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Human–Snake Encounters and Folk Remedies in Nepal

2018; Elsevier BV; Volume: 29; Issue: 1 Linguagem: Inglês

10.1016/j.wem.2017.08.006

1545-1534

Alok Atreya, Tanuj Kanchan,

Marine Invertebrate Physiology and Ecology

To the Editor: In some countries, envenoming from venomous snakes remains a major health hazard. Globally, South Asia probably is the most affected region.1Alirol E. Sharma S.K. Bawaskar H.S. Kuch U. Chappuis F. Snake bite in South Asia: a review.PLoS Negl Trop Dis. 2010; 4: e603Crossref PubMed Scopus (304) Google Scholar In the Himalayan nation of Nepal, snakes are commonly venerated. Snakes figure prominently in Hindu mythology, as they do in some other cultures. In Hindu tradition, Sheshanaga (Shesh Naag)—the “king of snakes”—plays the pivotal role of supporting the Earth on its head. The possible philosophical basis of the symbolism of the universe being supported by Sheshanaga’s thousand heads is that the existence of the world rests on good deeds and so forth. In yogic and spiritual practice, the unravelling of kundalini (the source of life force, energy, and consciousness) from the base of the spine is linked to the uncoiling of the king cobra. There is a blend of tradition among Hindus and Buddhists in Nepal, and this includes the spiritual interpretation of snakes. As per the Vinaya Sutra, a 7-headed serpent king, Mucalinda, sheltered Buddha during a great storm. According to Hindu mythology, the deity Lord Vishnu is shown as in control of, and resting on, the 5-headed naag Adisesha in the middle of the ocean. Lord Shiva, another Hindu deity, carries the snake Vasuki around his neck as a garland (Figure 1A). These are depicted as idols and images in Hindu household and places of worship (Figure 1B). Likewise, snakes are worshipped and offered milk by Hindu devotees on a special day of Naag Panchami during mid-August. Snakes are thus worshipped either singly or along with other deities in Hinduism. Of all the snakes, cobras have gathered much attention in Hindu traditions. Idols of cobras are placed and worshipped at water sources because it is believed that cobras reside in such areas and worshipping them would not only prevent human bites but also provide surplus water supply. In Nepal, 89 species of snakes are documented, of which 17 are considered to be highly venomous.2Sharma S.K. Pandey D.P. Shah K.B. Tillack F. Chappuis F. Thapa C.L. et al.Venomous Snakes of Nepal—A Photographic Guide.. BP Koirala Institute of Health Sciences, Dharan, Nepal2013Google Scholar Annual mortality from snakebites is speculated to be 162 per 100,000 population in Nepal.2Sharma S.K. Pandey D.P. Shah K.B. Tillack F. Chappuis F. Thapa C.L. et al.Venomous Snakes of Nepal—A Photographic Guide.. BP Koirala Institute of Health Sciences, Dharan, Nepal2013Google Scholar, 3Schleich H.H. Kästle W. Amphibians and Reptiles of Nepal. AR Gantner Verlag, Ruggell, Liechtenstein2002Google Scholar Human–snake encounters are reportedly high during summer and rainy seasons. Snakes emerge from their cover during summer in search of cooler places, and during harvesting season, they are attracted by rodents and frogs.4Monterio F.N.P. Kanchan T. Bhagavath P. Kumar G.P. Epidemiology of cobra bite in Manipal, Southern India.J Indian Acad Forensic Med. 2010; 32: 224-227Google Scholar Hunting snakes for their utility in Ayurveda and traditional medicines and for their use as a source of livelihood by serpent charmers are some of the other unusual human–snake encounters in this part of the world. Cobras are often linked to phallic symbols (eg, lingams). The cobra’s ability to spread, or “erect” its hood is relevant to Ayurvedic medicine because various forms of snake oil (eg, Naga oil, purportedly obtained from cobras) is prescribed for erectile dysfunction. Other Hindu folklore suggests that that individuals affected by erectile dysfunction who are fortunate enough to observe the mating of king cobras will be “cured” and attain peace and prosperity for their families. It is not an uncommon practice to place the sacred yellow cloth at the site where these snakes are observed. In addition, serpent charmers collect cobras and often remove their fangs to perform street shows for their livelihood. These unusual snake interactions carry several risks and undesirable features, including severe damage to the snakes that often results in their death. In addition, fang removal is temporary, and bites sustained from some of these snakes can still prove fatal. Furthermore, removal of these snakes from local areas may result in an explosion of rodent populations. Expanded rodent populations can contribute to local spread of rodent-borne diseases. Geographic inaccessibility, remoteness, and faith