World NTD Day: How community voices are essential to tackling the silent crisis of snakebite

Hiral Naik is the Africa Programme Manager at ‘Save The Snakes’, an organisation dedicated to mitigating human-snake conflict globally. Hiral is currently running a snake education and outreach project in South Africa in collaboration with the Hoedspruit Reptile Centre.

The flickering tongue, a pair of glittering eyes. Many people bitten by snakes don’t even see this much of their aggressor, who may bite at night, under the cloak of darkness. What is painfully visible is the appalling consequences if people don’t get the treatment they need fast. Such treatment is unlikely, in many places today, where snakebite is a daily hazard.

It’s often said that snakebite is the world’s most neglected disease. It kills between 81,000 and 138,000 people a year and leaves many more with life-changing disabilities. Snakebite is one of the 20 WHO’s Neglected Tropical Diseases (NTDs) included on the Roadmap agreed by Member States in 2019, with the aim of substantially reducing the damage and suffering caused by these diseases by 2030.

But that target is looking increasingly unreachable. The challenges in tackling snakebite are multiple, and the solutions may be equally diverse. A key consideration that’s gaining more ground is the necessity of engaging the affected communities themselves, to close the gap between the experiences and reality on the ground and the more remote places where policies and funding are determined.

Hiral Naik is a founder member and chair of the steering committee of a newly created network, the Snakebite Community Engagement Network (SCEN) that aims to bring together affected communities to share experiences and learn from each other. As well, a key aim of the network is to strengthen the voices of people impacted by snakebite so they can bring their knowledge and experiences to influence decision-making on snakebite policy at national, regional and international levels.

Six months after the creation of the SCEN, we sat down with Hiral, to ask her what’s been achieved so far and to share the objectives for the network going forward.

At the first meeting convened by SCEN, what were you hoping to achieve and did it go well?

Yes! We had a very good turnout with representatives from India, Malaysia, Thailand, many African countries (both in the south and east of the continent), and participation from South America. It gave us a very powerful opportunity to learn more directly about what’s actually happening in our different countries and communities, and about the diversity of efforts people are directing towards dealing with snakebite. We learned more too about the huge gaps that are currently in so many places in tackling snakebite effectively at community level.

What were the common challenges you identified together?

We were able to learn about a range of common challenges from our different communities, such as the paucity of effective education, training and prevention measures, and, where they do exist, we heard about the differences in approach. For instance, in some places like India where snakes are revered, snake-handling is being used to train people, whereas in other places, snakes are reviled and killed and play no part in the education and training — it’s very academic. What became very clear from our discussions is that there are no ‘one-size-fits-all’ solutions to all our shared challenges.

Why do you think it’s important for the voices of communities impacted by snakebite to be heard at national and international level — what do these voices bring to the table?

You can’t come up with effective solutions if you don’t understand the exact nature of the challenges faced by communities on the ground. And that’s our problem, even we, from the communities of people affected by snakebite, don’t know enough still about the experiences of people on the ground and the challenges people are facing even where we live. So, while it might be comparatively easy for people to reach out to governments for help as we have heard in, say, India, that might not be the case at all for the communities in Zambia or Ecuador. That’s where we are hoping our network can help by sharing experiences and finding ways of working together, so that communities are inspired by what they learn from us, and are empowered to use their voices to set out what’s actually happening in their communities with snakebite, what the problems on the ground really are, and thus contribute to laying the ground for finding relevant and sustainable, community-based solutions. At the highest level, we also need WHO to recognise that currently we just don’t have any effective international guidelines in place on how we can better manage snakebite at the community level to make a real difference to people’s lives and that this needs to change.

One of the major challenges is the difficulties in engaging the local healthcare workforce at community and national level. Is this a matter of a lack of trust, or a lack of education, training and knowledge about snakebite?

It depends. For instance, in South Africa, where I live, we have very good healthcare systems and so it’s been easier for us to approach and work with the healthcare workers. In fact, we’ve seen the creation of a national snakebite database that can really help spur on our understanding of where and how snakebite is affecting our communities. And while we’re still not getting enough data input yet from doctors, nurses etc, it’s still a really useful first step. Now, in Zambia, we hear from our Zambian representatives, it’s a lot more challenging to get such a project off the ground because of a weaker relationship among the community, the healthcare workers and the national government. We need the visible backing and support of an international community network like the SCEN to make this kind of thing happen in many places, pointing to the good example of the action taken in South Africa.

Running a medical workshop on snakebite for healthcare professionals © Hiral Naik

What kind of shared education needs to happen to help prevent snakebite, across the board?

