The Snakebite situation in Papua New Guinea.

The Australian Venom Research Unit (AVRU) PNG Snakebite Research Project is dedicated to lowering the morbidity and mortality due to snakebites in Papua New Guinea, the eastern half of the second largest island on Earth.

To put this into perspective we can compare the snakebite scenario in PNG with that of Australia, with which it shares many similar or closely related medically important venomous snakes (death adders, blacksnakes, brownsnakes, taipan).

Australia has a human population of approximately 21million and suffers an average of 3,000-4,000 venomous snakebites annually, but due to the facilities available to the victims the fatality rate is low, only 2-3 persons a year.

The situation in neighbouring PNG is quite different. The population of the mainland (there are no medically important elapids on the archipelagos to the east) is approximately five million, less than one-quarter that of Australia. The annual death rate has been estimated at somewhere between 200-400 and extrapolation suggests it could exceed 700 but as there is no legal requirement to report deaths in rural communities it is almost impossible to determine the exact figure. Suffice to say the annual death rate from snakebite in PNG is high.

Put this into a personal context. Look up the population of your town on the internet. Many towns and small cities have populations of 50,000-150,000. Working on an average population size of 100,000 (the usual per capita figure), Australia would suffer 0.010-0.014 annual deaths in such a population. In other words, one person would die of snakebite in that population every 70 years or so. PNG, however, would suffer between 4-8 deaths a year in the same sized community (at the death rate of 200-400 per annum). This is the fifth highest snakebite mortality rate in the world, and there are locations in PNG where the rate is much higher, up to 14-33, places where snakebite kills more people than malaria, tuberculosis or pneumonia.

Looking at it another way. Take an average life expectancy as 70years. The likelihood of an Australian dying of snakebite is 1 in 120,000 whereas the likelihood of a Papuan dying of snakebite is 1 in 180-360 (at the death rate of 200-400 per annum). If those were the odds of winning the lottery everyone would buy a ticket.

Either way you look at it, this is unacceptable in this day and age, especially when you consider that snakebite is a treatable disease, there is a cure, if it is in stock and administered in time. That cure is antivenom. But even those patients not fortunate enough to receive antivenom (PNG frequently runs out) would survive if they were placed on ventilators.

Unfortunately both fridges for storing liquid antivenom and ventilators for maintaining life, require electric power and many rural clinics have spasmodic supplies at best, and none at all at worst. There are also only three working ventilators in the country, in the main hospital in Port Moresby, and no spares if they break down. Antivenom from Australia is expensive and up to 20% of supplies have been subject to theft and black-market profiteering. Indian antivenom has been imported by unscrupulous persons and sold, at vastly inflated prices, as a cure for Papuan snakebite, for which it is worse than useless.

AVRU’s small but highly qualified team comprises physicians, tropical medicine specialists, epidemiologists and herpetologists, from PNG, Australia, New Zealand, Germany and the UK, who are striving towards changing this situation through a many pronged approach. The team carries out fieldwork to gain a better understanding of the biogeography, distribution and relationships of the medically important elapids, collecting DNA and live specimens for the Serpentarium established in Port Moresby (no snakes are exported out of the country). The team conducts workshops around the country, teaching correct snakebite first aid to barefoot health workers and snakebite treatment and management to a range of nursing and medical personnel from nurses from rural aid posts to emergency room doctors and consultants in ITU departments.

Mark O'Shea with large Papuan taipan on his seventh expedition to PNG (2006).

