এক সাপ পাগলের মনের কথা
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Photo Gallery page of this site is updated on 16th July 2016 . New album " 2016 Update" is added . You may get useful information about the Institute of Health & FW . And also details of Procedure of arranging Snakebite Training sessions.
Aakashbani Kolkata -A ( আকাশবানী কোলকাতা-ক) had aired Three Days' Radio Talk on Snakebite on 4th, 5th and 6th July , 2016. One Public Awareness Video is prepared with those Audio recordings. Now available in You Tube: https://youtu.be/Crr5YUh8EeQ
Death of Imran Sk of a remote village of Farraka Block of Murshidabad District of West Bengal after a Veper snakebite is not just " another death". Read details from the link given. http://www.she-india.org/imrans-death-a-tragic-case-of-human-rights-violation/
This case exposes a number of faults in the 1) Society, 2) Health System ( Both State and Central) 3) System in Govt. offices like the Disaster Management Department.
Also this case Unveils some positive aspects of some Extraordinary People working silently behind the Focus of So Called modern Media , 1) Emotional attachment of a young Lady Doctor, 2) Team effort of medical and social workers, 3) Positive thinking of a Govt. Officer like BDO of Farakka and many more.
The Bengali Draft for Death Exgratia ( given by Govt. of W B in case of death due to Snakebite) may also be useful to some people.
7 yrs old girl was admitted at a S D Hospital of Burdwan district of WB. Had a peculiar history . The girl told that , she had dream of a snakebite in sleep. Was treated for pain abdomen for 3 days. Then was shifted to a Paediatrician of Hoogly district , with another additional complaint of difficulty in swallowing. Was diagnosed to be a case of Common Krait bite with the sign of Bilateral ptosis. Saved by 10 vials of ASV infusion at Chuchura Dist Hospital of Hoogly on 1st Sept 2015.
This was a 40 yrs lady treated at Dhoniyakhali Rural Hospital of Hoogly District by Dr SEKH RAJIB on 9th July , 2015. This lady was admitted on 7th July at 5.30 PM with Pain Abdomen only. 3 doctors treated her for pain abdomen before Dr Rajib examined her on 9th July at about 9.30 AM. Dr Rajib got BILATERAL PTOSIS and perfectly diagnosed it to be a case of Common Krait bite. There was a suspicious history of " some insect bite in bed" in early morning of 7th July 2015.
Dr Rajib started 10 vials of ASV at about 9.30 AM , and the patient was symptom free by 2.00 PM . Only her Ptosis persisted for 72 hours. Only initial dose of " AN" injection was given.
1st Picture is after cure on follow up on 15th July 2015 . 2nd one is on 9th July at 9.30AM.
You can down load the PDF of the 164 pages Guideline from here :
One 32 yrs lady attended the Sonakhali Rural Hospital of West Midnapur District on 18th July at about 5.30 PM , with a history of Russell's Viper bite 2 hours back. Bite was told to be on her left index finger. Treating doctor , Dr Arnab Adhikari had some doubt about bite mark. Dorsum of Lt. hand was a bit swollen and tender till morning of 19th July. 20WBCT for clotting defect was done thrice before 10.00 AM on 19th. All tests revealed no clotting defect. Doctor was confident about a Dry bite. But patient party along with some local political leaders were constantly pressing to start ASV. Swelling spread up to elbow joint in the mean time . But no other systemic sign of envenomation like bleeding from any site or any neurological sign were noted.
Inj. Ceftriaxone 1 gm IV was started on 19th July at about 10.30 AM . Inj. Dexamethasone 4 mg IM was given at 11.30 AM. Tab. Cetrizine 10mg. Mag Sulf compress.Swelling began to subside from the evening of 19th July. See the 2nd picture to note almost no swelling on 20th morning. No ASV were used.
Dr Sovan Sikdar of Jangipara BPHC of Hoogly district of WB, India got a typical Common krait bite patient presenting with Gastro Intestinal symptoms in the early morning today ( 24.6.2014). Dr Sikdar tried his best with ASV infusion and Atropine & Neostigmine injections. As the patient ( Ranajit Malik , 16yrs , Male) was in paradoxical respiration , Dr Sikdar was bound to transfer the pt. to MCK ( the most prestigious Medical College in the Eastern region ). Unfortunately the patient died before reaching MCK.