We definitely need to mainstream education about snakes and snakebite and make sure it is information that’s made available in schools, other places of learning, workplaces, etc — in order to share the risks with people who might be affected and can then take preventive steps to avoid being bitten. Healthcare workers specifically also need more education about snakebite. It’s not just a question of treating patients for their symptoms when they arrive in clinic. It’s important to be able to identify which kind of snake has bitten the patient, and what is the nature of the bites they have received. This information will then help them pinpoint the symptoms more accurately and swiftly, and narrow down what treatment is most likely to be effective.

Presumably there are some obvious shared barriers to getting people in the community educated, trained and engaged — such as language barriers?

Absolutely. We want to be able to connect with communities and build that trust and the only way to do that is to be able to connect to them in their own language. In my own educational efforts, I have found that when we and our local partners speak to the learners or the community members in the local language, it’s a lot easier for them to connect and understand our messages. That’s how we will not only share information on how to minimise the risks of snakebite, it will also make the task of involving local stakeholders much easier — whether you’re training local community members or working with existing organisations that you know work in the community. They will already be speaking the same language, and so we need to be working with them as opposed to starting a whole new project on our own.

You emphasise the importance of working with all the existing stakeholders in community, does that include traditional healers?

Yes. We need to hear and learn from them about what they have been doing — which may not be guided by the correct information — and then help to change that by sharing our own knowledge and perspectives. I think what I’ve realised is that a lot of people are trying to do things their own way instead of trying to engage and learn from each other. And once you change that approach, I think there’s a lot more room for us to be able to work together. I don’t think it’s going to be easy, and it will take time. But I think if we start having those conversations, trying to understand them, and help them to understand us, it will be a lot easier.

Most people bitten by snakes live in rural settings. Is this a challenge to connecting people together to create an active community?

Yes, these communities are often very isolated. They are far from the places where decisions on funding and policies are made. That happens in cities, whether we are talking about national governments, or international bodies, or even companies that are willing to fund certain initiatives. These people don’t take the time to try and connect with those communities on the ground. They offer funding or donations for education or for rural communities, but they never discover if there’s any kind of positive outcome for the money they have invested in the community, because they haven’t properly connected with the communities. You have to understand that people in rural communities often don’t have the money to get a cell phone or a computer to be in touch with people outside their immediate vicinity. Even if contact is made with the leaders of the community, they too don’t often have the money to go and communicate with government or to travel around. So that creates a real blind spot where the situation on the ground is not appreciated by the people with the power and the money to change things.

So beyond just the geographical remoteness of these communities from the centres of power, they are also made vulnerable through poverty?

Absolutely. In a lot of these locations, people don’t have doors and windows on their houses for instance. They don’t have the basic kind of security that people in a city or well-established area might have. They live in huts or shacks that are very close to the wild environment, so nothing is preventing snakes from coming into the house. And, when they are outside the home, at work for instance, they usually go barefoot or in flip flops that barely protect their feet and ankles.

You’ve shared some of the common challenges. How easy is it to find solutions together as a network?

There is no one-size-fits-all to any of the different challenges. For instance, one prevention strategy proposed is for companies to hand out boots to their workforce to protect their feet. Unfortunately, I know that where I live, in South Africa, people just wouldn’t easily agree to wear boots routinely. However, another proposal of mosquito nets at night when people are sleeping — that’s a fantastic idea that could work in a lot of different places. So, if we could get funding to buy and give away nets to community members, I would find that quite an effective and more universally acceptable prevention strategy. It’s clear overall that to capture the diversity of responses, we should carry out surveys in our different settings to learn about the experiences that different people have with finding solutions, so we can then help create specific targeted prevention measures, and help establish what works or not.

Do you think people at the top — in the ministries of health — are aware of the needs of the community?

No, as I said, people from the very top don’t have a clear perspective because they are not going down to the communities to learn, to spend time with them to understand the issues they are facing. They just come up with simplistic solutions like, we just have to kill the snakes. So that’s where I hope the SCEN will make a difference. Through our network, we will learn from people on the ground what their issues and challenges really are, and then take these to the top and highlight what is actually happening and needs to be addressed.

Following your first meeting all together, what are the next steps for SCEN?

We want to diversify the membership, and to bring in people who are not snakebite experts per se, but who can contribute to building up the full picture on the ground of what’s happening — for instance farmers, social scientists, economists. This way, we will be able to give a better and more holistic picture of what is happening; for instance, how snakebite is impacting local economies, and to help document how the disabilities caused by snakebite are impacting households, the economy and the healthcare system. So, I would say we are still in the recruiting phase for SCEN, bringing people and different stakeholders together to engage them on this shared challenge of supporting the snakebite community.

At the same time, it remains top priority for us to help build up and give the people in the communities impacted by snakebite a platform for their voices, an opportunity to share their own experiences. And we want to share these experiences with the world, because it’s still not understood how big a crisis snakebite is for so many neglected communities. We need to get their voices heard and work together to end this neglect!

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Thank you very much, Hiral, we look forward to hearing how things progress with the SCEN and your work to tackle snakebite together.

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