The rat plague threatens without snakes. But those who are bitten in the African kingdom of Eswatini, formerly Swaziland, must fear for their lives. A woman does not want to accept this – and fights with hooks and tongs.
Thea Litschka-Koen leans over the hospital bed and grabs Qiniso’s swollen hand. While examining the giant blister on the back of her hand, the 36-year-old patient says: “I was woken up by a sharp pain, I shook my hand and felt something fall to the ground.” Qiniso saw blood between the index and middle fingers and suspected a snake bite. His brother took him to a hospital in Manzini, a town in the small kingdom of Eswatini, which lies between South Africa and Mozambique and was called Swaziland until April 2018. At home at Qiniso you actually found a Moçambique spitting cobra in the drawer of a workbench, it is one of the most poisonous snakes in southern Africa.
“I have never had such severe pain in my life. It was like my flesh, my veins, even my bones were on fire, ”says Qiniso. He was injected with an antidote at the hospital. However, treatment had to be interrupted for a few hours because the patient began to tremble uncontrollably and developed a rash all over the body – side effects of the saving antiserum. That was three days ago. Since then, the hand and arm have swelled more and more. Thea Litschka-Koen explains that the snake’s venom has a necrotic effect and that he will need surgery to cut away the tissue that dies. Unfortunately, there is no magic bullet in such cases.
Every year around five million people are bitten by a snake worldwide. 2.7 million of these bites lead to poisoning, which causes 138,000 people to die and 400,000 to suffer permanent damage: Sometimes amputations are necessary, the bitten people go blind or suffer from post-traumatic stress disorders. However, these numbers are only estimates, official statistics are rare. The problem mainly affects the poor, rural population of Africa, Asia and South America.
There is often a lack of medical infrastructure, affordable and effective antidotes, and doctors who can treat snake bites properly. The situation is aggravated by ignorance and superstition among the population. Snakebite poisoning has not been considered a global health issue in the past and has received little attention. However, the World Health Organization, or WHO for short, added it to the list of neglected tropical diseases in 2017 and published an ambitious strategy in 2019 to halve the number of snake bites and their consequential damage by 2030.
In the Kingdom of Eswatini with 1.2 million inhabitants, 200 to 400 snake bites occur annually, an estimated ten percent of the victims die. Over the past decade, however, the country has made great strides in education, prevention, and better treatments, and could serve as a model for other countries concerned. This is mainly thanks to Thea Litschka-Koen. She was part of the WHO working group that helped develop the snake bite strategy. The 52-year-old is neither a doctor nor herpetologist, but the managing director of hotels and restaurants in northeastern Eswatini’s.
In her office at Simunye Country Club is a photo of her younger self holding a black mamba. At that time, the photo was taken fifteen years ago, her fascination with reptiles awoke. Her seven-year-old son was supposed to do a school project on snakes, she helped him, browsed the internet and stumbled across the website of a herpetologist in neighboring South Africa who offered courses on snake handling. She registered – together with her husband, who declared her insane but was still persuaded. “It was the most exciting thing I had done in years,” says Thea, as everyone calls her, who was the only one in the course who dared to catch a black mamba.
The photo is proof, her husband immediately framed it and shows it to everyone. A few days later, the first to find a snake in their house called Thea to come to catch them. Now your phone rings at all times of the day and night. Especially in the summer months from September to March, when the rain falls, temperatures rise, it is snake season and hundreds are caught.
Thea’s son, who is terrified of snakes, is out of college, and his mother has trained more than forty snake catchers over the years to help her volunteer. They are called to remove Moçambique spitting cobras ( naja mossambica ) from fields or bedrooms, to get the banded cobra ( N. annulifera ) out of the garage or to pull a highly toxic boomslang out of the tree.
They also move for non-toxic pythons and brown house snakes. Just a few days ago, Thea responded to the cry for help from a man who had slipped a puff over his feet when he was sitting on the toilet, and in the warehouse of a sugar factory she climbed over sticky mountains of a black mamba ( Dendroaspis polylepis ). The next case was “a Mamba emergency call,” says Thea, standing up from her desk, grabbing rubber boots, snake hooks and tongs and a black trash can with the words “Danger, venomous snakes, do not open” (danger, venomous snakes, do not open) from a corner of their office. Bongani Myeni, who works as a warehouse manager at Simunye Country Club, accompanies her. The 32-year-old is an excellent snake catcher.
Thea and Bongani drive past sugar cane plantations, which are being replaced by dry scrubland. From the main asphalt road, you go over a red dirt track towards the range of hills that separates Eswatini from Moçambique. At some point, the team reached a simple homestead, far from the next village. Thea looks around: “This is perfect snake country.” In this area, the farmers keep their animals close to their huts and houses. The cattle feed attracts rats and mice, which in turn are delicacies for snakes.
