Magazine article Geographical

I'm a Geographer

Magazine article Geographical

I'm a Geographer

Article excerpt

I became interested in expedition medicine when I was personally involved in a student expedition to Lake Chad, an activity that would now be impossible due to Boko Haram. I was involved in a student project from Oxford University to look at the prevalence of Bilharzia in agricultural workers.

Snakebite has been a very great interest of mine since the 1970s. I was working in northern Nigeria. I was working on bites by the most important species there, the saw-scaled viper.

Primarily, I went there to research meningitis, which is an annually occurring event in the dry, cold season in the whole meningitis belt. As part of my work as a hospital physician and teacher I came across numerous cases of snakebite and was appalled to find so little was known about the species of snakes responsible, and also that there was a lack of specific treatment.

The problem with snakebite is that it stimulates very little interest in the UK where we have one venomous species and relatively few bites. But it is a major cause of rural deaths in places like India and the Sahel region of Africa.

After Nigeria I expanded my interest to Thailand and began my engagement with Myanmar. I also worked in Sri Lanka as a substitute because India was difficult to get into for bureaucratic reasons. Then, more recently, I worked in Latin America, Brazil, Ecuador, and Peru.

There's a lack of well-designed community-based studies on snakebite worldwide. One a couple of years ago was originally designed to examine the impact of tobacco on the Indian population. The researchers designed a scrupulous, random study in areas with populations of about 1,000. The cause of death was determined through verbal autopsy where you contact friends and neighbours of the certified dead. This can be a sensitive issue and difficult when dealing with a disease like malaria, but snakebite is more melodramatic and is more likely to be remembered.

The India study showed, to enormous surprise, that 50,000 people died in the country from snakebite in 2005. Snakebite accounted for 0.5 per cent of all deaths among children.

Snakebite is often an agricultural disease confined in rural populations, usually farmers, herders and plantation workers. A second common theme is that it achieves its peak influence during or after the annual rains, which is to do with changes in the snake's activities.

Most bites are inflicted on legs and ankles. Footwear is an obvious solution, but if you're a rice farmer and wear boots into the flooded rice field, they are likely to be sucked off your feet as soon as you take a step. …

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