The early cases I witnessed that guided my work

Authored by Abul Faiz, Toxicology Society of Bangladesh (TSB)

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I received my PhD from the University of Newcastle upon Tyne, UK in 1993 based on research on ‘Neuromuscular effects of the venom of Russell’s viper. On return, I joined Chattogram Medical College in Chattogram, Bangladesh in August 1993. On the 2nd day of work, I came across a pregnant women admitted with profound neurotoxicity following bite of ‘something’ in the buttock while she went out at night for natural call. No details were provided, but my impression was a neurotoxic snakebite with venom induced ‘myasthenia’; could gather an outdated antivenom lying at the medical store. Successful antivenom delivery reversed the features of envenomation. To my utter surprise, I could gather information on recovery, that despite her knowledge about snakebite inflicted she was told by an in-law not to name ‘snakebite’ in case her baby in the womb might die.

Soon after, a 10-year-old boy was bitten by a cobra and developed paralysis when mechanical ventilation was unavailable, supported by intubation and assisted by using ‘Ambo bag’ for 72 hours with complete recovery. Since then I was thinking to educate the health care professionals and the community on snakebite prevention, first aid and management.

I noticed that few cases of snakebite (~15 per year) admitted to hospital were managed in a non-uniform manner, having no standard protocol to record and manage the cases. Inspired by the director and head of medicine, soon we established a 24/7 ‘Snakebite Clinic’ under my care which was used for structured recording of all the cases of snakebite, with 1668 cases in 10 years. With a team of young doctors and nurses, this was used as a hub for clinical service, data generation as a part of research and developing human resources by providing training, and creating community awareness on snakebite.

A three year-long collaborative research on Snakebite funded by the Wellcome Trust of UK was conducted at CMCH along with three universities of UK- Newcastle, Liverpool, Oxford. During this study, a dedicated mechanical ventilator was procured for managing neurotoxic snakebite cases. Discovery of ‘greater black krait’ (Bungarus niger) in Chattogram area causing neuromyotoxicty and monoclellate cobra bite causing neurotoxicity and soft tissue necrosis not reversed by existing antivenom were important achievements.

A grant from the Ministry of Science and Technology, Government of Bangladesh was utilized for development of National Guideline for Management of Snakebite (2000). Data generated on snakebite was used for dissemination in professional meetings and for policy advocacy to raise the profile of snakebite among the policy makers. Health education materials were developed and disseminated including poster, leaflet, popular writings, video clips, mass media talks, community meetings on snakebite prevention and first aid. A Bengali book on ‘Snakebite and its Treatment’ was written in 1998 updated in 2006, 2019.

Being a leading international tropical medicine and public health expert and globally recognized especially for research achievements on malaria, snakebite and poisoning. I was the Co-Chair of the WHO Snakebite Envenoming Working Group that developed the WHO Global Strategy for the Prevention and Control of Snakebite Envenoming in 2019.

I gained extensive experience conducting multi-country collaborative research projects especially on malaria, snakebite and kala azar that globally changed public awareness, health policy and clinical management.

During a lifetime career (1978-2011) in the public sector I served in different capacities including Professor of Medicine, Principal, Dean and Director General of Health Services. Salient snakebite activities were: to provide teaching, career support for undergraduate and postgraduate medical students; to provide training on snakebite to doctors; and guiding a dozen dissertations from postgraduate students in tropical diseases & snakebite.

I have been a Board Member of The Global Fund; a member of the Joint Coordination Board (JCB,TDR); Chairman Editorial Board, Journal of Bangladesh College of Physicians & Surgeons; Member, Guidelines for the Management of Snakebites, WHO, SEARO Region (2010, 2016); a member of Drugs for Neglected Diseases Initiative’s (DNDi) Board for ten years, and I’ve done advocacy for including snakebite in the agenda of DNDi;

As the President of the Bangladesh Association for Advancement of Tropical Medicine, I organized seminar on snakebite and I’ve conducted collaborative research on snakebite. A notable outcome: the researchers utilized said research for implementation from Bangladesh perspective.

I’ve given presentations on snakebite in national and international professional meetings and arranged community awareness meetings on snakebite in schools, colleges and in local communities. I’m published widely on snakebite in popular press and in peer reviewed journals (n=80). I’ve contributed to establishing snakebite as a Neglected Tropical Disease by WHO (2018) by conducting advocacy at National and International arenas.

I was a contributor in the drafting of the Regional Strategy for snakebite envenoming (SEARO, WHO); Received the Gold Medal of the Bangladesh Academy of Sciences and was the Chair for developing and reviewing the National Program on snakebite.

I’ve contributed as a member/Co-Chair in committee meetings of WHO or DNDi on snakebite and as a Member of the Board for the Asia Pacific Association of Medical Toxicology. I’ve also served as a consultant, chairman and member in policy development and development of documents of within the government of Bangladesh.

Abul Faiz is currently the Chief editor of the National Guideline for Management of Snakebite and President of the Toxicology Society of Bangladesh.