The snake struck 11-year-old Beatrice Ndanu Munyoki as she sat on a small stone, which lay atop a larger one, watching the family’s eight goats. She was idly running her fingers through the dirt when she saw a red head dart from between the stones and felt a sharp sting on her right index finger.
Never a crier, she ran to her father, David Mutunga, who was building a fence. He cut the cloth belt on her dress into strips with a machete, tied her arm in three places and rushed her to a hospital 30 minutes away on a motorcycle taxi.
As the day stretched on, her finger grew darker, but the hospital in Mwingi, a small town in Kenya, had no antidote for that kind of venom. Finally that evening in November 2023, she was taken by ambulance to another hospital and injected with antivenom.
When the finger blistered, swelled and turned black despite a second dose the next day, “I understood that they will now remove that part,” Mr. Mutunga said with tears in his eyes. Beatrice’s finger was amputated.
In Kenya, India, Brazil and dozens of other countries, snakes vie for the same land, water and sometimes food as people, with devastating consequences. Deforestation, human sprawl and climate change are exacerbating the problem.
According to official estimates, about five million people are bitten by snakes each year. About 120,000 die, and some 400,000 lose limbs to amputation.
The real toll is almost certainly much higher. Estimates are generally based on hospital records, but most snakebites occur in rural areas, far from dispensaries that stock antivenom and among people too poor to afford treatment.
“We don’t actually know the burden of snakebite for most countries of the world,” said Nicholas Casewell, a snake researcher at the Liverpool School of Tropical Medicine.
Scientists are now trying to better quantify the problem. In nearly every country studied so far, the true toll of snakebites has been found to be much higher than the numbers registered in hospital records.
The problem was mostly ignored until recently.
Venomous snakebite has jumped on and off the World Health Organization’s list of neglected tropical diseases. In 2019, the W.H.O. announced a plan to halve the number of snakebite deaths by 2030 and the Wellcome Trust, a charity in Britain, invested 80 million pounds (about $102 million) into treatment research, a big boost.
Still, most countries have not allocated needed resources to fighting this danger, which mainly affects rural people with little political clout. Farmers, migrant workers, nomadic groups and residents of remote villages encounter snakes in their dilapidated homes, while sleeping on the floor, using outdoor toilets or walking barefoot.
India accounts for about half of snakebite cases globally, but some African countries lead the list relative to population size. “The fatality rate for snakebite episodes is much higher in sub-Saharan Africa,” said Diogo Martins, who leads research on the issue at Wellcome Trust.
Unseen Attackers
Snakes avoid people as diligently as people avoid them. They are shy, biting only when they perceive danger.
“They know you are useless prey,” said Dr. George Omondi, who heads the Kenya Snakebite Research and Intervention Center in Nairobi, the capital. “They would rather spend their venom on something they could eat.”
Fear and hatred of snakes often drives people to kill them on sight, but the creatures have a role to play in the ecosystem, Dr. Omondi said.
There are about 4,000 known species of snakes, and some 200 are venomous enough to kill people. “There are many more new ones to be discovered,” said Kartik Sunagar, a researcher at the Indian Institute of Science.
On one trip to the Andaman Islands in India, Dr. Sunagar found hundreds of poisonous sea kraits on the beach. He has also discovered a new species whose venom is about 15 times as toxic as that of the common krait.
Sub-Saharan Africa is home to dozens of snake species, but the most deadly and feared are the puff adder, cobra and black mamba.
Cobras and mambas have short, erect fangs at the front of the mouth that inject neurotoxins under the skin, paralyzing the victims. A black mamba’s venom is so toxic that it can kill people or prey within an hour.
Cobra bites also demand immediate attention, but with treatment recovery can be dramatic, reversing symptoms like a tape running backward. Spitting cobras can shoot venom into their prey’s eyes from up to five meters away, or about 16 feet.
Snakes like these are giants. Black mambas can stretch to 14 feet, and the longest king cobra ever recorded was 19 feet.
Puff adders are petite by contrast, as short as six inches and no longer than six feet, but very thick. They have long, retractable fangs that can deliver poison into muscle.
Their venom destroys blood-clotting factors, and victims die slow, gruesome deaths, bleeding in the brain, eyes and mouth.
