At Guinea's only specialized snakebite clinic, doctors need luck and antivenom
Fatoumata Lamourana was oblivious to the green mamba's approach. But as the 68-year-old led her cattle through the scrubby bushlands of western Guinea, she felt its short fangs penetrate the flesh above her ankle.
"When it bit me, I tried to run away but could only go so far before I collapsed and started vomiting," she said.
Within less than half an hour, deadly neurotoxins from the western green mamba had surged through her bloodstream, attacking her nervous system. By the time Lamourana arrived at Kindia's centre de traitement des envenimations, Guinea's only specialized snakebite clinic, her eyes had rolled to the back of her head, her breathing was shallow and she was unable to speak. Doctors drilled an intravenous catheter into her left tibia to deliver antivenom. Lamourana's veins had collapsed.
As his patient lay writhing in bed, chief physician Mohamed Ciré Diallo conceded the prognosis was bleak. "When snakes lash out at herders, they are normally riled up after being trampled by cows. An angry snake will release much more venom than usual," he said.
About 3,600 people are killed by venomous snakes in Guinea every year, according to the state-sponsored Research Institute of Applied Biology of Guinea (IRBAG). The small West African nation of 13 million people accounts for well over 10% of all such deaths on the continent.
Sometimes though, the Guineans bite back. At a bushmeat restaurant in Kindia, the town where the clinic is based, snakes are descaled, boiled and served at about $3 per dish. But this does little to dent the abundance of serpents imperiling local residents.
If anything, the number of snakebites appears to be increasing. In response to an urgent request from the Guinean Health Ministry, the World Health Organization took the unprecedented step of dispatching 100 doses of antivenom to the capital, Conakry, in August. It plans to send a further 500 in the coming weeks, according to Mohamed Sankhon, a communications officer with the WHO in Guinea.
"Guinea is like a miniature Africa," said Dr. Mamadou Cellou Baldé of IRBAG, which houses the clinic. "We have four biomes: mangroves, mountains, savannah and forests. This provides considerable habitat for different snake species."
Venomous bites from mambas and cobras account for about 70% of fatalities at the clinic. Baldé says that number is likely to increase as the mamba population grows due to deforestation, which has caused the populations of birds of prey — one of the snakes' only natural predators — to decline. The other deaths are mostly caused by vipers whose venom can cause patients to blister at the wound and hemorrhage from the eyes and mouth.
But no matter the culprit, victims are routinely treated with INOSERP, a polyvalent antivenom developed with collaboration from Professor Baldé and his team. Patients are asked to pay 850,000 Guinean francs (about $98) per dose, often indebting themselves to do so.
"I try to reason with the families," said Dr. Diallo. "In our culture, it is customary to organize a ceremony and sacrifice a cow when someone dies. The cost is often double that of lifesaving antivenom."
Most venomous snakebites require multiple doses of antivenom and practically every patient at the clinic receives at least some free vials from the Asclepius Snake Foundation (ASF), an American-based organization that provides vital clinical and material support to the clinic. No one is sent away.
But elsewhere in Guinea, the situation is dire. Of the country's eight regional health centers, the best-stocked has a reserve of just 18 antivenom doses — half the strength of those at Kindia clinic — and some have none at all. "If you take Guinea as a whole, there is obviously a need for way more antivenom than we can provide," said Jordan Benjamin, ASF's founder.
Most patients travel to the Kindia clinic by motorbike, sandwiched between two family members to keep them steady. The bumpy journey along the country's dirt tracks and potholed roads can take hours — and a mamba bite can kill within one. Many patients, like Lamourana, are hypothermic by the time they arrive due to the arduous trip out in the elements. Countless others die on the road.
Traditional healers remain a fast and cheap, yet dangerous, alternative. In a forest clearing outside Kindia's town center, Papa Daboh gathers bundles of leaves to be crushed and then dried in the sun. He says he inherited the gift of healing from his father and that his patients pay only what they can afford.
"You should mix this powder with water and add lemon juice for flavor," he said. "You will vomit for three days and the venom will exit your body."
Far from purging venom, which travels in the bloodstream, this method only serves to dehydrate and weaken patients, causing a shift in electrolytes and reducing their chances of survival. Other healers are known to make incisions around the puncture marks, applying herbs, dung or charred cow bones to draw out the toxins. This frequently leads to infection, necrosis and amputation, even in cases of nontoxic snakebites.
But when Papa Daboh boasts of a 100% success rate, it is possible he is telling the truth. Snakes can take weeks to regenerate metabolically costly venom, meaning they frequently deliver "dry bites" in which no venom is released. Humans, who are not considered worthy prey, are regularly on the receiving end of this phenomenon. But not everyone gets lucky.
Mohamed Bangoura, 14, was bitten by a black mamba in June. His family took him to a local healer, who served up a concoction to make him vomit. His father, also named Mohamed, was on a work trip in Kindia when he heard the news. "When the others realized that his health wasn't improving, that is when they sent him [to the clinic]," he said.
As Mohamed thrashed around, ripping out his IV, medics said they had to hold him down. Six doses of antivenom later, his vital signs began to stabilize, although his respiratory muscles were exhausted. Close to midnight, he jolted upright and died from a cardiac arrest triggered by what Jordan Benjamin, who was on duty when the boy first came in, described as "secondary envenomation," which is when toxins trapped in tissue around the wound are suddenly released.
Mohamed's father said his son was a studious young man with a passion for soccer. "He was someone that we all thought would go very far," he said. Mohamed was the third member of his family to suffer a fatal snakebite within 12 months.
"The worst cases we get at the clinic are people who first went to visit a traditional healer," said Dr. Diallo. "The key thing is that they waste time and delay treatment. The only effective solution is to administer antivenom as soon as possible."
ASF researchers spend their days scouring the bush around the clinic to search for snakes — an activity that insiders know as "herping." Captured serpents are taken to a lab and administered a dose of ketamine that leaves them slithering drowsily into a corner. Their venom is then extracted for analysis. This data is cross-referenced with clinical records to help better inform medical practice and develop more effective antivenoms.
The decades of research since the first antivenom was introduced to Africa in the 1950s was key to saving Lamourana's life. Despite community pressure to stay with a local healer, her family brought her to the clinic almost immediately. After five days of treatment and six doses of INOSERP, she made a full recovery.
"When I was bitten, people told me not to come to the clinic. They told me I would die. Thank God I was brave enough to make the journey," she said, before returning home to her herd.
Sam Bradpiece is a freelance journalist based in Dakar, Senegal. He regularly reports as a TV correspondent for France 24 and has written for The Washington Post, The Times of London and others.
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