites in Cambodia, but it is well documented that some people in remote areas continue to believe in ‘magicians’ who can spit on wounds to decontaminate snake venom. As a result, victims of snake bites are in danger of dying preventable deaths.
On July 3, a 12-year-old boy named Song Reaksa, a resident of Tuol Balang village, Kors Kralor commune, Battambang province’s Kors Kralor, died hours after being bitten by a black-and-white striped malayan krait when he followed his father to the field to trap the rats that had been eating their taros.
According to a local police source, the child died because of the beliefs of his father.
Chey Dara, police chief of Kors Kralor commune, told The Post that on the evening of the snake attack, Reaksa followed his father to guard their taro farm near the foot of Mount Ari in Ta Nuot village, in their commune.
He said that at 4am, a snake crawled into the victim’s hut. Due to the lack of electricity, the child did not see the snake. As he opened his mosquito net to go out to check the rat traps with his father, his hand touched the snake, which reacted by biting him.
“The snake was beaten to death by the victim’s father shortly after it bit his son, but he did not rush his child to the hospital. Instead, he lit incense and prayed to the mountain spirits to help remove the snake venom from his child. They continued to check the rat traps until dawn. The exercise pumped the snake’s venom through the child’s body and he died shortly after arriving at the Moung Russey District Referral Hospital,” said Dara.
Si Song, 46, the father of the victim, told The Post that after killing the snake, he immediately asked his son: “Do you feel any pain in your body?” His son answered, “I’m not sick, I’m just tired.” Then they went to check on the traps.
“That morning was the worst day of my life. Not a single rat was trapped,” said an emotional Song.
He said that after checking the traps, he and his son returned to the hut and his son went to sleep. Song prepared fish and rice for breakfast and woke his son to eat at 10am. He son said he was not hungry.
“Daddy, I feel very sleepy and anxious,” Song said, quoting his son at the time.
He said that when he heard his son say that, he lit incense and prayed to the mountain spirits to help remove the venom from his son. His prayers were in vain.
He took the child Kors Kralor Health Centre, but there was no snake venom antiserum in stock. Song said the nurses at the health centre sent his son to Moung Russey Referral Hospital, but Reaksa died within 30 minutes of arriving at the hospital.
Dr. Ieng Kavei, acting director of the referral hospital, told The Post that searching for a magician’s saliva, burning incense or prayer was completely useless when a person had been bitten by a snake.
“When a family member is bitten by a snake, do not delay, take the victim to a hospital immediately, otherwise the venom will penetrate the nervous system and the heart, which could result in death,” he said.
According to Kavei, the victims of snake bites who ask ‘magicians’ for help or those who take traditional medicine made from the roots and stems of plants or parts of some animals are at risk of death or disability. Those types of ‘treatment’ will not prevent the venom penetrating the blood vessels and organs of the victim, he added.
He recalled the case of a 45-year-old woman in Ta Nuon village, Preah Phos commune, Kors Kralor district whose family sent her to Moung Russey Referral Hospital a year ago after she was bitten on her foot by a Russell’s viper while digging cassava in her backyard. Before being taken to the hospital, her family took her to a village magician for five days, and the wound swelled and bled continuously.
“The woman was saved after more than a month of treatment. She needed 20 bottles of snake venom antiserum to survive,” he said.
“Each bottle is very expensive – a single bottle costs just over $500. Fortunately, the government provides it for free,” he added.
Kavei could not provide details about the number of snake bite victims that were treated at his hospital each year, but said that most patients were bitten during the rainy season, especially during floods. Sometimes there were 30 to 40 cases per month, he said. In the dry season, there are usually just 4 or 5, and in some months not a single incident is reported.
Sou Sanith, deputy director of the Battambang Provincial Health Department, told The Post that there are nine main species of snake that are a danger to rural Cambodians, and that they can be classified into two groups. Each group’s venom works in a different way, he added,
The first group is the snakes whose venom contains an anticoagulant. This inhibits blood clotting. There are three species in this group: the Malayan pit viper (Calloselasma rhodostoma), Russell’s viper (Daboia russelii) and the white-lipped pit viper (Trimeresurus albolabris).
The second group’s venom attacks the nervous system. There are six snakes in this group: The king cobra (Ophiophagus hannah), the Indochinese Spitting Cobra (Naja siamensis), the Monocled Cobra (Naja kaouthia), the Malayan Krait (Bungarus candidus), the Banded Krait (Bungarus fasciatus) and the Red-necked Keelback (Rhabdophis subminiatus).
He explained that a snake bite can cause severe pain at the site of the bite and may cause the wound to bleed profusely (in the case of venoms that prevent blood clotting).Victims may feel drowsy and lose their appetites. If the snake’s venom is attacking the nervous system, the victim may have difficulty breathing and might lose mobility in their limbs.
“Snake bites can be mild or severe depending on the type of snake. If your child is bitten by a non-venomous snake, they will almost certainly be fine. If they are bitten by a venomous snake, their life may be in danger if they are not treated immediately,” he said.
“Parents are terrified when their child is bitten by a snake, but should know how to give first aid until the child makes it to a hospital,” he said.
He recommended washing the site of the bite thoroughly with soap and water to prevent infection. The victim should not move the infected limb much, as this could increase blood flow and distribute the venom throughout the body more quickly. This would increase the speed the venom worked and meant there was less time to seek treatment, he warned.
They should administer a tourniquet using a towel or a scarf to prevent the venom from flowing into the rest of the body. It should be tight, but not so tight that it cuts off all circulation. Victims may be given paracetamol if they are in pain, but under no circumstances should cuts be made to make the venom bleed out. Nor should anyone attempt to suck the venom from the wound, he added.