/ 30 May 2023

Snake handler comes to the rescue in eSwatini antivenom crisis

Eswatini Antivenom
Thea Litschka, the country's only woman snake handler and founder of the eSwatini Antivenom Foundation.

While collecting firewood in a forest in Lubombo, eastern eSwatini, a black mamba bit 29-year-old Cindy on her lower thigh. 

Back in her village, someone from the neighbouring home quickly brought a concoction for her to drink. Desperate, she drank the bitter contents before a friend rushed her to the hospital.

Thea Litschka, the country’s only woman snake handler and founder of the eSwatini Antivenom Foundation, was on duty at the hospital that day and recalled that Cindy (whose surname has been withheld) was brought in with classic black mamba symptoms: sweating, restlessness, nausea and respiratory distress. But there was also blood in her vomit.

The team attending to Cindy thought it had made a mistake with the diagnosis, Litschka explained, because black mamba snakebite victims do not bleed profusely internally.

“She was coughing up blood and when she vomited, it was bright red. Her abdomen was swelling rapidly — something was very, very wrong,” she said.

A referral was quickly arranged to The Luke Commission, which still had antivenom and life support critical for severe black mamba bites.

“We asked her friend if she had taken a home remedy. She said no. Blood units were immediately given. She was also given a large dose of antivenom, but her condition continued to deteriorate,” Litschka recalled.

Shortly after that, Cindy’s heart stopped, and a little later, she was declared dead. 

“We finally discovered that the concoction she drank was so corrosive that it had destroyed her stomach and intestines, which was the cause of the bleeding. She didn’t die from the snakebite but from the concoction, a supposed traditional snake bite cure.”

Cindy’s case is one of the numerous daily cases that Litschka has handled. Her work in snake conservation and education dates back to 2005. 

Recently, however, Litschka’s work has been jeopardised by an unexpected development. The facility that produces antivenom for many countries in Africa — the South African Vaccine Producers — has been hit by nationwide power outages. The unit is now desperately trying to catch up, but deliveries outside the country have been badly affected. 

“Antivenom is an essential medicine. Without it, the victim will die or lose a limb. Not having antivenom in eSwatini is beyond unacceptable. Unfortunately, the supplier from South Africa has let the entire Southern African continent down. We can’t buy, even if we wanted to. They can’t supply. I am still waiting for the stock we paid for in November 2021,” she said.

The countrywide shortage of antivenom means the foundation’s volunteers are constantly on call, working with hospitals and clinics to assess bites and, if necessary, transfer patients to The Luke Commission, the only facility that still has vials of antivenom left.

“Despite receiving and treating 110 patients so far, they have never turned us away, and because every bite is carefully assessed and consulted, they have never run out of antivenom. Yet.”

Moreover, antivenom is expensive and unaffordable for most people in the kingdom. The cost to treat one Mozambique spitting cobra victim is $1 620, and a black mamba bite is $1 080 — much more expensive than the average Swati can afford.

So Litschka and her team at the foundation, who, she says, were concerned about supplies as far back as 2016, pushed through and found funding to develop a product and to put it through preclinical testing.

“Sadly, it is taking quite long to get it registered and imported into eSwatini but we are hopeful that it will be in all the health centres and hospitals for the next snakebite season. The cost is also one-quarter of the price we are paying now, which will assist with the financial burden, not just for the foundation, but also for the country,” she added.

In addition to this, Litschka and the foundation are involved in development research for antivenom that will be free to snakebite victims. This research entails studying snake venom to see if it changes in captivity.

“Companies who extract venom for the production of antivenom are not controlled. It is our suspicion that if you keep a snake in captivity for many years and only feed it dead food, the venom composition may change,” she stated.

The study is being conducted on 180 snakes. Some are fed dead food only, others only live mice and the third control group, a variety of live food as they would find in natural settings.

Several research projects have since been completed, and they are busy with a few more.

Snakebite data from all the major health centres and hospitals in the country was also collected.

A special data book captures data regarding the victim (age, occupation, region), what the victim did when they got bitten, the effects of the venom, if antivenom was used and the outcome.

“This helps us determine where we need antivenom. We have 15 antivenom banks throughout the country and where education is most needed. Then we put the data of snake rescued in the mix as well as habitat. We have developed a ‘risk map’ together with the university that will help us plan better,” she added.

They have also conducted further studies to look into the effects of Mozambique spitting cobra venom and the effectiveness of the antivenom.

Snakebite assistants were stationed in all the hospitals, who called when a victim arrived and sent pictures.

“I would then tell them if the victims should be included in the study. We monitored the wounds, how big, blisters, blebs, etc. We have also studied the effectiveness of our new antivenom,” she said.

Litschka is confident that these efforts will soon bear fruit. — bird story agency