Features
can snakebite cause long – term health problems ?
by Ifham Nizam
Snakebite is a neglected tropical disease that mainly affects socio-economically underprivileged farming communities in the tropical world. Venomous snake bites cause many health problems immediately afterwards, including tissue injury, even death, and other adverse effects such as blood clotting, kidney failure, paralysis, etc.
Speaking to The Island, the Head of the Department of Parasitology of the Rajarata University, Professor Anjana Silva, said that, unfortunately, our knowledge of the long-term effects of snakebite was poor. This could be due to the fact that after patients are discharged from hospital, following recovery from acute health issues, there is no follow-up.
Even if patients develop various health problems, related to the snake bite, after discharge, they seek medical advice from general practitioners, local hospitals, or indigenous medicine practitioners and, therefore, such health issues are not documented. Because of that, reporting of the long-term effects of snake bite is scarce in the scientific literature.
Prof. Silva added: “The annual number of snake bites in Sri Lanka, proportionate to our population, is one of the highest in the world, and the North-Central province is the most-affected region in the country. So, as researchers from the Rajarata Medical Faculty, in order to provide high-quality scientific information to combat the snakebite problem, we launched a long-term research study to investigate snakebite in 2012 at the Teaching hospital Anuradhapura; it is called “Anuradhapura Snakebite Cohort”.
This study was supported by Prof. Geffory K. Isbister from the University of Newcastle, Australia, who is one of the top global experts on snakebite, and the South Asian Clinical Toxicology Research Collaboration.
“We carefully record all the epidemiological and clinical information of snakebite patients, including accurate scientific authentication of the offending snake, either morphologically or by detecting specific snake venom in patients’ blood. This study lay a foundation to conduct studies related to all aspects of snakebite, including the long-term effects of snakebite. Now this is the largest such snakebite study in the entire world” says Prof. Anjana Silva, the principal investigator of the Anuradhapura Snakebite Cohort.
“Before we investigate the long-term effects of snakebite in Anuradhapura, we wanted to explore the existing knowledge of the long-term effects of snakebites reported globally and to compile that. After reviewing the research studies, conducted throughout the world, we figured out that there are only very few scientific studies available globally on this topic.”
Disability due to amputations, deformities and chronic wounds are not uncommon among victims of African and Asian cobras, and Central and South American Pit-vipers. In addition, the progression of acute kidney failure, into chronic kidney failure in Russell’s viper bites, has been reported in several studies from India and Sri Lanka. Neuromuscular toxicity does not appear to result in long-term effects, but hormonal anomalies have been reported after Russell’s viper bites.
In addition, psychological issues such as depressive symptoms, post-traumatic stress disorder and other mental health issues have been reported after snakebite. Blindness is also a serious, debilitating long-term effect of some snakebites.However, the team found that most of the available studies on the long-term effects of snakebite have been conducted retrospectively, assuming a correlation between an existing health issue with a snakebite that happened long ago. In most of the studies offending snake species were not authenticated scientifically.
“Therefore, we decided to investigate the long-term effects of snakebite on the patients recruited to the Anuradhapura Snakebite cohort, avoiding these weaknesses. In the Anuradhapura Snakebite Cohort, we record accurate information of what happened to snakebite victims, immediately, since they got bitten by the snake”, said Dr. Subodha Waiddyanatha who studies long-term effects of snakebite for her PhD.
To study the long-term effects of snakebites in Sri Lanka, she followed up with snakebite survivors one year and four years after the snakebite, under the supervision of Prof. Geoff Isbister and Prof. Sisira Siribaddana. Those patients were reviewed in person in the Professorial unit of the Rajarata University of Sri Lanka.
“We contacted patients over the phone and invited them to attend the review clinic. When it was not possible, we had to send invitation letters. Sometimes a field research assistant visited the snakebite survivors at their houses and invited them to the study. It wasn’t an easy task to bring them down to the hospital for a health review as most of the patients are farmers and they have many other important tasks in their everyday lives, such as supplying water and fertilisers to their farmlands, protecting the crops from wild animals, like elephants, and selling their harvests for a fair price,” Dr. Waiddyanatha shared her experience about the difficulty in reviewing patients after the discharge.