in traditional healing practices are important factors that contribute to the morbidity and mortality from snakebites in Nepal. In folk medicine, treatment and remedies are based on oral tradition that is transmitted from one generation to the next and is based mostly on treatment with botanical products. Selecting a particular plant for medicine is based upon hits and trials of treatment. If a plant is found beneficial, it is retained; otherwise, it is discarded. Prostrate surge (Ayuvedic name: dugdhikā), Euphorbia prostrata (family: Euphorbiaceae; common name: round leaf bindweed; Sanskrit: Dugdhika; Nepali: Kanike ghans), dwarf morning glory (Hindi name: Vishnukrantha), and Evolvulus nummularius (family: Convolvulaceae, also known as the morning glory family; common name: prostrate sandmat; Sanskrit: Akhuparni, Musakarni; Marathi: Nimulwel; Nepali: Chhatbatiza) are plants commonly used in Nepal for treating snakebites with Ayurvedic medicine.5Gewali MB. Aspects of Traditional Medicine in Nepal. Awale S, ed. Toyama, Japan: Institute of Natural Medicine, University of Toyama; 2008. Available at: http://documents.scribd.com/docs/pbaqobfv3iyua8j7pcb.pdf. Accessed April 12, 2017Google Scholar There is often an unconditional trust in the local healer, and the “medicine” also is locally available.5Gewali MB. Aspects of Traditional Medicine in Nepal. Awale S, ed. Toyama, Japan: Institute of Natural Medicine, University of Toyama; 2008. Available at: http://documents.scribd.com/docs/pbaqobfv3iyua8j7pcb.pdf. Accessed April 12, 2017Google Scholar Treatment of the ailment is based solely upon the patient's history. This is more attractive to poor and less-educated Nepalese who either do not trust or are fearful of the scientific allopathic system, which may seem imposing and removed from their local traditions and cultures. Apart from the application of the aforementioned plants directly over the bite area, beverages prepared from these plants are also consumed orally for the treatment of snakebites. It is a common practice in rural Nepalese population to apply a tight tourniquet proximal to the site of the snakebite. Application of a tourniquet is contraindicated, as it may compromise the blood supply leading to ischemic necrosis. Attempting to remove venom from the bite site by stimulating or causing bleeding is also sometimes used as “first aid” after snakebites. This practice is not only associated with a serious risk of infection but also injury to blood vessels, nerves, and tendons. Such incision would further lead to uncontrolled bleeding. Suction of the bite performed to draw out venom either orally or with the use of hen’s cloaca is also a common practice in the rural communities, which is not only unorthodox but is also strongly condemned by the scientific community.6de Silva A. Mendis S. Warrell D.A. Neurotoxic envenoming by the Sri Lankan krait (Bungarus ceylonicus) complicated by traditional treatment and a reaction to antivenom.Trans R Soc Trop Med Hyg. 1993; 87: 682-684Abstract Full Text PDF PubMed Scopus (18) Google Scholar, 7Kanchan T. Rapid Review of Toxicology.1st ed. Jaypee The Health Sciences Publisher, New Delhi2017Google Scholar, 8World Health OrganizationGuidelines for the Management of Snake-bites.2nd ed. Regional Office for South-East Asia, World Health Organization, New Delhi2016Google Scholar Relying upon folk remedy in snakebite cases thus will do more harm than good. A venomous snakebite is a life-threatening emergency, yet lack of education and information, poverty, and remoteness are the reasons for reluctance and delay in seeking medical attention. Snakebites, folk remedies, and myths thus form the trio responsible for the increased numbers of snakebite casualties in the region. Spreading awareness that snakebites are not due to bad luck or bad spirits and that timely medical intervention can be lifesaving is likely to encourage the public to seek timely medical intervention in such incidents. Faith healers, head of village committee members, and priests should be made aware of the need for prompt treatment and the concept of the “golden hour” after snakebite. They should be encouraged to send victims of snakebites to the nearest health care facility for proper assessment and management. Seeking consultation from a tertiary center in complicated cases through telemedicine or video calls will provide prompt and accurate diagnosis and proper management. Mass education in the form of street plays, radio/television advertisements, and pictorial brochures/pamphlets encouraging bite victims to seek treatment at hospitals and discouraging application of herbs, chemicals, or other unscientific methods can prove effective in reducing snakebite-associated morbidity and mortality in rural areas of Nepal.