The Safari Antivenom Project

This is the planned two-year project that will provide Antivenom and education to people in the Kitui and Malindi districts of Kenya so as to reduce deaths by snake-bite.

EXECUTIVE SUMMARY
This proposal outlines the current work performed by BIO-KEN and the James Ashe Antivenom Trust (JAAT) and clearly indicates how any funds received by the Trust would be used to reduce death and disfigurement from snakebite. The project will also cover the current situation of Antivenom in Kenya, in particular, the Kitui and Malindi Districts. The goals of the project will be outlined, with more specific objectives and longer term plans. Before presenting a budget plan, the proposal will cover descriptions of activities that the Trust shall use to create a constantly expanding pool of knowledge about snakebite related issues as well as the conservation and protection of snakes, especially the non-venomous ones.

INTRODUCTION

JAAT
In October 2004, Royjan Taylor and Sanda Ashe formed the ‘James Ashe Antivenom Trust’ (JAAT) in memory of James Ashe, who had dedicated his life to the conservation of snakes and the reduction of deaths by snakebite. The main goal of the Trust is to bring good quality Antivenom into Kenya and to distribute this Antivenom at cost price to those in need as well as to deliver education both in the ‘first instance’ of snakebite as well as in the subsequent correct usage and monitoring of Antivenom treatment.

The Trust, under its old name, The Watamu Antivenom Fund, has had an enormous impact on its immediate area, using Watamu in Malindi District, as its working base. The Trust at present purchases its Antivenom from the South African Institute for Medical Research (SAIMR) and this is then made available throughout Kenya.

BIO-KEN
Bio-Ken Snake Farm, Laboratory and Research center, (BIO-KEN) is an internationally recognized institution and has many well-known supporters, many of which are the World’s leading authorities on snakebite treatment. The Bio-Ken International Snakebite Seminar is held every two years with International contributors coming together with the common aim of reducing deaths and maiming by snakebite. Past speakers at this seminar have included Professor David Warrel who has attended all our seminars and is a World authority on snakebite treatment and a trustee of JAAT, from Oxford University. Professor David Theakeston from the Liverpool School of Tropical Medicine, Professor Immre Loufler from Nairobi, Professor Ralf Sauter from Uganda and Dr. Roger Blaylock from South Africa, all of whom are experts in the field of snakebite and its treatment.

SNAKEBITE AND ANTIVENOM
JAAT currently provides funding which buys two different types of Antivenom from the SAIMR. The first being a Polyvalent Antivenom that covers a range of common large venomous snakes being Cobras Naja sp, Mambas Dendroaspis sp and Giant Vipers Bitis sp. The second is the Monovalent Antivenom which is used to treat more specific snakebites from either the Boomslang Dispholidus typus and Carpet or saw-scaled Vipers Echis sp. Due to the fact that the Watamu Antivenom Fund is now officially registered as a Trust, the Antivenom is available to JAAT at a discounted price, however it still costs KSH 5000 per 10ml vial. Most victims of snakebite are adequately treated with one or two vials, however, it is not unknown for a victim to need up to six vials of this Antivenom in the case of a very bad bite.

The current situation in Kenya is that there is not enough Antivenom in the country. Many of even the very large hospitals throughout the country do not stock it and there are very few medical professionals who are suitably trained in correct snakebite treatment. Medics are often unaware as to where to acquire Antivenom even in an emergency. The majority of people who get bitten are the very poorest who work in the orchards or digging in the fields, both areas that can have very high snake concentrations, the combination of the two factors result in large numbers of people being bitten that can’t afford the cost of antivenom. JAAT plays, and will continue to play, and extremely vital role in the provision of Antivenom and the crucial training that must accompany this in order to make best use of the Antivenom. Therefore funds given to the Trust will be used for two specific purposes:

1. For providing key hospitals and clinics in the Kitui and Malindi areas with good quality Antivenom and maintaining these stocks.
2. For providing essential education and training in first aid for snake bites and correct usage of Antivenom to all members of these societies.