However, considering the benefits of attending the review clinic, 367 people participated in their study.After reviewing survivors one year and four years after the snakebite, they were able to uncover some interesting facts, which included certain health issues perceived by snakebite survivors, which cannot be explained by the mechanisms of action of snake venom in the human body.

Minor long-term effects’ caused by Hump-nosed viper and Russell’s viper bites. Even if the permanent injury is ‘minor,’ as one would think, that could affect the productivity and the quality of life of that person
“There were many patients who complained of body aches and pains, fatigue, and visual impairments like features which they firmly believed to be due to the snakebite. Some of the patients complained of loss of teeth, teeth avulsion, and receding gums following snakebite. The occurrence of these symptoms has increased with time.
This is a very interesting finding that we came across and we think that we need to study further to understand why these medically unexplained symptoms occur, and whether there is a broader psycho-social explanation for these symptoms,” said Dr. Waiddynatha.
“Luckily, we didn’t see many patients with severe permanent deformities involving the snakebite-affected limbs, mainly because of the species that commonly cause snakebite in Sri Lanka often resulting in relatively minor local effects, unlike in regions like Sub-Saharan Africa. Also, most of our snakebite patients are taken to hospital quite early, so that they get good quality care without delay, which prevents them from developing severe complications.
The commonest deformity is scarring at the bite site which doesn’t interfere with their daily routines. Out of 367 patients, only four patients had to undergo amputation of their affected fingers. All these patients were bitten by either Russell’s viper (Thith polanga) or hump-nosed viper (Kuna katuwa). With these findings, we understood that the vipers commonly found in our country do not cause severe local long-term effects frequently. However, even if the permanent injury is minor as one would think, for example, loss of a part of the thumb of the dominant hand, might greatly affect the productivity and the quality of life of that person.” said Dr. Waidyanatha.
Prof. Anjana Silva said: “In addition, these patients were investigated to find out their kidney functions long after snakebite. Anuradhapura is an endemic area with Chronic Kidney Disease of Unknown Origin (CKDu) and many previous research studies have suggested snakebite as a potential cause of CKDu later in life. However, our studies showed convincing data that suggests snakebite does not play a significant role in developing CKDu. However, severe renal failure that occurs after snakebite still could progress into chronic kidney disease in some patients.”
In this study, they have shown that being a victim of a snakebite does not greatly restrict one’s engagement with farming even though the majority of the patients were bitten by snakes while working in their farmlands, such as paddy fields, chena, and home gardens. Moreover, a majority of the patients do not wear protective footwear, even after suffering snakebites. “The general public does not pay enough attention to that, maybe because snakebite is so common and that they feel it as a part of their lives. Snakebite prevention could be achieved only through awareness, said Prof. Silva.
Features
Trump’s tariffs, AKD’s gazette and Sri Lanka’s diplomatic slumber
“We are rather respectable in Colombo. We go to bed fairly early, and we remain there till morning. “
According to Sri Lanka’s diplomatic folklore, the late S.W. R. D. Bandaranaike uttered these words while explaining the reasons for Sri Lanka’s abstention on the UN resolution condemning the Soviet invasion of Hungary. Apparently, SWRD’s foreign ministry officials were asleep at home when the diplomatic cable seeking instructions was received from New York. In those days, there were no cell phones, Internet, or even fax or telex machines. The diplomatic cables were sent through post offices. Decoding them was a slow and time-consuming process. Thus, the government could not provide appropriate instructions to our mission in New York in time, and the Sri Lankan delegation abstained on that sensitive UN vote.
Sri Lanka’s Absence from Section 301 Consultations
But then, how does one explain Sri Lanka’s absence from the crucial bilateral consultation held in Washington by the Office of the United States Trade Representative (USTR) during March-April on “Forced Labour” under the Section 301 of the US Trade Act of 1974? Didn’t our foreign and trade ministries send appropriate instructions to Washington in time? Even if the instructions from the foreign ministry were transmitted to our embassy in Washington by pigeon carriers, there was enough time for Sri Lanka to participate in those meetings.