Patient party was seriously agitated by a “ most irresponsible and nonsense comment” of a doctor ( we would be happy to know if he was a junior doctor ), that it was not at all a case of Snakebite. Doctors of Jangipara were about to be manhandled and hospital was to be demolished by the agitated patient party.
Fortunately enough, Post mortem report from the MCK revealed it to be a “ Neurotoxic Snakebite “ . And , last but not the list, reminds us great teaching of great Doctor Himmat Saluba Bawaskar , “ One Common Krait Snake was recovered from the room where the patient slept in the previous night”.
We know , most of our teachers of Medical Colleges are “ NOT INTERESTED to teach Snakebite” ; But may we expect that, they would teach their juniors , “ Not to give any adverse comment on any patient treated by his fellow colleague working in the rural health centers”?
Prof. M A Faiz of Bangladesh has informed us that, they had identified 5 varieties of Common Kraits in Bangladesh. Mr. Bijan Bhattacharya , Secretary, Canning JSS has agreed that, they have detected one other variety of Common Krait besides the most common one. Probably these atypical varieties of C K snakes are responsible for the ASV failure cases (3) at Canning S D Hospital in 2012.
Two avoidable deaths :
I am extremely sorry to inform you about two snakebite deaths reported to me today (15th Nov.2012). I had seen Brij Kisore Sing, 50 yrs male of Dihi Gobindapur of Baruipur, South 24-Paraganas district, yesterday, at CNMC&H, Kolkata. He was bitten on 6th Nov. In the evening; he was treated first at Baruipur S D Hospital in that evening and was transferred to CNMC in that night. He developed AKI and was getting Dialysis from SSKM hospital, Kolkata (irregularly). He has died yesterday at SSKM Hospital.
The 12 yrs boy of Singur Hospital,of Hoogly district who was first treated at Singur on8th Nov evening has died to-day at Sambhunath Pandit Hospital, Kolkata. This boy was first given 5 vials of AVS in a slow drip; later on another 5 vials were added as Visal Santra (dedicated social activist) talked with the EMO on duty. The BMOH (of Singur) and the Dy.CMOH II( of Hoogly) were informed immediately.
Which is more painful to me and also to the parents of the boy is that, the doctors of S N Pandit Hospital had asked for Post Mortem examination of the dead boy. What for? Do we have any doubt about the cause of death? Both the victims were being treated at tertiary care hospitals for more than a week, for Acute Renal failure due to viper bite.
I am feeling helpless to note these two unnecessary deaths as both the districts concerned had recently completed “Modular Training on Snakebite Management for Medical Officers”.
Dr D B Majumdar, Resource person for Snakebite training for the state of West Bengal.
West Bengal is the First state in India to Publish Snakebite Treatment Protocol. .This is published as a poster ( 6 ft X 4 ft) by the Public Health Department of Govt. of West Bengal on 7th May 2012. You can see the poster in the " Photo Gallery" page. WHO consultant for Snakebite Prof. D A Warrell has congratulated us for the Poster.
All India Snake Guide Map Published by Canning Juktibadi Sanaskritik Sanastha at Kolkata Press Club on 9th March 2012.
One Viper bite patient , S . Naskar , 53 yrs M , from Ramnagar Village , near Haldia Port of West Bengal, did not get any AVS at Haldia S D Hospital on 4th October 2011; he was referred to Tamluk District Hospital , about 60 KM away ; only 5 vials of AVS was infused at the District hospital and the patient was transfered to N R S Medical College & Hospital , Kolkata ( Bed No. 8, Male Medical Wd ) on that night. No AVS was available in this Medical College Hospital and the patient had to purchase 10 vials of AVS from out side on 5th Oct. 2011.