KITUI AND MALINDI
The East African region is home to many extremely dangerous snakes such as Black Mambas, Puff Adders and Spitting Cobras amongst many others. Although Kenya has large numbers of both Venomous snakes and deaths resulting from snakebite in many areas, it is not possible to cover the whole country in this project. It has therefore been necessary to focus down onto two districts in order to establish an in-depth and effective project that will set a benchmark for future projects of a similar nature.

Both of the above-named districts have very high populations of venomous snakes and are therefore likely to be good representatives of the country as a whole in terms of ‘bite types’, symptoms and importantly, difficulties in access to antivenom and trained medical personnel. These are remote locations, many hours drive from any city and major hospitals.

KITUI DISTRICT
The JAAT wishes to include the Kitui district in this project for two main reasons. In addition to the more general reasons mentioned above, it is also the ‘home district’ of Safari Kimanzi who has become a very well known personality in recent years. Tragically, soon after Safari’s return to his village, his mother died as a result of snakebite. It therefore seems very appropriate that funds donated by people who have held sympathy for Safari in the past, are used in this area. Secondly, this area is also home to two of the five Medical professionals that traveled to Australia for training in snakebite and toxicology, being Dr David Musyoka the Director of Kitui District Hospital and Mr. Silas Nthaka the MO from Kasaala clinic also in Kitui. The many rural parts of this district are underdeveloped, although it does have some Government hospitals that have the facilities needed to keep Antivenom, namely electricity and therefore refrigeration as well as telephone communication made easier now with cellular networks covering most parts of the district.

MALINDI DISTRICT
The Malindi district has been under the umbrella of the Watamu Antivenom Fund (JAAT’s predecessor) and its Antivenom stock for more than eight years. As already mentioned, JAAT is the holder and supplier for Antivenom in the area which is stored in the Antivenom refrigerator at BIO-KEN and has access to discounted Antivenom from SAIMR. The District has a number of Doctors in Watamu, Kilifi and Malindi itself that are experienced in the treatment of snakebite and the use of Antivenom. These Doctors have regular contact with Royjan Taylor and Sanda Ashe at BIOKEN and are extremely supportive of their work in those areas of the district. Two of the five Medical professionals that traveled to Australia for training in snakebite and toxicology, are Dr. Anisa Omar, the District Health Officer of Malindi, and Dr. Eugine Erulu who is very experienced in snakebite treatment and based in Watamu, within Malindi District. These experienced and well-trained Doctors would provide excellent local knowledge and help in spreading the effects of the Trust to the more remote areas, as well as playing a major part in the proposed project activities in Kitui.

GOALS OF THE SAFARI ANTIVENOM PROJECT
This project aims to:
• Reduce the number of people who are bitten in the first place through basic education on how to avoid poisonous snakebite. e.g. use a torch at night, don’t step over logs without looking first, sleep off the floor, don’t create rubbish which attracts snake food such as rats and mice, etc..
• Reduce the number of people that die as a result of poor or in some cases very bad first aid. e.g. no cutting and sucking at the bite, no tourniquets or ligatures, no so called electric shock therapy, etc.. In this part of the world there is still a great belief in ‘witchcraft.’ This often does more harm than good as various things are often rubbed into the wound and potions may be taken by mouth, often confusing symptoms.
• Reduce the number of people who die from snakebite as a result of unavailable antivenom or medics who are un-trained in the correct treatment of snakebite. e.g. “You will have to go to Nairobi because we don’t have antivenom here”, “ I think for snakebite you should gargle with the antivenom and you will be fine”, etc..
• Supply key local hospitals with a number of emergency Antivenom vials to keep in storage until needed, which would allow a victim to either be treated fully at that hospital or allow enough time for a victim to be transferred to a main hospital where further Antivenom could be given.
• Provide training to those key members of society such as Doctors, Priests, Mobile Health Workers and teachers, who would then go on to spread information about snakebites and treatment, creating a ‘trickle-down’ effect through the communities.
• To spread general knowledge about snakes and snakebites, and how to help medical staff in the identification of potentially dangerous snakebites, as well as simple ways of minimizing or avoiding encounters with dangerous snakes.
• Gain knowledge and up-to-date data, statistics and case studies of snakebites throughout the two named districts.

