Management of Snakebite and Research Management of Snakebite ...

Management of Snakebite and Research
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DISCUSSION
From the study it becomes clear that the boots under trial are superior to the locally
available rubber boots. Although the former are slightly more expensive than the latter
(350 Kyats vs 300 Kyats), a majority prefer the former because of comfort, ease in wearing
and ability to work for the whole day with minimum discomfort. These provide a sense of
full protection against snakebite so that the farmers could concentrate on their work and
more productive work could be expected. While undergoing the trial, two participants
who happened to step on Russell’s vipers at work were prevented from being bitten by the
snakes.
Although there is a traditional custom of prohibiting wearing footwear in the field, a
majority of farmers from Taungdwingyi have been wearing boots for decades because of
scare of snakebite and its consequences. However, a proportion of farmers (28%), nonusers
who could not afford to buy boots are still at risk. In order to encourage universal
wearing of the boots, they need to be subsidized and sold to the users at an affordable
price of 250 Kyats per pair.
Since majority of the users have an intention of continually using them, they should
be encouraged and the price of the boots should be kept to minimum. Since snakebite
can occur even before they leave their houses (Sann-Mya et al., 1998) it is suggested that
they should wear the boots before leaving the house until coming back home in the
evening. No place is safe especially in snake-infested areas.
Health education targeted to the users, selling and distribution of the boots directly
to the users at an affordable price will be next strategies in order to bring down snakebite
morbidity and mortality rates in the country.
ACKNOWLEDGMENTS
We would like to thank U Thein-Pe, former factory manager and staff of Rubber Shoe
Factory 1, Yangon, for their untiring efforts in preparation of snake-fang proof rubber
boots, U Khin-Aung-Cho and staff of Veterinary Section of Myanmar Pharmaceutical Factory,
Yangon, for conducting the biting experiments and Dr. Tin-Oo, Township Medical Officer
of Taungdwingyi Hospital, the health assistants, the local health workers and the elders of
the five villages of Taungdwingyi Township for their help in executing the boot trial.
References
Myint-Lwin, Warrell, D.A., Phillips, R.E., Tin-Nu-Swe, Tun-Pe and Maung-Maung-Lay (1985). Bites by Russell’s
viper (V. russelli siamensis) in Burma: Haemostatic, vascular and renal disturbances and response to treatment.
Lancet, ii: 1259-1264.
Sann-Mya, Tun-Pe, Aye-Aye-Myint, Nu-Nu-Aung, Khin-Aye-Kyu and Tin Oo (1998). Russell’s viper bites in
Taungdwingyi civil hospital: clinical features and response to antivenom. Myanmar Health Sciences Research
Journal, 10:26-30.
Tun-Pe, Tin-Nu-Swe, Myint-Lwin, Warrell, D.A. and Than-Win (1987a). The efficacy of tourniquets as a first-aid
measure for Russell’ viper bite in Burma. Transactions of the Royal Society of Tropical Medicine & Hygiene, 81:
403-405.