Forging a different path leading to global action to save lives and improve livelihoods

Authored by Dr. David Williams, WHO

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I’ve never been particularly comfortable talking about myself or the work that I do, which in many respects makes me an unusual champion for this cause. One of the reasons why I avoid social gatherings is my unease at having to explain to people I meet what I do, and why I do it. Of course, if you put me in front of an audience, that’s a whole other matter. I’m perfectly at ease speaking to a crowd. But one-on-one conversations are a cause for instant anxiety.

David at age seven, with a Blue-tongued skink.

When I was younger, I put this down to simple insecurity and lack of confidence. But the truth is a little deeper. As a child, I developed a fascination for the natural world very early. My mother will tell you my first encounter with a venomous snake was at the age of three, and no sooner had I started school two years, I began catching and keeping small bearded dragons (Agamid lizards common in my home town in rural New South Wales). In no time at all I had a menagerie of lizards and tortoises in the back yard, much to the reluctant consternation of my parents. When I was eight, I brought home the first venomous snake I was to keep as pet; a highly venomous (albeit juvenile) eastern brown snake. As my interest grew, so did the distance between myself and my classmates at school. As most of us know, ‘conformity and sameness’ are important in human communities, and as a primary and secondary schooler, I was as far from conforming. Animals were my passion, and I was a target for bullying, name-calling and laughter that made me both independent and introverted. I learned the hard way that taking a different path to others wasn’t something to advertise. And it wasn’t just the other kids who made it tough. Only a handful of my teachers saw potential in me. Others told my hard-working, community-minded parents quite bluntly that I would never amount to anything and that I needed to get my head out of the clouds and realize that there was no future “playing with snakes”.

Fortunately, I am nothing if not stubborn.

I packed my bags and made the choice to follow my boyhood dream of spending my life working with and around these much-maligned animals that have such a strong hold over me.

David at 17, with a red-bellied black snake.

After leaving school I had brief success landing a job as a reptile keeper at zoo on the outskirts of Sydney, learned some important (and rather tough lessons) and then, probably much to my parents’ relief, spent several years trying to conform to other people’s expectations. But even as I worked a series of “regular” ‘9-to-5’ jobs my singular passion was always the same. Venomous snakes absolutely fascinated me. I could sit in a field and watch a tiger snake forage along the edge of a creek for hours, marveling at how effortlessly it could move over rocks and logs, glide through water, ascend shrubs and use its nose to dig away at small cracks and crevices into which a frog or lizard had retreated from its path. That fascination has never grown old. Even today I’m captivated by the mere sight of a snake in the wild, no matter where it is, or what it is doing.

This fascination has led me to where I am now, but it is far from the only motivation.

David with a brown snake at the Australian Reptile Park in 1983.

In my mid-20’s I turned my back on that normal life many hoped I was going to settle for. I packed my bags and made the choice to follow my boyhood dream of spending my life working with and around these much-maligned animals that have such a strong hold over me. And for years after, I struggled to keep a roof over my head, made mistakes, turned my mum’s hair grey and sometimes found myself wondering why I persisted in such stupidity. For a time, I scraped a living running a business exhibiting reptiles to the public, educating people about the dangers of snakebite, and what they should do if they were bitten, or encountered a snake. The more I learned about the snakes I worked with, the more fascinated I became about their venoms, and what these could do – both good and bad. In the mid-90’s, with some friends and a small cadre of local shareholders, I worked on creating a business to use snake venoms to develop new medicines and diagnostic tests for various diseases. This brought me into serious contact with the medical and scientific world for the first time, and while the business ultimately failed, the next big step in my life was just around the corner.

In 1995 I had my first brief visit to Papua New Guinea, the country directly to the north of Australia on the eastern end of the island of New Guinea. PNG as it is known is an incredible melting pot of humanity. Melanesian by ethnicity, but with more than 800 different language groups, hundreds of different ethnic groupings and all the problems that any small nation newly independent of colonial occupation might expect to be lumbered with. Every day in PNG was a new experience, even after living there for over 20 years. But it was a visit to several communities in 1996 that really transformed the entire direction of my life. Over the course of a week in one of them, where I’d gone to find and photograph venomous snakes, four young people died from snakebites, one of them, a young mother who’d only given birth to a new child a little more than a month before. As chance would have it, I was at the health centre when she was brought in by her husband, and I saw first hand how the nurses fought to resuscitate her with nothing more than basic equipment that was clearly not up to the task. I’ve never forgotten the face of her husband. A fit, proud man broken into pieces as he watched his wife die.

