By Lankien standards, the patient with the snakebite is an old man. He says he is 50, but he is probably older. Few people in Lankien know their birthdates or their ages. The snake bit him on his right foot yesterday evening. He is sure it was a snake, but didn’t see it well enough to describe it. Overnight he vomited blood and developed bloody diarrhea, but he is more worried about the itching and swelling at the site of the bite. My concern is that he has developed a bleeding disorder from the snake venom. I take 5 ml of his blood in a test tube. If his blood clotting is normal the blood with completely clot in 20 minutes, if it is not, the blood in the test tube will take longer to solidify.
I hustle back to the compound, test tube in hand, to get the snake anti-venom from the fridge and check the Snakebite Protocol. MSF has protocols for most problems encountered in the field and they can be invaluable. The antivenom is called FAV-AFRIQUE and it is a polyvalent anti-venom that requires ‘cold chain’. Cold chain is the term used for vaccines and medicines that need to be maintained at a certain temperature and ‘polyvalent’ means that it is effective against different types of snake venom.
In 20 minutes the blood in the test tube is still runny, at 40 minutes the same. At 50 minutes, it has finally coagulated into a solid clot at the bottom of the test-tube. Meanwhile, we have started an intravenous and the FAV-AFRIQUE. He receives antibiotics, pain relief, tetanus toxoid, and local wound care.
The day spirals out of control and I never get to do another clotting test but I stick my head into the ICU tukul several times during the day to see how he is doing. He looks fine and the staff tell me he has had no further bleeding. The next morning he is discharged from the in-patient department still complaining about the itching in his foot.