Identifying the attacker can help tailor treatment. But many people never see the snake that bites them or, if they do, cannot identify it. To the untrained eye, venomous snakes may look indistinguishable from harmless ones.
The names don’t make it any easier. Green mambas are green, but black mambas are pale gray to dark brown; they are so-named because the inside of the mouth is black. They are better recognized by their coffin-shaped head and unnerving smile.
Some scientists are building A.I. models to identify snakes, so that anyone with a smartphone might be able to distinguish them.
About a third of snakebites are in children. They occur less often among pregnant women, but the outcomes — which include spontaneous abortion, ruptured placentas, abruption, fetal malformations and death to both mother and fetus — can be catastrophic.
Often the victims are farmers. The loss of a breadwinner devastates families.
Ruth Munuve’s husband worked as a driver in Nairobi and came home to the family farm every other weekend. He was bitten on a Saturday in April 2020, at age 42, while walking through the brush on his way home from a night out.
Two hospitals scrambling to treat Covid patients turned him away. By the time he died two days later, his body had swelled to double its size, a hallmark of a puff adder bite, said his sister, Esther Nziu.
Ms. Munuve now grows maize and cowpeas, mostly for food, and sells green grams. Ms. Nziu has five children of her own, but she is doing her best to help raise her brother’s four children.
Money is tight, but the women still paid to fortify the house. “I don’t want anybody else to be bitten by snakes,” Ms. Nziu said.
Elusive Treatment
Nearly everyone in Africa could survive a snakebite if they had the right antidote and care. But stocking and delivering the right antivenom, at the right dosage and in time is tricky.
The first hour after the bite is crucial. If the swelling crosses the joint closest to the bite, “that shows that the venom is rapidly acting,” said Cecilia Ngari, a scientist at the Kenya snakebite research center.
Antivenom must be kept cold and sterile and administered intravenously. It may help even days after a bite, but it should ideally be administered within six hours.
In Kilifi, on the east coast of Kenya, the median time to hospital admission for a snakebite is nearly seven hours, and administration of antivenom takes another three.
That’s in part because clinicians are not trained to recognize bites or to treat patients. Some may dismiss the puncture wound as an insect bite, or mistake the initial symptoms of pain, nausea and weakness for other ailments.
Ms. Ngari was a trainee nurse in Kenya’s Nakuru County when a young boy was brought in with difficulty breathing. The staff gave him oxygen, but he died shortly after.
When the mortician described the fang marks, Ms. Ngari was distraught. “Because snakebite is not something that is taught in schools, it did not cross my mind,” she said.
With antivenom hard to find in rural areas, some snakebite victims pay traditional healers with a chicken or a small goat to apply herbs, bones and even dung. Many believe tourniquets can halt the venom’s flow, but they often cause more harm than the bite itself, cutting off blood supply and leading to amputations.
There is only one antivenom manufacturer in all of sub-Saharan Africa, Johannesburg-based South African Vaccine Producers. Many other nations import antivenom from Asia and South America.
But antivenoms from one country often don’t work on snakebites in another. Antivenoms made in India, where kraits are most common, is useless against the black mambas or puff adders that terrorize Kenyans.
The fragmented market makes it hard for companies to earn healthy profits on antivenoms, so the supply has dwindled even as the need has risen.
To be effective, an antivenom should be tailored to the snake. Each species produces a special blend of dozens of toxins. Even within a species, the venom can vary by region, age, diet and season.
Antivenoms are no match for this complexity. They are still made much as they were 130 years ago: A small amount of venom is pumped into a horse or camel, and the antibodies produced in response are harvested and bottled.
Most products were never tested in clinical trials, or officially approved by the W.H.O.
Until 2023, the Kenyan market was rife with counterfeit or diluted antivenom. The country has now rid itself of Indian-made antivenom that was ineffective against local species. It has only one product sanctioned by the W.H.O.
Each vial can cost 8,000 Kenyan shillings (about $62), and treatment may require five, 10 or even 50 vials depending on the amount of venom coursing through the body, a ruinous expense for many rural families.