Goodwill Msibi and his almost ninety-year-old father Elias is already waiting for the two snake catchers. The old man saw a black mamba in his rusty corrugated iron shed. His son wanted to kill her, but the courage left him, so he called Thea instead. “That’s a good thing,” she says, and every year you have to bury people who try. The snake was lightning fast, unpredictable, and defended itself if it was pressed. “If you don’t get the death blow exactly, then chances are that you will be bitten.” That is why Thea and Bongani immediately get to work and get their equipment out of the car. When they carefully open the door of the shed, Thea sighs: the room is full of boxes, in between straw, tools and the spiral springs of a mattress, the snake could hide anywhere. Together they empty the shed, piece by piece until Bongani calls: “I can see them!” A light gray snake rears up on the back wall. With grasping pliers, the two experienced catchers pull the reptile closer to the door, holding it to the ground. After all, Thea, who may not be athletically slim, but extremely agile, can grab the snake with one hand just below her head and the other at the back, she drops the animal, which is about two and a half meters long, into the bucket, and Bongani pushes it Lid on it.
It is actually a black mamba, named after the color of the inside of its mouth. “Thea, Thea, thank you! Now my old father is at least safe again, ”Goodwill calls excitedly and wraps his arms around the woman tightly. And tears come to her eyes: “If someone is bitten in this remote area – there is no public transport, the ambulance would take hours – it would be a death sentence.”
The next day, Thea heads south again, this time with a trunk full of venomous snakes, which she has caught over the past few days and weeks and which are each housed in a closable tube. The destination is provisional office containers along the way. It was booked to teach employees of a construction company who are currently paving a street how to deal with snakes and first aid for bites. Across the country, Thea teaches security companies, waterworks, officials, field workers, students, and villagers, and begins her course by explaining to participants how important reptiles are to humans. “If we don’t have snakes, we’re literally starving.” In areas where too many snakes and birds of prey have been killed, rats are now plagued. The rodents eat the fields empty,
The construction workers seem skeptical. Only seven of the around sixty snake species native to Eswatini are dangerous, Thea explains. “We can live with others. They provide us with important services. ”That is why she gives simple tips on how to avoid contact: do not leave food lying around, keep house and property clean. And so that you don’t get bitten by a Moçambique spitting cobra at night: “Don’t buy your girlfriend chic shoes or a pretty handbag. You buy a mosquito net. ”Pinched under the mattress, it stops snakes from crawling into bed. The Moçambique Speikobra describes Thea as her nemesis. The snake is responsible for more than seventy percent of the serious bites in Eswatini, it bites in trembling toes even without provocation when its victims are asleep, restless fingers or clattering eyelids. “Think about battery acid,” Thea explains the effect. “You won’t die, but you may lose an arm or a leg.”
Snake venom is a complex mixture of different toxins that are said to help paralyze or kill prey, but also to aid digestion and defend. Depending on the type, the toxic cocktail is composed differently and causes different symptoms. So the poison of the Mozambique Speikobra destroys cell membranes, which leads to necrosis; there is severe swelling and the pain is extreme. Their poison mostly only acts locally, around the entry wound. The bite of a black mamba, on the other hand, is comparatively painless, its predominantly neurotoxic poison spreads through the blood or lymphatic system in the body, blocks nerve impulses and paralyzes the respiratory muscles. Already after ten or fifteen minutes it has an effect, the victims become dizzy, they feel a bitter taste in their mouth, a tingling sensation in the lips and tongue, thirsty and sweating. If no antidote is administered, death can occur after a few hours.
Thea almost never has to do with a bite of a boomslang or a Cape bird snake. These two species are extremely shy, keep away from people. Their poisonous mixtures affect the blood, destroy erythrocytes and blood vessels and influence coagulation so that the bite site bleeds, bruises occur and internal bleeding. In the end, there is multiple organ failure and coma. In the case of the boomslang there is an antiserum, but not for the Cape bird snake. “You are bleeding to death,” Thea warns her course participants. The pictures of disfigured bite victims that she shows so that people stay away from the venomous snakes are also drastic but effective. Because this is not always possible, she demonstrates in the practical part how to catch a snake safely with hooks and pliers. The workers of the road construction company have to overcome themselves visibly, they heard countless myths and legends about the reptiles from childhood. One asks if there are really flying snakes. The expert knows all of these questions and answers: There are neither flying snakes nor one with seven heads and none with a feather on the back.
