Waifu

At Uncle Paul's request...
This is a photo I took of a dead carpet viper a patient brought in. It was about a foot long. People generally have one of two stories about how they got bitten. The first is that they were simply walking on a path and were bitten on their foot. The second (and very common) is that a common game for little boys to play is stick your hand in a hole. Basically little boys go around sticking their hands in holes to see what they can find, maybe a bush rat, maybe nothing, and maybe a waifu (snake).

In general, the actual bite site is not impressive. In fact, I don't think I've taken any pictures because there really isn't much to show. The affected limb starts to swell, usually with what looks to be cramping in the limb (trying to get that translated is an issue, but that is what it looks like). We either tie arm to an IV pole to keep it elevated, or raise the foot, to help bring the swelling down. Immediately a clotting time is drawn on the patient because the venom's deadliest quality is that it affects the ability of the blood to clot, it disrupts the bodies clotting cascade. I just spoke with Dr. Hewitt, who said he has an article on how it affects the blood and how the anti-venom works, so I might be a little more educated in a few days.

So pretty much universally the blood won't clot because of the snake venom, at that point the nurse finds a doctor and we order ASV (anti-snake venom). I'm not exactly sure how the ASV works, Dr. Hewitt's article will hopefully clear that up. It likely either binds to the venom, inactivating it, or competes with the venom for binding sites on the proteins it affects in the clotting cascade. We then order another clotting time to be done about 12 hours later.

Depending upon how fast the patient gets to the hospital after the snakebite and other factors, sometimes one dose will be enough to correct them. Some though can go through several doses before their blood clots, Dr. Faile said the upper limit is 10 vials of ASV. We keep them at the hospital until they have had at least 2 successive blood draws that clot. It is frequent for them to have one that clots, and then the next one doesn't clot, so you have to go back and give more ASV. ASV has to be refrigerated, and it seems most bites come in during the night. All the doctors and at the guest house, we keep a supply of ASV, so when we are woken up in the night, we just go get them the ASV and write the order to give it.

We are heading in snake season because it was explained to me, the snakes get too hot in their holes. So they come out near paths, and then people walking down the path get bitten. Since no one (except us Obruni--white people/foreigner) use flashlights, and because the the snake blends in well with the path, it is very easy to come across one unexpectedly.

By the way, they do eat snake around here. However, not usually the carpet viper. They usually eat cobra. Yesah, one of the cooks at the guest house, is known for cooking us waifu, if the opportunity presents itself. (it has not so far)

I am horrible at speaking Manpruli, the main tribal language here, but waifu (snake) is one of the first words I learned.

I hope that satisfied you Uncle Paul!