Along with the desired antibodies, antivenom may contain horse or camel proteins that can set off harsh allergic reactions when injected directly into veins.
Dennis Kitheka, 3, arrived at Kitui County Referral Hospital at 2 a.m. the November night he was bitten on his arm as he slept. At 11 a.m., he was put on an antivenom drip but had an anaphylactic reaction, forcing the doctors to stop treatment.
More than a week later, the boy lay whimpering in his bed, his arm a mass of raw flesh, as if the top layer of his skin had been burned off. He had a rash on his back and an infection in his armpit — perhaps from bacteria in the snake’s mouth — slowing his recovery.
Changing the bandage on his arm caused him such agony that he shrank from anyone who approached. Not even orange soda and mandazi, his favorite doughnut-like treats, cheered him up.
His mother, Ruth Kitheka, said she had no idea how she would pay the hospital for his care.
Some scientists are pursuing new approaches to treating snakebites, including lab-made monoclonal antibodies that would disarm the most important toxin families present in snakes across several continents. These antidotes would not run the risk of causing an allergic reaction.
Targeting the most important toxins might be enough to save lives, and a cocktail of the drugs could treat snakes of every stripe. “If we can get solutions to all of the toxin families, then maybe we can get something that’s much more universal,” said Dr. Casewell, the researcher in Liverpool.
Dr. Casewell and his colleagues are also testing two oral drugs “not necessarily as cures,” but to buy patients enough time to find antivenom.
Risky Research
Kenya’s snakebite research center is on the edge of Nairobi. Inside, stacks of clear containers hold dozens of cobras, mambas, puff adders and other vipers, including one with tiny horns on its head.
Some of the snakes lay as if dead. A black mamba’s forked tongue darted in and out of its coffin-shaped head, most of its 13-foot body slowly uncoiling to hover an inch above the floor and then absolutely upright, as if defying gravity.
Geoffrey Maranga, a herpetologist at the institute, readied himself to “milk” venom from an Egyptian cobra. He and a colleague put on a thick armor-like apron that fangs could not penetrate.
The cobra, still in its box, hissed loudly and, hood unfurled, tried to strike visitors, including a reporter — a terrifying sight despite the barrier.
As his colleague held the lid of the box slightly open, Mr. Maranga inserted long steel tongs, closed them around the snake’s head, then grabbed it. The whole sequence took 33 seconds.
Over 16 years, he has caught more than 1,000 snakes and never been bitten, he said, though he has had venom spat into his eyes and mouth.
“It is risky work,” he said. He does not try it when has not slept well or is agitated. “Whenever I am in difference with my wife, I don’t do it,” he said.
Mr. Maranga held the cobra’s head open and gently pushed it down until the fangs sank into thin, waxy plastic covering a small glass jar. As the precious liquid dripped into the jar, he massaged the venom glands to elicit more.
The cobra’s venom was a golden color that he likened to that of a lager. A mamba’s venom looks like gin, and a puff adder’s like egg yolk. The collected venom must be frozen within minutes.
Some of it is eventually injected into camels at a farm in Naivasha, about 55 miles away, to produce antibodies.
At Watamu Snake Farm on Kenya’s east coast, the milking sessions are open to the public, and the staff is focused on educating people about how to live with snakes: Wear shoes, keep homes and yards clean, raise beds off the floor, clear paths.
“They’re like all other animals,” said Kyle Buster Ray, the farm’s chief snake handler. “Give them space and they’ll leave you be.”
Mr. Maranga used to work at the Watamu farm, and he and Mr. Ray are both members of a WhatsApp group, Kenya Snake, that responds to distress calls all over the country.
In the rainy season, flooding forces snakes out of their holes, and the calls come nearly every day. Hot, dry seasons send snakes in search of food — rats, poultry, eggs — and water.
“One of the messages we give is put a pot of water in the middle of the farm, away from the house,” Ms. Ngari said.
In Mwingi, everyone knows someone who has been bitten. Beatrice’s ordeal has left emotional scars on the entire family, her father said, and he is more fearful now as he goes about his work.
Beatrice herself was more positive, despite her missing right index finger. In the year after the surgery, she has taught herself to write with the other fingers on her right hand.
“I will not be scared,” she said.
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