It’s cold, wet and raining so no call-outs. Thought I would sit down and write (a loooong story to while the time away ) about our weekend.
Some of you may know Dr. David Williams. He was at the snakebite symposium in Kenya and we had planned that he comes to Swaziland to see what our clinics and hospitals look like. David was supposed to arrive on Thursday, but due to unforeseen circumstances only arrived very late on Friday. This meant we only had one day (he was leaving early on Sunday to meet Arno) to see what needed to be seen.
We went up to one of the bigger hospitals where I know some of the doctors quite well. David wanted to chat to them just to get a general idea of the problems we face. As expected, the reception was lukewarm, but we persisted. There was one young girl with a minor bite in the children’s ward and two adults had just been discharged.
As we were leaving I asked if they had any antivenom – the Doctor assured me that they had enough (I supply them with antivenom when and if I have any) stock. David and I checked at the pharmacy and found 5 vials – not too bad.
We drove home, eager for lunch! Before we even reached home, a doctor from said hospital called. Could we please come back, there was a mamba bite victim. David turned the car around and drove (in record time I may add) back up the hill.
This young man was putting his books away into a cardboard box when he felt a small prick on his finger. The snake was small but he recognised it as a black mamba.
He panicked, ran outside, saw a piece of wire and used it as a tourniquet. Just to make sure, he used a shoelace as backup. Now this guy is from a rural area and is as poor as a church mouse. He tried desperately to find a lift to the hospital – begged and pleaded for anyone to help him.
His arm started to hurt, and thinking it’s the effect of the venom, decided the only thing he could do to save himself was cut.... He slashed away with a razor until he thought it was bleeding enough to get rid of the venom.
Finally he found a kind soul, who agreed to drive him to help. He finally arrived at the hospital 4 hours after the bite occurred.
David and I arrived to find him lying on the bed. I don’t want to go into details about the treatment or rather lack of it on a public forum, but if it wasn’t for David, who very diplomatically stepped in to help, the outcome may have been rather poor for this poor young man. The good thing is the doctor who was rather cool during the previous visit, showed a lot of interest and asked a lot of questions about the treatment process.
The young man was definitely bitten by a Black mamba as his symptoms included sweating, gooseflesh, shivers, fasciculation’s (involuntary muscle twitching - quite fascinating to watch really), severe dry mouth, paraesthesiae (pins and needles), bitter taste and was clearly agitated and totally frightened
(Pics by Dr. David Williams)
The bite site was only one tiny fang mark on the finger (bruised area), this probably saved his life. If it was a bigger snake with a proper two fange bite, he would most likely have died long before he could get to a hospital.
The young man lying on the bed in the ER. Notice all the blood on his longs and the sweat stains on his shirt.
The tourniquet/s. I know it is never a good idea to tourniquet but what do you do if there is no way to get to a hospital, nobody knows basic first-aid, you have nothing but a piece of wire and a shoesting, and you have been bitten by the most feared snake in Africa? I would do the same thing - ok not with wire and a shoestring I must admit - but NOBODY must tell me they would just "tata ma chance" and hope they make it to the hospital...which will take 4 hours...
His butchered arm – boy that must have hurt! See how strangely his arm is swollen from the tourniquet and the marks from the wire and shoestring.
There was no time to waste so the antivenom was administered I.V. push.....ice-cold, it couldn’t have felt pleasant at all but he didn’t even seem to notice. He kept on moving his head from side to side, clearly feeling bloody awful.
Anyway, it turned out ok. He is still in hospital but not because of the venom but because of the infection in his arm.