Dr Rob Harrison is appearing on the The Health Show this Saturday and Sunday.
Providing a cheaper and safer anti-venom for snake bites
Nigeria is home to some of the deadliest snakes in the world, including cobras, mambas and saw-scaled vipers. It’s thought that the saw-scaled vipers kills more people than any other African snake. Its venom causes severe, uncontrolled bleeding and extensive tissue damage. Without quick access to antivenom, their victims can be permanently disabled – or die.
There are no official statistics for how many people have been killed by snakes in Nigeria, but globally 95,000 people die every year as a result of snakebites.
Often, people are unable to seek treatment, as they live too far from a hospital with the correct antivenom or they can’t afford the treatment.
The Liverpool School of Tropical Medicine is working with the Nigerian Ministry of Health to develop cheaper and safer anti-venoms.
It’s a complicated and dangerous process, which involves separating out the most toxic parts of the venom.
“Venom comprises approximately 200 different proteins”, explains Dr Rob Harrison of the Liverpool School of Tropical Medicine. “But a lot of those proteins are not particularly toxic and so we rationalise that if you make an antivenom which is specific only to the dangerous toxins you won’t need as much of the anti-venom to effect a cure, and, because we need less of the new antivenom, it should make it safer than the existing product.”
The Nigerian Ministry of Health sent hundreds of snakes from Gombe State in the North East of the country. The Liverpool team is now working to identify the genes that produce only the most dangerous toxins in their venom.
Paul Rowley, the only person in the UK licensed to extract snake venom for medical research, is working with the team. He has first-hand experience of snake bites and antivenom as he was bitten by a rattle snake in 2002. “I had a lot of swelling and intense pain”, he explains. “I felt like my arm was broken.”
Paul was given antivenom and it saved his life. But like nearly half the people treated, he suffered a serious adverse reaction. He was seriously ill and was almost re-admitted to hospital.
The team is hoping to produce cheaper treatments that don’t have such severe side-effects.
“If we’re successful”, explains Dr Harrison, “we should be able to generate a pool of antibodies which when combined will neutralise the main pathological toxins of all the venoms of all the deadly snakes in one region.”
The team is currently testing the effectiveness of a new anti-venom designed to work against all African saw-scaled vipers. Preliminary results are due in the next few months. But it will be several years before it can be manufactured in bulk.
Dr Harrison explains that there needs to be a greater effort on a global scale to improve treatment for snake bites and to provide accurate country data on snake bite incidences and fatalities. “The Global Snake Bite Initiative is playing a key role in this” he says, “but international health agencies and national governments need to do more to prioritise snake bites as an important medical problem.”
Testing for cancer with vinegar
Low cost alternative to cancer screening in Rwanda
According to the World Health Organisation, the death rate from cervical cancer is almost a third of the total female cancer deaths, with 80% of these occurring in low-income countries. In Rwanda, it is the leading cause of cancer death among women.
There aren’t enough qualified health workers or the right equipment to properly screen the disease, therefore thousands of women never receive a diagnosis. By the time they seek treatment for their illness it is often far too late.
Cervical cancer is one of the few cancers that can be fully prevented through vaccination and screening. Therefore, the Rwandan Ministry of Health has devised a national plan for the prevention, screening and treatment of this disease.
As part of this plan, screening machines will soon be available. But in the meantime, a team of American medical volunteers is working closely with the Ministry of Health to provide a low-cost alternative.
The programme, called See and Treat, uses a technique called Visual Inspection with Acetic Acid - or, as it is more commonly known, vinegar.
Over 800 women have descended on Ruhuha to be screened. Some of them have walked for three hours to get there. Unfortunately, there was only time to see 110 women.
After filling in a questionnaire and receiving private counseling, the women are ready to be screened.
Dr Pam Silverstein who is leading the project explains how it works: “Vinegar is placed on the cervix for one minute and what the vinegar does is coagulate the protein so when you have abnormal cells in the cervix it coagulates to become a white lesion that you can see with the naked eye.”
Using this test, 23 women are shown to have abnormal cells in their cervix and they receive treatment immediately. This involves cryotherapy, which is effectively freezing the abnormal cells.
“These women usually come from 2-3 hours walk away so doing the screening and the treatment in one day is vital”, explains Dr Silverstein.
The team of volunteers are only in Rwanda for two weeks, so they spend much of their time passing on their skills to the community health centre nurses.
Dr Silverstein is delighted with what they have managed to achieve in Rwanda and concludes: “The outcome of this project was really gratifying because I realised that we can send teams not only to other places in Rwanda but other places in Africa and this could be replicated in many developing countries in the world.
Overcoming odds to fulfill personal dream in Lesotho
Learning to ride to save lives
Riders for Health is training three new recruits. This is their second day. None of them have ever ridden a motorbike before.
One of them is Isaac Monokwa, who works as a HIV counselor. “My duty at the clinic is to encourage people to check their status. I do the tests myself and if they test positive, I talk to them about the treatment they must follow”, he explains, “but the challenge I have is when people don’t take their treatment properly. The problem is they often live far from the health centre and they end up not coming to get their treatment and that’s a serious problem. The bike will help me. I’ll be able to get around much quicker and will be able to get to more villages in a day.”
The two week course proves particularly difficult for Isaac. He tests his bravery and the patience of his instructor to the hilt; almost running over his instructor and falling off the bike several times.
But he perseveres. “Today’s training was really tough but I liked it. I’m going to sleep like a baby. I‘m really tired.” He is determined, as he has a very personal reason to succeed.
“I discovered I was HIV-positive. When I found out my life became miserable, and back then the treatment wasn’t really available. I went for counseling and they were looking for people who weren’t ashamed to come out and talk about their status. I found myself as one of the brave ones and they gave me training.”
With HIV/AIDS carrying such a stigma in Lesotho, the fact that Isaac is not ashamed of his status and is prepared to counsel other people - persuading them to get tested and seek treatment - means he has the potential to save countless lives.
Isaac finally passes his test and is ready to hit the road. On his first day he travels to a village called Gamosethe to follow up on a patient that he hasn’t seen for months. He is over the moon when he sees Isaac arriving.
On arriving back at the health centre, Isaac concludes: “My first day was really exciting and I’m so happy as I was able to see several patients. It was a bit challenging because of the slippery roads but I think I have done well.”
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