In March, the USTR initiated these 301 investigations on 60 trading partners, and invited all of them for confidential consultations. Out of the 60, 46 participated in these consultations. Sri Lanka was not one of them. Other countries that didn’t participate in these consultations included China, Russia, and Venezuela! In addition to that, the Section 301 Committee conducted a public hearing with interested parties on April 28 and 29. Washington-based diplomats, representatives from few trade ministries as well as representatives from many foreign trade associations and chambers participated in these hearings. Sri Lanka was once again conspicuously absent.
As a result, when the USTR published the proposed forced labour tariffs on June 2nd, Sri Lanka ended up with a 12.5% duty. Pakistani and Indonesian diplomats participated in these consultations and took appropriate follow-up measures, and managed to enter the 10% duty category. As even a threat of a modest tariff hike could disrupt supply chains and reduce competitiveness, particularly in an industry such as garments, I discussed this issue on 15 June and underscored the importance of Sri Lanka’s participation at the next hearing, which was scheduled to be held from July 7th .
Awakening from Diplomatic Slumber and AKD’s Gazette
Fortunately, Sri Lanka finally awoke from weeks of diplomatic slumber, and Ambassador Mahinda Samarasinghe participated in the public hearing on 9 July, and promised, “…. · We have agreed to the text in our negotiations with the USTR on forced labour, …. The gazette as we speak is being printed and I’m getting the gazette tomorrow morning, and the gazette will be shared with USTR as I get it“.
As promised, President Anura Kumara Dissanayake issued a gazette on 10 July banning the imports of goods produced by forced labour. These new regulations are very similar to what Pakistan and Indonesia enacted in April, after their consultations with USTR in March. Why couldn’t we do it in April? Why did we wait till the very last minute?
Challenges ahead
“War is too important to be left to generals alone,” is a famous saying attributed to former French Premier Georges Clemenceau. Similarly, monitoring our main markets is too important to be left to diplomats alone. The United States is the largest single-country market for Sri Lanka. Therefore, Sri Lankan trade chambers and associations should become more proactive in these markets and participate in these events. For example, the chairman of the Pakistani apparel exporters association participated in the April hearings. Similarly, representatives from the Indian Agricultural and Processed Food Products Export Development Authority, the Federation of Indian Chambers of Commerce and Industry, the Confederation of Indian Industry, and Reliance Industries also participated in July hearings. At an event where each speaker is given only five minutes (strictly enforced), having a number of speakers from a country is an advantage. The presence of industry representatives in these kinds of events also help them understand the market dynamics and the future challenges. This is important, particularly because there will be many more challenges with Trump’s tariffs.
With the gazette issued on 10 July, Sri Lanka has imposed a prohibition on the importation of goods produced with forced labour. Now, the challenge will be to effectively enforce the prohibition. And what are the goods produced with forced labour? The USTR list only focuses on aluminum, cotton, electronics, lithium-ion batteries, rice, and tobacco. However, according to the U.S. Department of Labour, the list is much longer. Hence, this list may change continuously during the next two years and tariffs may fluctuate once again.
So, this is definitely not the time to slumber.
(The writer, a retired public servant, can be reached at senadhiragomi@gmail.com)
by Gomi Senadhira ✍️
Features
Tales of Mystery and Suspense 10 Casino for Sale
After the overwhelming grotesquerie of J K Rowling’s latest Cormoran Strike novel (written, I should have noted, as the others were, under the pseudonym Robert Galbraith), I thought I should return to the world of fun, and also a much shorter description since this thriller moves quickly without the layers of detail that Rowling engages in.
I then move to the second comic thriller by Caryl Brahms and S J Simon. This, their second story to feature Vladimir Stroganoff and Adam Quill, was Casino for Sale, as lunatic a romp as the first, though without the emphasis on the ballet that characterized A Bullet in the Ballet.
This one begins with the impresario Stroganoff buying a casino cheap from Baron Sam de Rabinovich, only to find that it was a rundown place, not the grand casino of La Bazouche, a resort on the Frenc+h Riviera, as he had initially thought. The grand one belonged to Lord Buttonhooke, and Stroganoff could not compete, until he thought of bringing the Ballet Stroganoff to the casino – which of course leads to Buttonhooke deciding to have ballet performances in his Casino too.
