Pahi Bhumij shudders to recall that day, and says she is grateful to have escaped death.
On May 5, as part of her routine, Bhumji went to work in a tea garden adjacent to her village in Assam’s Sivasagar district. The 16-year-old had been employed as a temporary tea plucker. In the afternoon, as she was picking tea leaves, she felt a tinge of pain in her ankle, and noticed a monocled cobra (Naja kaouthia) sliding through the grass underneath the tea plants. Bhumji had been bitten by the snake.
She was taken home and later in the evening shifted to the Demow Model Hospital, a government healthcare facility in the Sivasagar district.
“She was unconscious, and there was no visible carotid pulsation with extremely short breathing,” said Surajit Giri, the anaesthesiologist at the hospital. “We were stymied by the lack of an ICU [Intensive Care Unit] facility, but we still wanted to give the case a shot. The ambu bag came handy in the end.”
An ambu bag, also called a bag valve mask (BVM), is a handheld tool that is used to deliver positive pressure ventilation to a patient with insufficient or ineffective breaths. It was used to manually resuscitate Bhumji’s lungs, as the required dosage of antivenom injections were being administered. A few minutes later, her heartbeat returned to normal and she was conscious. The antivenom succeeded in neutralising the cobra venom in a few hours. Bhumji was discharged the following day. “I do not want to recall that dreadful day, but I am grateful to alive,” she told Mongabay-India.
A tea plantation in the Sivasagar district of Assam. Tea bushes are planted close to each other to make harvesting easier. However, when tea pluckers venture into the middle of the field with waist-high tea plants, their feet are completely hidden from view and they can barely see things underneath. This increases risk of snakebite. Photo by Bikash K. Bhattacharya.
Assam’s tea industry has 4.17 lakh women workers and most of them work as tea pluckers. Evidence suggests that a considerable number of women tea workers in Assam suffer snakebites each year. And not many of them survive a cobra bite, owing to lack of timely access to antivenom.
The World Health Organisation (WHO) designated snakebites as a Neglected Tropical Disease (NTD) in 2017 and launched a global initiative in 2022 to halve death and disability due to snakebites by 2030. The WHO estimates that 81,000 to 138,000 people die each year from snakebites worldwide and about three times that number survive but are left with amputations and permanent disabilities. India is among the countries most dramatically affected by snakebites and accounts for almost half the total number of annual deaths in the world.
Women tea workers are more vulnerable to snakebites
The issue of snakebite in tea plantations of Assam finds a mention in George M. Barker’s A Tea Planter’s Life in Assam (1884), one of the first sustained accounts of life in Assam’s tea industry in its early days.
The Shramshakti Report, published in 1988, identified snakebite as an occupational hazard for tea plantation workers. More recently, in 2021, a study by Assam Agricultural University also enumerated venomous snakebite as one of the occupational hazards for tea workers, especially for women who harvest tea.
In plantations, there is a traditional gendered division of labour. Generally, women carry out the job of harvesting tea for processing. The men primarily work in factories and in other mechanical and heavy labour-intensive work.
A poster pasted to a tree inside a tea plantation in eastern Assam says not to hunt wildlife including snakes found in the plantation. These plantations record numerous snakebite incidents, sometimes leading to retaliatory killing of snakes which include endemic and vulnerable snake species. Photo by Bikash K. Bhattacharya.
As a consequence, women tea plantation workers are more exposed to deadly snakebites than their male counterparts.
“Tea bushes are planted close to each other to make harvesting easier,” says Bhumji. “This means when we venture into the middle of the field, our feet are completely hidden from view. And we barely have time to take any notice of whatever is underneath. We are required to pluck a certain amount of tea leaves each day.”
What further complicates the matter is that some venomous snakes found in the region, such as several species of green pit vipers, can camouflage in the green tea foliage.
Giri told Mongabay-India that majority of the snakebite patients at the hospital come from rural areas and they either work in farms or tea plantations where human-snake contact is common.
