Posted by Bibhav Acharya
One of Nyaya Health’s board members, Bibhav Acharya, reflects on a patient’s story from the summer of 2008.
She went into cardiac arrest as she was carried into the clinic. The men carrying her said she had been bitten by a snake. We put everything on hold and rushed to assist her. There was no pulse and she was having difficulty breathing. Epinephrine was administered. A non-specific anti-venom was injected. Endless chest compressions were started and her heart started beating again. The team worked on her for five hours, after which, she died.
Her husband rushed out, wailing. We stared at each other in muted shock. Her relatives waiting outside the clinic started crying. The screams were not loud but still deafening. The medical staff swiftly made their way out of the room. Some were weeping. I was staring at her, still in disbelief. Her right arm was hanging off the examination bed. Her eyes were closed and her mouth was gaping. She looked lifeless. It was the first death at Nyaya’s health center.
Jason Andrews, one of Nyaya Health’s co-founders, was still in the room, his eyes welling with tears. I asked him if there was anything we could have done to save her. Did we lack equipment? Did we lack a particular medicine, an antidote? Did we allow her death by not raising enough money?
Jason wondered about her chances of survival even at the most plentiful institutions of the world. She had been bitten by Krait (Bungarus), which is about 15 times more poisonous than a cobra, and arrived at the clinic eight hours after being bit. She had several factors working against her that had drastically decreased her chances of survival, even if she had come to the kind of US institutions where Jason and I receive medical training.
A Krait snake, which is extremely poisonous and relatively common in Achham (photo courtesy of http://wildindia.org/wiki).
It was not a reassuring thought. Was the poison her killer or was it the fact that her nearest medical care center, Nyaya’s clinic, was an 8 hour walk from her home?
We went outside to speak with the family. As rehearsed when learning to deliver bad news, I told the weeping husband that he had done everything he could have to help her – he had carried his wife on his back through mountains for hours. I told him her death was not his fault. The deadly poison was the cause of death.
Other family members started consoling him. We asked how a nocturnal snake had bitten her. The snake had attacked her at 3 a.m. when she was sleeping in a temporary shed in the woods. We wondered why she was sleeping in the woods. Dr. Jhapat Thapa, Nyaya’s physician and an Achhami native, explained: it is not uncommon in Achham and its neighboring districts that women bring the family’s cattle to the woods and stay there for weeks during the monsoon season. The caretakers stay in temporary sheds in the middle of thick vegetation while the cattle feed day and night on the lush foliage following several months of starvation due to the dry winter. Dr. Thapa told us about his childhood days when he had also spent several nights in such sheds. They are bamboo structures with walls and floors of hay. Injuries, falls and snake bites are known – and (helplessly) accepted – prices for feeding the cattle.
We called the phone nearest to their home so the woman’s relatives could be informed. They would have to walk overnight to reach Sanfe Bagar for her cremation ceremony the next morning. The family members began to collect materials for her cremation at a river bank a few hundred meters from our clinic. Next, we had to fill out her Death Report. Cause of death was going to erroneously say cardiorespiratory arrest secondary to neurotoxin from krait bite.
She died because she was bit by an extremely poisonous snake. She died because it takes 8 hours to reach the nearest health center from her home. She died because she was forced to risk her life by living in the woods so her starving buffalo could get food.
Hello,
Truly heart-rending and it’s amazing how you guys are making such a big difference everyday. I will soon join you as a humble participant in the process.
Anil
what a sad story.
you are truly hero’s for helping people in need.
i hope i can help more.
much love and respect to everyone involved in this project.
kishu
I am numb after reading the story. What a sad situation! I applaud the work you are doing with Nyaya Health.
-Rajendra
An important and deeply moving story…..and sad to say, you have it right. This death less about neurotoxins and the bite of a poisonous snake than it is about distance and time needed to traverse it. Nyaya cannot be everywhere. But, for the future, you don’t have to believe it if you don’t want to…..
Frank Bia
AmeriCares Foundation
This is a horrific accident…the life conditions in this region it amazes me really …
Your work is very impressive and admirable
Karen
Truly a touching story.
You are doing a great job! I am sure Nyaya will be able to save countless no of lives in the future..
Good Luck
Sandeep
Together with snake bites, women are at risk of being atacked by bears every trime they go to the forest to pick up wood! It ‘s crazy how people have to risk their lifes to be abble to heat!!
Unfortunatly we cannot save all lifes! But Nyaya Health is already making a massive difference for those who leave in Accham district.
Love your work guys…
Good lck with everything there!
Ana
Together with snakebites, women are at risk of being ataccked by bears every time they go to the forest to pick up wood! It ’s crazy how people in Accham have to risk their lifes to be abble to eat!!
Unfortunatly we cannot save all lifes! But Nyaya Health is already making a massive difference for those who leave in Accham district.
Love your work guys…
Good luck with everything there!
Ana
True relection of facts, and village life. The story ended sad.. but as I went through, I am gaining more hope that there are some who have and will have unique and suffienct knowledge as well as passion for service for those who badly need it… this really makes a difference in life..
Millions of thanks to Bibhav and his team!
Deb
It’s simply not possible to save every life. Whether in the remote and underserved regions of the world, or in a tertiary teaching center of a developed country, there will be those that do not survive despite our best efforts. Medicine is part knowledge, part timing and part luck. By establishing Nyaya, you have brought chances to those that did not have them before. With each experience, we learn for the future and can always hope for better outcomes, wherever we are.
That was a touching story – and it reached us and to the whole world because of the dedication, intelligence and caring nature of Bibhav.- great work keep it up.
By the way, sometime back there was an article in kathmandu post regarding their job when diarrhoea was in spotlight.
A very challenging story, emotionally and for all who works hard to bring healthcare to the people less serve.
What comes to mind is training basic first aid measures, in the hope that it can help retard complications and/or negative outcomes. Maybe simple things can help.
This is the kind of situation where words fail us and we simply feel inadequate. In addition to patients’ well being, we should also be concerned about Nyaya’s doctors who have to face this kind of situations everyday.