Stroganoff invites Quill to visit him, which Quill decides to do since he has left Scotland Yard, having come into a legacy. No one believes this, and he has to face questions as to what he did to have been sacked, with sympathy for having been found out.
The day he arrives in La Bazouche there is a murder, of a vitriolic critic called Citrolo, in Stroganoff’s office. He had been going to write a damning review of the opening night of the ballet and Stroganoff, when he realizes Citrolo cannot be swayed, drugs him and dictates the review himself to the papers. He leaves Citrolo sleeping and finds him shot the next morning, whereupon he decides to muddy the waters and leave a suicide note and lots of other murder weapons. So much overkill, as it were, of course ensures that he is arrested.
But the excitable French detective who makes the arrest follows up his suggestion that Buttonhooke was also involved, and so the two casino owners find themselves in cells next door to each other, with the detective Gustave quite happy to provide creature comforts for a fee.
Quill decides he must investigate, and finds Gustave most cooperative, since he has a laid back attitude to work. So it is Quill that finds a notebook which makes it clear Citrolo is an accomplished blackmailer, and that there are lots of possible murderers, including Stroganoff’s croupier, who was crooked, Rabinovich, who was now working for Buttonhooke, a confidence trickster called Kurt Kukumber, whose prospectus for a dud gold mine was found in the office and Prince Alexis Artishok who was engaged in a deal to buy diamonds from the ballerina Dyra Dyrakova.
Stroganoff had been trying to get Dyrakova to dance for him, but having done so previously she had refused. But then to Stroganoff’s chagrin she agreed to dance for Buttonhooke. The clearly crooked Artishok had told Buttonhooke’s mistress Sadie Souse, who was not very bright, that Dyrakova possessed diamonds she was willing to sell cheap, and Sadie was determined to have them.
Quill meanwhile finds out that there was a secret passage to Stroganoff’s office, the obvious solution to what had begun as a locked room mystery, and that this was known by almost everyone apart from Stroganoff himself. And then Rabinovich is murdered, just after Gustave had released his two original suspects, leading him to blame Quill for having insisted on that and thus allowing them to kill again.
Soon afterwards Dyrakova arrives, and the town is full of posters announcing that she will appear in the casinos, elaborate posters for either one, since Stroganoff is determined that she will dance for him, and if she does not come willingly, he has devised a scheme to make her do so unwillingly. So, though Buttonhooke has her taken off to his yacht immediately she arrives at the station, Quill along with Arenskaya gets her into a launch and to Stroganoff’s casino, where she performs to tumultuous applause, not knowing for whom she is dancing.
When Quill asked her about the diamonds, she said she had sold them long ago, and that gave Quill the solution to the mystery. Rabinovich had known about this, and Artishok had killed him to prevent Sadie learning it from him, he had killed Citrolo who had recognized him for an accomplished card sharper, not a Russian prince at all. But before he is arrested, he gets away in a boat, and the police launch that pursues him is on the point of catching him up when it runs out of petrol.
Again, lots of excitement, and entertaining references – Gustave grows marrows – and if not quite as brilliant as its predecessor, Casino was certainly a delightful read.
Features
The challenge of being positive about SAARC
It was a few years back that a former President of Sri Lanka took it on himself to pronounce SAARC ‘dead’. Since then there have been other sections of Sri Lankan opinion that have joined the critics of SAARC and taken the solemn stance that SAARC has indeed died what may be called a natural death.
Their fatalism is understandable. SAARC has failed to meet at heads of government or state level for the past several years to take the SAARC process notably forward. Regional cooperation has more or less been only an appealing idea. No substantive concrete projects have taken off to make the idea a hard reality. ‘Inner paralysis’ seems to be SAARC’s lot. Hence the fatalism in these circles.
However, being one of the worst cash-strapped regions of the world and a teemingly populated one with people virtually left to their devices, what choices do the ‘SAARC Eight’ have other than to try their best to band together and continue with their cooperation efforts, however small they may be?
There is no escaping the mounting debt trap for many of these countries and bankrupt Sri Lanka is a glaring example, but ‘throwing in the towel’ and abandoning themselves entirely to the diktats of the strongest economies and their agencies will prove a ‘living death’ for many countries in the SAARC fold.