1st State level workshop on Snake Bite was held on 8th February 2010 at the Swastha Bhaban , Saltlake City , Kolkata . W S arranged by the Asst. Director Public Health , Govt. of West Bengal . for all the Hospital Supers , Dy. CMOH I and physicians of 2nd tier hospitals. It was a fruitful one.
The Juktibadi Sanaskritik Sanstha of Canning , South 24-Paraganas has started " help lines " for snakebite. The helpline numbers are 03218-216006 , 9635995476 and 9733822825 .They are guiding snake bite victims immediately after the accidents .Tendency to visit the faith healers ( Ojhas) is reduced by this.
Photograph of a green Pit viper in the hand of a lady worker of Canning Juktibadi Sanaskritik Sanastha ( CJSS). This snake was rescued recently from the Basanti block of 24-Paraganas district of West Bengal ( India) .
This snake had bitten on the leg of a young male patient . Though Pit vipers are known to be venomous ( Hematotoxic ) only in the Kerala state of India ( Hump nose Pit vipers ) ; here in the case of Basanti BPHC patient there was severe local swelling only . Practically the patient was in distress due to severe cellulitis of one leg . The patient was treated with 10 vials of Indian Polyvalent AVS and cured .
· Dr. C Rajendiran of Tamilnadu informed on 7th June 2010 that, though rare , they have got Pit viper bite cases in TN also ; and all of them presented with severe coagulopathy and renal failure requiring dialysis.
If you are interested in the PDF version of the " Snake bite management Flowchart ", just send a request to firstname.lastname@example.org
The Flow Chart is upgraded in August 2011 with inclusion of Preventive Adrenaline Injection before AVS infusion.
Tutorial videos on Indian Snake bite Management in three parts are now available in YouTube .http://www.youtube.com/watch?v=7i82X1Z-8h4
These 2 Videos are upgraded in December 2010.
Dr. Anirudhwa Ghosh , Asst. Prof. Chittaganj Medical College of Bangladesh informed at the AMPTOX2010 held on 11th and 12th December 2010 at KPC Medical College , Kolkata that, thaey had got a case of Black Krait bite at Chittaganj. Besides all neurological features of Common Krait bite this patient suffered from HAEMOGLOBINURIA..
Silver Jubilee of Canning Juktibadi Sanaskritik Sanastha on 11th and 12th February 2011. Voluntary organizations are cordially invited . Contact Secretary ( 9635995476 ) for details.
See the Workshop photos at profile album of Dayal Bandhu Majumdar at facebook.
See YouTube link for some Great workers for the benefit of the Snakebite Victims :
The Banner of the Workshop Speaks all . Dr H S Bawaskar and Dr Dilip Pundey are here in this Photograph.
Very recently Dr Jeevan Kuruvilla had reported a case in Whats Group , Common Krait Bite Case of Chhatisgarh showing features of Renal complication .Dr ( Sister) Archana of same Chhatrishgarh state had reported same type of renal complication in her case also . We had another case of Common Krait bite with Renal Complication at Basirhat Dist Hospital in 2015. The picture of the snake sent by Dr ( sister) Archana is being posted here. We have to think of a new variety of C. Krait(?).
Case Details as Posted by Dr Jeevan Kuruvilla :
18 yrs old girl had come to. Kachhwa Hospital on 2nd July with history of krait bite. Patient had ptosis on arrival. Responded to 20 vials to ASV. Pt developed itching and urtricarial rashes on ASV. She also swelling of the face after first 10 vials. Even on the 4th July, swelling of face persisted because of which blood tests were sent. S.creat was 2.3, TC 21000, DC P80, L20. Urine exn showed Alb 3+, Micro - Pus cells 20-25, RBC 70-80. On 5th July, S. Creat 1.2, Blood urea 44. On 6th, TC 26000, DC P87, L13. S.creat 1.2. Urine micro PC 20-22, RBC 60-70, urine Alb 2+. Ultrasound today shows minimal loss of corticimedullary differentiation. Could this renal involvement in Krait bite be because of reaction to ASV or there is a hemotoxic component of the venom. One case of hemotoxicity has been documented in a black krait bite.
Please down load the Bengali Book from this link.