Another student wants to know if she works with traditional healers. They are often the first point of contact for bite victims, on the one hand, because there is a shortage of doctors and therefore no alternatives. On the other hand, snake bites are often considered an ancestral punishment or a curse. That these healers achieve alleged treatment success can be explained, among other things, by the fact that in half of the cases it is estimated that non-toxic snakes are responsible or that there was only a “dry bite”. In the Kingdom of Eswatini, people mostly rely on Sibiba, a powder made from dried snake, bark and other parts of plants. It is swallowed or applied to the skin and offers no protection against the snake venom. What damage traditional healers can do with wrong treatment after a bite had to experience Thea when a child died of internal bleeding. Not the venom of the attacking diamond toad viper (Causus rhombeatus ) was responsible for the death, but a caustic drink that a healer had given the child. So that such a misfortune never happens again, Thea works with healers in the hope that they send critical cases to the hospital. This takes time and tact: “Snakes are part of our culture, our belief. You can’t just say: don’t act like that; you can’t just uproot the culture. “
But not only healers, but the medical staff are also often helpless. How many snake bites can be treated is only a marginal note on the curriculum at many African universities. That is why Thea founded her “Eswatini Antivenom Foundation” more than ten years ago. The foundation holds a symposium for doctors, nurses and nurses every year, at which experts from all over the region give lectures. And helpful instructions have been developed that take the country’s medical infrastructure into account: “We have no laboratories here. So you don’t write in the treatment protocol: ‘Do blood tests A, B and Z’, ”says Thea. The symptoms should help identify what type of poison it is, so doctors don’t have to rely on vague descriptions of the snakes. In addition, the goal was to eliminate harmful practices, says Jonathan Pons, who provides medical advice to the foundation. Pons heads the Good Shepherd eye clinic in Siteki in the east of the country, near the border with Mozambique, and explains what has led to success there: that snakebite patients are no longer treated by surgeons, but by general practitioners. “We surgeons have a temper that leads us to do something with the knife.” Another achievement is that the Ministry of Health in Eswatini now requires hospitals to record all the snake bites treated. Appropriate measures can only be planned if you have facts and figures. Pons heads the Good Shepherd eye clinic in Siteki in the east of the country, near the border with Mozambique, and explains what has led to success there: that snakebite patients are no longer treated by surgeons, but by general practitioners. “We surgeons have a temper that leads us to do something with the knife.” Another achievement is that the Ministry of Health in Eswatini now requires hospitals to record all the snake bites treated. Appropriate measures can only be planned if you have facts and figures. Pons heads the Good Shepherd eye clinic in Siteki in the east of the country, near the border with Mozambique, and explains what has led to success there: that snakebite patients are no longer treated by surgeons, but by general practitioners. “We surgeons have a temper that leads us to do something with the knife.” Another achievement is that the Ministry of Health in Eswatini now requires hospitals to record all the snake bites treated. Appropriate measures can only be planned if you have facts and figures that lead us to do something with the knife. ”Another achievement is that the Ministry of Health is now obligating hospitals in Eswatini to record all the snake bites treated. Appropriate measures can only be planned if you have facts and figures. that lead us to do something with a knife. ”Another achievement is that the Ministry of Health is now obligating hospitals in Eswatini to record all the snake bites treated. Appropriate measures can only be planned if you have facts and figures.
Another task of the foundation is almost more important at the moment: It helps when hospitals no longer have an antidote in stock. Financed by the snake courses, the sale of fishing gear and private donations, it takes on a role that the government should actually be performing, but the country has been plagued by droughts for years and is in financial need. In addition, each ampoule of antiserum costs the equivalent of around 94 euros. This adds up if up to 25 ampoules are necessary for snakebite poisoning to neutralize the poison. In order to ensure supply nationwide, a kind of antiserum bank network was also founded: private entrepreneurs from agriculture and industry who can afford to store antidote for their own needs and those of their employees.
An important step because in most countries where snakes are a problem, affordable and effective antisera are lacking. Production is complex, costly and has hardly changed since its development more than 120 years ago: small amounts of snake venom are injected into horses, sheep, donkeys or camels over a longer period of time, with increasing doses, so that the animals produce antibodies that are themselves then let it be extracted from their blood plasma. However, such an antiserum is not a universal agent but acts specifically – against the one injected poison, which varies depending on the snake, sometimes even within one species depending on the region. Quality and effectiveness also fluctuate greatly because there are no uniform production standards and controls. Fewest antisera have been tested in clinical trials because they cost a lot of time and money. “Antidote is lawless,” says Thea. The wrong products are used and there are inferior ones in circulation. According to the organization “Doctors Without Borders”, only two percent of those affected who are bitten by a venomous snake in southern Africa receive a high-quality product. Doctors and patients have therefore lost their trust in antisera. Demand is falling, prices are rising, there are less production and no more investment in research and development. that are bitten by a venomous snake in southern Africa, a high-quality remedy. Doctors and patients have therefore lost their trust in antisera. Demand is falling, prices are rising, there is less production and no more investment in research and development. that are bitten by a venomous snake in southern Africa, a high-quality remedy. Doctors and patients have therefore lost their trust in antisera. Demand is falling, prices are rising, there are less production and no more investment in research and development.
