Shahar Madjar, MD

On that particular sunny day as Amelle was walking with her family in the North Region of Cameroon, she was bitten by a snake. She remembered the snake making a “sizzling” warning sound but couldn’t move fast enough to avoid the swift bite. She was 25 year old, and 7 months pregnant. Her husband chased the snake and killed it. Later, he brought it to the emergency room. There the snake was identified — a dead carpet viper.

At the emergency department of the Poli District Hospital, Amelle told the doctors that she felt tired and dizzy. “My belly is aching,” she told the doctors, “and my left leg, where the snake bit me, is aching and numb.” Her heart was beating fast and her blood pressure was low. She seemed pale. Her left lower leg was swollen, tender, and bruised. And on close examination, the doctor could see two minute entry points caused by the snake’s fangs.

There wasn’t an ultrasound machine available at the emergency department so the fetus couldn’t be visualized, but the doctors recognized the fetus’ pulse and concluded that Amelle’s fetus was alive and that its heart rate was beating at a normal pace. Amelle’s bloodwork showed that she was anemic, her platelets levels were low, she had blood in her urine, and that the function of her kidneys was severely damaged. Severe vaginal bleeding was also noticed.

There weren’t any tests available at the hospital lab to confirm which clotting abnormality was at the root of Amelle’s vaginal bleeding, but a simple, bedside test that uses a single test tube confirmed that something went terribly wrong with her clotting mechanism–her blood just wouldn’t clot.

Here is what to do when a snake bites a person: keep the person as immobile as possible to slow the spread of the venom in the body; keep the person lying on his or her side with the upper leg bent to allow easier drainage if the patient vomits. And transfer the patient to a nearby hospital where proper medical care is available. Here is what not to do: do not cut into the site of the biting in order to “bleed out” the venom, nor should you try to “suck out” the venom. These measures won’t help and may lead to further complications.

Not all snakes are venomous. And not all snake venoms have the same physiological effects. The dead carpet viper’s venom contains a combination of enzymes, peptides, and metalloproteins that can deliver a deadly punch. The venom triggers robust inflammatory reaction, causes severe damage to muscle cells and to minute blood vessels, and disturbs the coagulation system.

When blood vessels are damaged, so are the organs they supply. That’s the reason for Amelle’s impaired kidney function. When the coagulation system is disturbed, both excessive clotting and uncontrolled bleeding can result. That’s the reason for Amelle’s vaginal bleeding and anemia.

The doctors in Cameroon were aware of all the devastating effects of a bite by a dead carpet viper. They considered Amelle’s clinical condition, the particular species of the snake, and the venom’s toxic effects. They resuscitated Amelle with fluids, cleaned and irrigated her bite wound, and gave her fresh whole blood. They also administered the anti-venom they had in stock.

These measures resulted in only partial, temporary improvement in Amelle’s condition. The vaginal bleeding, for example, had abated, but only for a while.

When the muscle cells within the uterus of a pregnant woman suffer, uterine contractions and premature delivery may ensue. On the fourth day of her hospitalization, Amelle delivered a live, healthy baby boy.

Despite an early diagnosis and aggressive treatment with blood transfusions and anti-venom, Amelle did not survive. She died shortly after delivering her baby. Her doctors admitted that “the hospital had insufficient supply of appropriate blood products such as clotting factors.” Instead, “the patient received a total of 10 pints of fresh whole blood.” And that “In Cameroon, only Inoserp anti-venom, which is not effective against all snake venoms, is available.”

Perhaps I’m stating the obvious here, but the following is an important point to understand: a person’s medical circumstances are often determined by matters of geography and timing. Being in the wrong place at the wrong time–colliding into a semi-trailer, diving into a shallow pool, or residing where venomous snakes abound–can be detrimental. Likewise, living in the right place, at the right time–in a society that allocates enough resources to modern, readily and widely available, high quality medical care–can often be the difference between life and death.

EDITOR’S NOTE: Shahar Madjar, MD, MBA, is a urologist and an author. He practices at Schoolcraft County Memorial Hospital in Manistique, and at Baraga County Memorial Hospital in L’Anse. Find his books on Amazon. Contact him at smadjar@yahoo.com