After a lot of searching I have found two companies from which I would be able to purchase antivenom to donate to one of my favorite places with a high population of red spitting cobras, black mambas, green mambas and puff adders. Both Sanofi Pasteur in France and SAVP in South Africa have a good polyvalent antivenom. True, they both need to keep under refrigeration - and both outdate in about three years. At least I found places where I could get it.

Next frustration was, everyone discouraged me from doing it. Everyone (medical) stated it needed to be given ONLY by doctors in a hospital setting.

Now, having worked in hospitals for 50 years (not a doctor or nurse), I know all too well that some people can have devestating results from medications, particularly those who are allergic to horse serums and/or have asthma.

Thus I searched to see if there was a program in Kenya that would train RESPONSIBLE people in starting an IV with antivenom until Flying Doctors could arrive or patient could reach hospital, to train them in using an Ambubag to assist if lungs become paralyzed and shut down and injecting epinephrine if someone goes into shock. No-one would even consider doing this.

I am totally frustrated at this point. Yes, someone could die from antivenom - but if they are going to die in 30 minutes anyway from a black mamba bite (not a dry bite) how does one access the risk of death from deadly snake bite versus POSSIBLE risk of bad reaction to antivenom?

To all you regular safari goers, if you got a serious (not dry) bite from a black mamba and knew Flying Doctors couldn't get to you for at least an hour, and the nearest hospital was at least three hours away,
would you take your chances on dying fast from the bite or would you rather take the chance at having a non-doctor start an antivenom drip and possibly having a bad reaction from that?

Some would say that letting a non-doctor initiate antivenom would be negligence - but isn't it also negligence at not doing anything and standing by and watching a patient die in 20 - 30 minutes from a serious bite? (I use the term negligence not in the sense of a law suit but as a general term).

Would be interested in your thoughts on this.
- Edited by Jan on 02.10.2008, 03:48 -

My thoughts are to get the anti venum in ASAP.
I think that some doctors or NON African doctors prefer not to have a patient touched as 1st aiders at times make mistakes and make the situation worse. However with a snake bit it is different.

If you get bitten by a snake in the bush - the chances of survival without INSTANT action usually could lead to death (depending on the snake, size and age of the person and area of the bite). If people would be trained - just like advanced 1st aiders - perhaps 1 or 2 people in hotels / lodges / camps or guides; it will help a lot and I would vote for getting a shot in my system ASAP - rather than have a greater risk of death.

I know quite a few people (including my wife), that keep anti venom for their dogs in case they eat poison. This doesn't guarantee that the dog will survive, but raises the chances significantly.

So yes, I would definitely go for the anti-venom on a snake bite.

Jan, can Bio-Ken not help you?

Bio-Ken did not have enough on hand to sell and didn't want it to get into untrained hands. They suggested that perhaps a clinic in Voi might be the answer (though at present this clinic does not have antivenom and it is a one-hour drive from camp). Sanda Ashe gave me the name of the doctor in Nairobi who could get the Sanofi Pasteur antivenom. I contacted him and he was willing to get it for me. SAVP is also willing. I contacted Flying Doctors to see if they might have a training program to teach people to initiate treatment if given the order by Flying Doctors while waiting for them to arrive, and they wrote back they didn't recommend anyone except doctors giving it. I know that about 10% of people getting antivenom have a severe or deadly reaction to it and that is probably their reasoning.

The camp manager just attended the Bio-Ken seminar in Watamu on Saturday. He has caught and relocated snakes in Kenya for over 30 years, and now even he is running scared and is changing his way of thinking.

I tried explaining to all the above people that if I dial 911 on my phone, a police car, fire truck and ambulance show up all within 3 - 4 minutes. All these people are trained as first responders, and the paramedics on the ambulance crew are in phone touch with the hospitals and are allowed to give medications and use Ambubags on doctor's orders and all these people are trained in CPR, Hemilich maneuver, etc.

I know because of finances and logistics of getting to people this is unrealistic at this time for most of Africa.
However, it would seem that there are many responsible people who could be trained to do IV's, give medications on orders, etc.

I also recently read that the Kenyan government had purchased 37,000 units of antivenom. Where is it? Most places don't have it and aren't trained on giving it. Wonder who they have distributed it to?

I know that just wrapping a limb is the recommended way of handling bites. It is no longer suggested using a tourniquet. However, because of what I have learned about the lack of antivenom in most places, I will request a tourniquet. I would much rather risk losing an arm or leg but live, then just wrapping as you would a sprain and have enough venom get through that you die.

Snake bites are just too unpredictable. We have an excellent TV program here called "Venom ER" from Loma Linda Hospital in California (they have a lot of rattlesnakes in that area), (and one of their ER physicians is the snake bite expert - he even catches snakes himself). On one program two men were brought in for snake bite treatment. One was so bad you just knew he was going to die. The other had a superficial bite on the finger, didn't appear ill, sat talking with the doctors, etc. Both got antivenom. the guy who was in such serious condition lived - and the healthy-appearing guy died from a related heart problem. The snake bite expert's 4 year old son was recently bitten by a rattlesnake and had to have 10 units of antivenom. Thankfully he too survived.

Anyway, both the bite and/or the antivenom, can cause very serious effects. My personal feeling is that I would want the antivenom and would take my chances with the side effects of it rather than just having people standing and watching me die without doing anything.

There are places in Africa you hardly ever see a snake. In others they are quite common. It is in these areas that I would love to see people trained to deal with this type of crisis until trained medical help could arrive. Anyone have any good ideas on how to get the authorities to think about this?
- Edited by Jan on 06.10.2008, 02:34 -

An area to look into is Asia - the most snakes I come across (You may have noticed that snakes fasinate me) in the wild was in Srilanka. Absolutely a snake paradise for those interested and I sat once watching aboy - no older than 5 years (younger than my son) playing with a cobra. The cobra had teeth and venum as his father later took the snake and milked it.
They have serious situations with snake bites in Asia on rise fields, tea plantatiosn etc etc - much higher death rate I think than Africa - anyone know how they handle antivenum?? Are people allowed to give antivenum there?

uch.....jan, that's all scary!

not the sanke or their bites but the whole anti venom situation!
i would have bet especially remote camps in the middle of nowhere where a high snake population is around they would have traiined staff and anti venom.

okay - now we have got the info that my "bet" is not mirroring reality: what can a guest expect when being bitten by a puff adder or cap cobra e.g.? DIEing?

anyway - to your question
i of course would appreciate anything done or applied by anbody at least i could hope to survive.

very interesting topic!