The gains may be meagre but giving-up on SAARC cooperation in full would prove self-defeating for the organization and South Asia. Right now, the collective intention ought to be to salvage what the region could from the tenuous cooperative efforts. Moreover, such initiatives could go some distance to generate a degree of goodwill among the Eight and help in sustaining a dialogue process.
Given this backdrop it proved ‘a stich in time’ for the Regional Centre for Strategic Studies (RCSS), Colombo, to recently host the SAARC Secretary General Ambassador Md. Golam Sarwar to a round table discussion on the unifying potential of SAARC and its future possibilities, besides other related issue areas.
Held on June 24th and moderated by RCSS Executive Director and former ambassador Ravinatha Aryasinha, the forum brought together a vibrant, wide ranging audience comprising academicians, diplomats, senior public servants, civil society activists and many others. Following the presentation by Ambassador Golam Sarwar titled, ‘Reigniting SAARC: Achievements, Challenges and the Way Ahead’, a lively Q&A followed.
The above forum could be described as an act of lighting the proverbial ‘candle’ rather than ‘cursing the darkness.’ It surely is a ‘darkness’ that could be seen as daunting considering that the region’s pivotal powers, India and Pakistan, are failing to act in a spirit of accord but are engaged in bitter finger-pointing on a number of questions of vital importance to SAARC.
On the other hand, what is the rest of the region doing to bring the above sides together? It is disappointing that to date the rest of SAARC has failed to launch a major diplomatic drive to bring peace between the feuding regional heavyweights. It needs to act without delay and establish its earnestness and this effort would need to prove SAARC’s staying power in the unfolding months and even years.
In assessing SAARC’s seeming failure local opinion in particular has failed to factor in what could be described as weak leadership. Since Sheikh Mujibur Rahman of Bangladesh, the founding father of SAARC, the region has failed to produce a visionary leader who could advance the SAARC cause with charisma and drive.
Among other reasons, weak leadership accounts considerably for the faltering and stuttering status, as it were, of SAARC. Badly needed are leaders who could go the extra mile, think less of narrow national interests and work diligently towards the collective well being of the region but SAARC’s millions of ordinary people have been made to wait in vain for leaders of such stature. Instead, they have been burdened with politicians who seem to be relishing the apparently moribund state of SAARC.
Looking back, it could be said that it was the dynamic leadership factor that led to the launching of the Non-Aligned Movement and for its sustenance for a few decades. True, it could be seen in some quarters that NAM is no more, but as in the case of SAARC, the former too has been unfortunate to be burdened over the years with politicians who lack the vision and drive to unflaggingly advance the fortunes of the South. NAM and SAARC lack the dynamism and vision of leaders of the stature of Jawaharlal Nehru, for example, to give them the required guidance and intellectual depth.
The reasons are complex for there not being among us currently political leaders with the vision and the steadfast commitment to advance the legitimate interests of the South. However, it could be stated with conviction that the majority of Southern leaders have too easily caved in to the demands of the global North and its financial agencies.
These leaders have failed to see, for instance, that the largely market economy oriented Northern governments would not view with favour a centrist economic model that attaches priority to the interests of the dis-empowered publics of the South. This realization ought to have dawned on the current government in Sri Lanka, for instance, some while ago but it has no choice but to abide by IMF dictates since economic survival at present is unthinkable without the latter’s succour.
Accordingly for SAARC this should be the time for some soul-searching. Priority needs to be attached to ending the feuding between India and Pakistan since at present the material fortunes of the region hinge largely on these regional giants giving peaceful relations among them a try. This is no easy challenge to meet but some daring, visionary diplomacy needs to take hold among the rest of SAARC.
There is some sense in SAARC bringing the peoples of the region together through programs that address their best collective interests. A meeting of minds among SAARC nations could enable SAARC and its agencies to build a region-wide people’s movement for progressive political and economic change that could in turn lead to the region’s political leaders sensitizing themselves more to the neglected needs of their publics.
However, the time is ‘now’ for the initiation of these progressive changes and the voice of SAARC well wishers would need to drown out those of their critics.
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