SPECIFIC OBJECTIVES
The specific objectives of the project run closely alongside the objectives of the JAAT, the main objective being to reduce maiming and deaths through snakebite.

The JAAT will also use the project to determine the effectiveness of training and education through encouraging communities to log and report any snakebite (see ‘snakebite report form’), be it life-threatening or not. The training and education will play a large part in determining whether or not community members choose to take snakebite victims to hospitals for treatment or not.

The project will also allow the Trust to identify whether or not the training and education has been beneficial and if first aid measures have been correctly carried out on people immediately after they have been bitten.

ACTIVITIES
The project is expected to have a time scale of two years, taking the start date from 1st October 2005 to 30th September 2007. Starting with the first Monday of October 2005 (3/10/05) the first training seminar will be held at the main Hospital in Malindi. This will also be the location for the second seminar one month later (7/11/05) unless otherwise recommended, which will be provided for all those people who were not able to attend the first seminar. Following on from these two events, there will be another two seminars held at Kitui District Hospital, following the same programme as the seminars in Malindi, on the 5th December 2005, and the 9th January 2006.

The team that is recommended to lead these seminars is as follows:

• Royjan Taylor, Sanda Ashe or Anthony Childs (Snake handlers and experts on snakes from BIO-KEN and JAAT)
• Dr David Musyoka / Mr Silas Nthaka (Director of Kitui District Hospital and Medical Officer at Kasaala clinic respectively)
• Dr Anisa Omar (District Health Officer for Malindi)

It is suggested that the on call local doctor should be Dr Eugine Erulu from the Watamu Nursing Home, as he has valuable experience and knowledge with snakebite and Antivenom treatment. The Chief Consultant for the project should be Prof. David Warrell from Oxford University, one of the worlds leading authorities on correct snakebite treatment. They are also in regular contact with Royjan Taylor and Sanda Ashe at BIO-KEN. This is yet to be confirmed.

Through these experienced professionals, information can be passed on through the communities on many levels. It is suggested that as many as fifty individuals from specific sub-locations in the two districts are both trained in snakebite first aid and are able to train in snakebite first aid. BIO-KEN already has educational leaflets printed in both English and Kiswahili (see attached examples), which cover basic information on snakes, and simple first aid for snakebites.

A range of different mediums for conveying information will accompany the leaflets. These will be target-group specific and therefore will be most relevant to the school children, teachers, doctors or key focal persons at which it is aimed. Two such methods are simply outlined and attached at the end of this proposal.

BUDGET

KITUI
Antivenom for Kitui district 60 vials (SAIMR) Polyvalent @Ksh 5,000/= Ksh 300,000/=
Transport and Seminar allowance for two training seminars @Ksh 20,000/= Ksh 40,000/=
Transport and allowance for end of first year assessment @Ksh 20,000/= Ksh 20,000/=
Transport and allowance for end of second year ass’ment @Ksh 20,000/= Ksh 20,000/=
5,000 copies of Simple Steps in Kiswahili – for District @Ksh 6/= Ksh 30,000/=
2,000 copies of Simple Steps in English – for District @Ksh 6/= Ksh 12,000/=
Props for puppet show and wages/fees to perform 50 shows @Ksh 2,000/= Ksh100,000/=
50% of cost make comedy sketch and purchase and copy VHS cassets Ksh 50,000/=
Other unforeseen costs and expences (if unused for purchase of Antivenom) Ksh 28,000/=

