Knowledge gained from the most venomous creatures on earth is being used to reduce deaths from snakebite in Myanmar.
Australian snake and health experts are part way through a three-year project to protect Myanmar’s 55 million inhabitants from snakebites by boosting the quality and quantity of antivenom supplies, establishing distribution networks and educating residents and health workers how to effectively treat and prevent attacks.
Australia is home to the world’s deadliest snakes including the Inland Taipan, Eastern Brown, Belcher’s Sea Snake and Mainland Tiger Snake. This has led to Australia becoming a world leader in anti-venom development and snakebite treatment and prevention strategies.
The Myanmar Snakebite Project began in late 2014 when the Australia Department of Foreign Affairs and Trade awarded the University of Adelaide $2.3 million for a three-year project, which is a partnership between Australian Government and the Myanmar Ministries of Industry & Health.
Two years on, a visit to the Australian city of Adelaide by Myanmar Union Minister of Industry U Khin Maung Cho has helped boost the profile of the project and strengthen ties with South Australia.
Opportunities for further collaboration
The Minister used the visit in late November to learn more about the project and the world-class snake venom facilities in South Australia and also to find opportunities for further collaboration.
Royal Adelaide Hospital Renal Physician Dr Chen Au Peh is heading up the project with Women’s and Children’s Hospital Toxinologist Professor Julian White and University of Adelaide Senior Lecturer in Public Health Dr Afzal Mahmood.
Snakes, primarily Russell’s Vipers and Cobras, bite thousands of people in Myanmar every year and lead to hundreds of deaths. They are a major concern in rice growing regions along the country’s biggest river the Irrawaddy.
While not as deadly as some Australian snakes, Russell’s Viper is a particularly dangerous snake because of the devastating impact its venom can have on the kidneys.
Up to 70 per cent of acute kidney failure in Myanmar is due to snakebite, placing a major strain on the country’s underdeveloped health system.
Rats and mice
Dominated by rice, agriculture is Myanmar’s major industry, accounting for about 40 per cent of GDP and 60 per cent of employment.
Rats and mice are attracted to the crops, which in turn attract the snakes.
Although the majority of snakebites occur in rural farming areas and many victims seek help from traditional healers rather than through the official health system, data has previously only been collected at major hospitals in Myanmar.
Professor White, one of Australia's pre-eminent toxinologists, said simple steps such as encouraging farmers to wear boots and seek help quickly from health care workers rather than relying on traditional healers could make a significant difference.
He said the scope of the snakebite problem would become apparent as data was collected throughout the project beyond what was captured at major hospitals.
“We don’t know the real figures for Myanmar yet, the official figure is 600 deaths and 13,000 cases per year but we think that figure will increase by a factor of between two and five once we’ve got more accurate data,” Professor White said.
Dr Peh said the project was unique in its approach because it involved working closely with people in Myanmar at all levels to ensure the system being established was sustainable beyond the life of the project.
He said the holistic three-step approach included increasing the quality and quantity of anti-venom supplies produced in Myanmar, establishing reliable distribution networks and educating health workers and the general population about how to treat and prevent snakebites.
The project has so far focused in the region of Mandalay, the biggest rice growing region and one of the worst affected by snakebite.
Reduction in horse mortality
Horses are used in Myanmar to produce antibodies to make anti-venom for Russell’s Viper and Cobra bites leading to Australian veterinary, horse husbandry experts and top-tier anti-venom producer Seqirus being called on to provide advice.
Since the snakebite project started, horse mortality has been reduced by 90 per cent while antivenom production has more than doubled to almost 100,000 vials a year.
Thirty solar-powered fridges have been purchased to store antivenom in remote areas in Myanmar and thousands of rural families have been educated about how to avoid being bitten and what to do if they are.
Dr Mahmood said South Australia was also well placed to share its health expertise with the nation beyond the snakebite project.
“We have been able to run refresher snakebite training for 200 doctors, we have run training for more than 200 primary health care workers, we have been able to reach 4500 families and provide them education in their homes, we have been to 150 villages and held community meetings,” he said.
“We have the skill set and there is also a huge potential to collaborate on the health side of things with the development of hospitals, health services training, hospital maintenance and it goes on.”
Professor White said the project was on track to have a significant impact by the time the current Australian Government funding ran out in 2018.
“By then the antivenom production will be meeting the entire national need, the distribution will be sorted out so it gets to where it is needed we will have assisted in teaching master trainers to provide sustainable ongoing training for all staff levels within their health system.
“Myanmar has a production capacity and thanks to our input and their hard work they have the potential to produce more anti-venom than they need so they could become an exporter in the region.”
“Snakebite is very much a major problem in the rural tropics – it’s not just isolated to Myanmar – if we cross over the border into India we know there are upwards of 45,000 people dying every year from snakebite.
“We think there’s an opportunity here to make this a much bigger and much longer-term enterprise involving skills from Australia and skills developed in Myanmar and pushing them out more broadly to the region.”
Andrew Spence is a senior writer with The Lead, South Australia