Lack of awareness and remoteness of tea estates
Assam’s tea gardens are home to a rich variety of snakes including king cobra (Ophiophagus hannah), monocled cobra (Naja kaouthia), banded krait (Bungarus fasciatus), black krait (Bungarus niger) and several green pit viper species endemic to the region. Each summer, in these tea plantations, there is a spike in incidents of snakebites and snakebite-related deaths, sometimes leading to retaliatory killing of snakes.
Prabhat Das Panika, a social activist from the Baksa district of Assam, said that awareness of snakes and snakebite treatment and access to antivenom treatment facilities have improved over the years in Assam. “Many company-owned big plantations have antivenom treatment facilities these days.”
However, that is not the case in several medium and small tea plantations that dot the remote areas of Assam. Evidence and anecdotes show there is still a critical lack of snakebite management in these tea plantations.
Angshuman Sarma is a PhD in Labour Studies from Jawaharlal Nehru University and specialises on Assam’s tea plantations. Sarma said that “all tea garden health centres are supposed to have snakebite treatment facilities, but most of the gardens still lack access to antivenom.”
Assam’s tea gardens are home to a variety of snakes. Each summer, there is a spike in incidents of snakebites and snakebite-related deaths, sometimes leading to retaliatory killing of snakes. Photo of monocled cobra by Jonathan Hakim/Flickr and Photo of black krait by Rejoice Gassah/Wikimedia Commons
Giri contends that the gap is both in terms of timely and adequate access to antivenom treatment and awareness about snakes and snakebite care. “As a result, many people still resort to alternative remedies—local healers.”
Giri has also written a book in Assamese language to make people aware of snakes and snakebites. “Mass awareness about venomous snakes can significantly lessen snake-human conflicts,” he said. “This is all the more important in places such as Assam because timely access to antivenom is still a far cry for a sizable rural population in the state.” He added that there is no antivenom to treat bites from certain snake species endemic to the region such as the red-necked keelback (Rhabdophis subminiatus) and several green pit vipers.
Moreover, tea plantations are generally situated in remote locations away from human settlements. A large number of the plantations are poorly connected to the nearest urban centres, with dilapidated roads or dirt tracks taking hours to reach them. This results in delayed arrival of snakebite patients in healthcare facilities equipped with antivenom treatment, which significantly decreases patients’ survival rate.
“The need of the hour is to make antivenom available within 20 kilometres of any locality so that a snakebite patient can access proper treatment within one hour of the bite,” Giri said.
Need for region-specific monovalent antivenom
India manufactures only polyvalent antivenom that effectively neutralise venoms from the ‘Big Four’ of Indian snakes — spectacled cobra (Naja sp.), krait (Bungarus sp.), Russell’s viper (Daboia russelli), saw-scaled viper (Echis carinatus sp.) — collectively responsible for a large number of deaths in most parts of India.
In northeast India, where Assam is located, only two subspecies of the Big Four species are commonly found: cobra and krait. Even for these two subspecies, the efficacy of Indian antivenom is relatively low.
Northeast India is home to a number of other venomous snakes such as several species of green pit vipers, red-necked keelback and king cobra. While pit viper bites are common in tea plantations and farms in northeast India, Indian antivenom is found to have no efficacy for viper bites. The red-necked keelback, a commonplace species in the region formerly thought to be non-venomous, is now known to be a rear-fanged venomous snake. There is little research and no antivenom for treatment of bites from this species.
Northeast India is home to a number of venomous snakes. The efficacy of Indian anti venom for some of these species is low. Photo by Barry Rogge/Wikimedia Commons
“Therefore, what we urgently need is research on the venomous snakes endemic to northeast India and work towards potential development of region-specific, monovalent antivenoms,” Giri added.
Banner image: Tea garden workers. Photo by CC BY-NC-SA 3.0 IGO © UNESCO-UNEVOC/Amitava Chandra.
This article originally appeared on The Third Pole. Read the original article here.