The suspicion was only slowly overcome in Eswatini. Useless preparations have been removed from the hospitals and doctors are now using a polyvalent antiserum from South Africa. This works well for Mamba, Puffotter and Banded Cobra. Only with the Moçambique spitting cobra is the result unsatisfactory, partly because the poison acts quickly, decomposes blood vessels and tissue, which then also stops the antidote. Otherwise, the antiserum helps reliably, but there are always bottlenecks because not enough can be produced.
Even if the polyvalent antiserum is in stock, it is not always administered: the side effects are avoided, for example a life-threatening anaphylactic shock, which is triggered by the animal proteins in the serum. However, rashes and fever are more common in response to contamination, as in the case of Qiniso – harmless, but inexperienced doctors are put off. That is why Thea Litschka-Koen wants a preparation that does not pose any risks or has to be cooled, so it can be administered anywhere. Then nobody would have to die on the way to the hospitals equipped for resuscitation. If such a product were readily available like a headache pill, hundreds of lives could be saved.
To get closer to this goal, Thea places all the snakes she catches in terrariums and boxes in a shed at the end of her garden for a while. The family estate is located in the middle of a sugar cane plantation, where snakes are typical visitors. A few days ago, Thea was woken up by the bark of her Jack Russell. She found the excited dog in the living room – at eye level with a spitting cobra. “How God created me,” that is, naked, but equipped with safety glasses, Thea caught the reptile and stuck it to the other sixty in her scales. Before the snakes are released, their poison is milked to test the effectiveness of four polyvalent antisera. This is to prepare a clinical trial which is the result of a joint initiative by the Antivenom Foundation and the Liverpool School of Tropical Medicine, funded by the Wellcome Trust. The British Foundation has promised around 94 million euros for scientific projects in which existing antisera will be improved and new therapies developed. The aim of the project in Eswatini is to determine an antiserum that is particularly effective in neutralizing snake venom and to test it in a clinical study. Thea hopes to soon be able to open her own snake farm to provide the poison as the basis for serum production in her home country. in which existing antisera should be improved and new therapies developed. The aim of the project in Eswatini is to determine an antiserum that is particularly effective in neutralizing snake venom and to test it in a clinical study. Thea hopes to soon be able to open her own snake farm to provide the poison as the basis for serum production in her home country. in which existing antisera should be improved and new therapies developed. The aim of the project in Eswatini is to determine an antiserum that is particularly effective in neutralizing snake venom and to test it in a clinical study. Thea hopes to soon be able to open her own snake farm to provide the poison as the basis for serum production in her home country.
Scientists around the world are working on new methods of treating snake bites. An international team led by molecular biologist Somasekar Seshagiri, for example, has the toxins of the South Asian cobra ( well, well) analyzed based on their genetic make-up, which may allow the biotechnological production of an antidote. Decoding additional snake genomes could lead to a universal serum that works against the toxins of various species. Other researchers are working on nanoparticles that, injected directly into the bite wound, are intended to stop or reduce the destruction of the tissue. And just recently, researchers in Utrecht have managed to grow simple miniatures of their venom glands from the stem cells of various types of snakes. These so-called organoids make it possible for researchers for the first time to examine poison production at the cellular level, which may facilitate the production of poisons and suitable antisera in the future.
Thea welcomes the fact that snake bite poisoning is finally receiving more attention, but she lacks short-term solutions: “While we are doing all this research, nobody is funding the people who need it most now.” Those victims of snake bites who have no medical treatment, no antidote: “They can’t wait fifteen years for the scientists to come up with a solution.”
Qiniso was lucky. Although treatment was interrupted, he was given enough antiserum. Without it, more tissue would have been destroyed, but even so it will have to deal with the consequences of the bite for a long time. He has now had three operations, the first being to cut the tissue on the back of his hand down to the tendons. A few days later he had to go under the knife again, his arm was cut open from the wrist to the elbow to remove pus. Then skin was transplanted from his thigh to his hand. After a month in the hospital, Qiniso was finally released. His operations and the antiserum have cost more than 5,600 euros, which the state bears, but he can hardly move his fingers to this day. It will take weeks before he can start his job again as a forestry worker. Until then, he doesn’t earn anything. Qiniso had to take his children out of school now, he can no longer pay the fees: “I never thought that a snake bite could be so serious. I wish everyone was more aware of that. ”
BY LAURA SALM-REIFFERSCHEIDT (TEXT) AND NYANI QUARMYNE (PHOTOS)
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