The Taipan’s Tale

The Papuan taipan (Oxyuranus scutellatus canni) is a large, alert and fast moving elapid, which frequently exceeds 2.0m and may achieve lengths of over 3.0m. It is distributed across the southern coastal lowlands of West Papua (Indonesian New Guinea) from the Wildoman River to Merauke and then across the border into Western Province, PNG, where it is common in the seasonally flooded grasslands and eucalypt savannas of the southern Trans-Fly region. It occurs again, across the Gulf of Papua, in the narrow coastal strip of similar habitat in eastern Gulf, Central, NCD and southern Milne Bay Provinces, PNG, between the Owen Stanley Mountains and the Coral Sea. Varying in colour from gunmetal grey, with a broad orange vertebral stripe, to uniform brown or black, this species is the single most important cause of snakebite deaths in Papua New Guinea. Its venom contains both post- and presynaptic neurotoxins, which cause reversible and irreversible respiratory paralysis respectively, and coagulants, which ultimately cause prolonged bleeding. This has caused at least one victim to bleed to death, before suffering death by suffocation, when the popular first aid technique of ‘razor cutting’ was carried out by ill-informed, but well-meaning persons. Without the correct treatment, which means antivenom to prevent respiratory paralysis or a ventilator to sustain life once paralysis has occurred, death may occur in less than one hour.

Although the taipan is primarily an open country snake and is rarely if ever found in natural woodland, we have discovered a location where it is particularly abundant in a closed-canopy habitat. Oil-palm plantation, established on former eucalypt savanna, may possess higher taipan populations than were present in the original habitat. In one such plantation the AVRU team sighted 42 taipan, and captured ten, in little over one week. Such a large population of venomous snakes would not matter if they did not come into contact with humans but the very nature of a plantation places a large number of the vulnerable workers and their families directly in harm’s way. These are the ingredients for a serious snakebite problem that have replayed around the world in oil-palm, coconut, sugar-cane and rubber plantations, paddi-fields and other man-made monocultural microhabitats. In southern PNG the oil-palm workers and their families are living cheek-by-jowl with one of the most venomous snakes in the world, and many are paying the price.

Mark O’Shea

Consultant Curator of Reptiles, West Midland Safari Park;

Research Fellow, Australian Venom Research Unit, Dept. Pharmacology, University of Melbourne;

Herpetologist with field experience in 35 countries on six continents.

Agent: David Foster Management @  http://www.dfmanagement.tv

Sources:

Chippaux, J-P. 2006 Snake Venoms and Envenomations. Krieger, Malabar. xii+287pp.

O’Shea, M. 1996 A Guide to the Snakes of Papua New Guinea. Independent Group, Port Moresby. xiii+239pp.

O’Shea, 2007 Wokabaut long kisim poisen snek: Part 1: All Work and No Play… no way! The Herptile 32(3):92-108.

O’Shea, M. 2007 Wokabaut long kisim poisen snek: Part 2: On the Trail of the Taipan The Herptile 32(4):128-151.

O’Shea, M. 2008 Wokabaut long kisim poisen snek: Part 3: In the Shadow of Mt Lamington. The Herptile 33(1):10-35.

O’Shea, M. 2008 Wokabaut long kisim poisen snek: Part 4: Return to the Island of the White Snake. The Herptile 33(2):55-75.

O’Shea, M. 2008 Serpents, Sorcery and Snakebite in Papua New Guinea - The Land of the Unexpected. A Keynote presentation. 1hr 40mins.

Williams, D.J. 2008 Proposal for establishment of a National Antivenom Unit. AVRU 150pp.

Williams, D.J., S.Jensen, B.Nimorakiotakis & K.D.Winkel (eds.) 2005 Venomous Bites and Stings in Papua New Guinea: A guide to treatment for health workers and doctors. AVRU. x+358pp.

For more information visit:

Mark O’Shea’s website: http://www.markoshea.tv/

This site includes blogs of the 2008 fieldwork in PNG which largely centred on herpetological surveys but included searches for New Guinea small-eyed snakes (Micropechis ikaheka) the only medically important PNG elapid without a close Australian relative.

There is a banner link to the AVRU PNG Snakebite Research project at the top of the homepage and a link to the ABC documentary, during which David Williams almost paid the ultimate price himself, below the 2008 fieldwork blogs, also on the homepage.

David William’s website: http://www.kingsnake.com/aho/research/research.html