That was a week where I learned that the privileged existence we “westerners” enjoy with our modern hospitals, aeromedical retrieval teams, drugs in abundance and help at the end of a phone line is really all the shallow, conceited flipside of another world where not even the most basic medical care can be taken for granted.

By 1996 I’d already survived three snakebites – all caused by my own carelessness, but treated effectively and efficiently in comfortable Australian hospitals with no long-term consequences.

What I found in Papua New Guinea, 90 minutes flying time from my home in Cairns, north Queensland, was a whole other world.

David in 2002 with a taipan in Papua New Guinea.

What I saw, took me home to start a university education as a path to being able to do something more than just stand by and watch someone die in the middle of nowhere. Earning degrees were never a path to a career for me, they were simply boxes I learned needed to be ticked to provide the credibility much of the world mistakenly demands of people we consider to be “educated” voices of reason. I earned my undergraduate degree in between long visits to Papua New Guinea where I talked to people in the medical, scientific, and business communities about my dream of solving PNG’s snakebite problems and traveled on local transport to communities all over the country talking about snakebite prevention, collecting data, and seeing firsthand what the real challenges were that needed to be overcome.

My PhD training was spent carrying out clinical research on the treatment of snakebite. In parallel I built an entire research programme in partnership with colleagues from the University of Papua New Guinea, my own university back in Australia, and with a wide range of international collaborators. I believed firmly that we could solve all the problems, and save countless lives, even if it had to be done one patient at a time. In 2007, we began working with collaborators in Costa Rica to develop an antivenom to treat bites by the Papuan taipan snake, a species that was responsible for over 90% of the serious snakebites treated in health facilities on the southern side of the country. Major manufacturers had rejected the idea when I had taken it to them. It was too costly they said. Not sustainable they said. But the Costa Ricans were different, they shared our vision, and most importantly, our philosophy.

As one of my colleagues, Professor José María Gutiérrez once said, “snakebite treatment is a human right”. No person should die or have their life irreparably destroyed simply because they of where they were born, where they live, or their socioeconomic situation.

David and his team retrieving a snakebite patient in his life-saving, custom emergency response ambulance in rural Papua New Guinea.

Over the next four years, José María and his team at the Instituto Clodomiro Picado (University of Costa Rica) developed the new taipan antivenom with us at no cost whatsoever. We supplied the snake venom and our intellectual input. They matched that with their own contributions, and in 2011, we published the preclinical analysis that would show the product had the potential to be at least as good as a much more expensive product the government of Papua New Guinea could simply never afford in enough quantity to meet the needs of everyone who was bitten. Our success led to an Australian government research grant to carry out clinical trials.

We used that grant to do exactly that, and in tandem we expanded our capacity to manage patients, developed an intensive care ambulance service to save the sickest patients who would have otherwise died long before reaching hospital, and saved hundreds of lives… it’s a story with many twists and turns, but in the end I am most proud for all the men, women and children who came to us on their most difficult day. A day when they “knew” they were going to die, one filled with terror for many of them, and yet, by making sure there was antivenom to treat them, and by ensuring they were treated quickly and well … nearly all of them were returned to their families safe and well.

David retrieving a snakebite patient in his life-saving, custom emergency response ambulance in rural Papua New Guinea.

David leading a healthcare worker training seminar in Papua New Guinea.

India Snakebite Working Group, 2016.

David speaking at a 2016 meeting with the late Kofi Annan, a champion who pushed for the adoption of snakebite envenomation as an NTD at WHO. Pictured left is Dr. Bernadette Abela-Ridder, WHO.

David with Costa Rican Ambassador Elayne Whyte, who was instrumental since 2016 in leading snakebite policy adoption at WHO.

Where I sit today is a long way from that world.

My time in Papua New Guinea came to an end, and now I am working with the World Health Organization to implement a strategy I helped to craft, that if successful, could reduce the burden of death and disability due to snakebite by at least 50 percent within the next ten years. The path still isn’t an easy one. The odds are still tough, and events such as the current Covid-19 pandemic definitely don’t help at all.

But I remind myself of two things. First, I’m stubborn.

And second. I’m the son of parents who never had it easy, who made sacrifices to raise a family of four kids, and who only ever wanted us to be happy in what we do. I chose the path I’ve taken because my mum (a paediatric palliative care nurse who lived for her young patients) and my dad (who volunteered in the community his whole life) taught me that we are only as good, as the good we do for others who need our help.

I hope the collection of stories assembled for International Snakebite Awareness Day will inspire many more people to feel the same way.

Dr. David Williams is currently a Technical Officer at WHO, bringing years of field expertise and clinical management of snakebite to implement WHO’s global snakebite strategy.