TOTAL FOR KITUI DISTRICT Ksh 600,000/=

MALINDI
Antivenom for Mld district 60vials (SAIMR) Polyvalent @Ksh 5,000/= Ksh 300,000/=
Transport and Seminar allowance for two training seminars @Ksh 5,000/= Ksh 10,000/=
Transport and allowance for end of first year assessment @Ksh 5,000/= Ksh 5,000/=
Transport and allowance for end of second year ass’ment @Ksh 5,000/= Ksh 5,000/=
5,000 copies of Simple Steps in Kiswahili – for District @Ksh 6/= Ksh 30,000/=
2,000 copies of Simple Steps in English – for District @Ksh 6/= Ksh 12,000/=
Props for puppet show and wages/fees to perform 50 shows @Ksh 2,000/= Ksh100,000/=
50% of cost make comedy sketch and purchase and copy VHS cassets Ksh 50,000/=
Other unforeseen costs and expences (if unused for purchase of Antivenom) Ksh 38,000/=

TOTAL FOR KITUI DISTRICT Ksh 550,000/=
TOTAL BUDGET OF PROJECT KSH 1,150,000/=
Ksh 1,150,000/= AT A RATE OF ABOUT ONE AUS $ = KSH 58/= AUS $ 19,827

LETS SAY THE SAFARI ANTIVENOM PROJECT WILL COST AUS $ 20,000/=

SNAKEBITE EDUCATION FOR SCHOOLS – THE PUPPET SHOW

This workshop is designed to put important information across in a fun and memorable way. A puppet show is used to demonstrate how two different choices can result in choosing between life and death.

The ‘play’ begins with two boys that have decided to skip school and go walking in the bush. They have big ears and noses and funny outfits so as to capture comedy characters. On a deserted pathway, one of the two boys is bitten by a snake. The two boys then have a discussion about whether to visit the local witch doctor or whether to go to the nearest hospital. This part of the play forms the basis of the lesson.

The first scenario shows the boys deciding to go to the local witch doctor. This choice by the boys results in the death of the young schoolboy because he did not receive the correct treatment. The leaders of the lesson then return the play back to the discussion about where the boys will go following the bite. Here begins scenario two, where the boys decide to go to the hospital for treatment. The boy survives and a discussion follows with the children asking questions and a more serious version of the lesson being put across before leaflets are handed out for the children to take home.

Such a lesson is very simple to put across, particularly in schools where it can be made relevant and funny without losing its meaning and importance. Teachers, school headmasters and other pupils names can be used in order to convey points and this adds more humor to the lesson, making it one that the children will remember and pass on in the future because for the one hour or so you have got all their undivided attention.

SNAKEBITE EDUCATION FOR ADULTS – THE VHS COMEDY SKETCH

This workshop is also designed to put important information across in a fun and memorable way. A comedy sketch recorded with a simple home video is used to demonstrate how two different choices can result in choosing between life and death.

The ‘sketch’ begins with two adult friends that have decided to ‘go drinking without their wives’ knowledge’ and go walking in the dark. They again have strange make up and funny outfits so as to capture comedy characters. On a deserted pathway, one of the two friends is bitten by a snake. The two men then have a discussion about whether to visit the local witch doctor or whether to go to the nearest hospital. This part of the sketch forms the basis of the lesson.

The first scenario shows the men deciding to go to the local witch doctor. This choice by the friends results in the death of the young man because he did not receive the correct treatment. The script then returns to the discussion about where the friends will go following the bite. Here begins scenario two, where the men decide to go to the hospital for treatment. The man survives and a discussion follows with a very brief but more serious version of the lesson being put across and where to get help if needed before the main attraction of the evening starts.
Such a lesson is very simple to put across, particularly in a lot of the very many side of the road VHS home made cinemas where people pay about Ksh 20/= to watch an old fashioned low budget action film like the Bruce lee films or a recording of last weeks premiership final between Arsenal and Liverpool, all of which are becoming more and more popular. The key here is to make it short and very humorous to their taste and the idea is that if VHS cassettes are distributed free and it is good people will request it and the more people it is played to the more people are listening to what it is that you are trying to say while you have got all their undivided attention.