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Snake Bite!

We have been touring with a University group since 2000 – initially, annually the group of students with academic staff would undertake a tour in South Africa of 4 to 6 weeks and the group size varied, on one tour we had as many as 42 students. With groups of this size you would expect things to go wrong – a student would fall out of a tree in the Kruger Park and break his arm, and this was a prank – and you would be faced with all the problems of getting the staff to give you permission to leave the Park in the middle of the night and go to the hospital in Nelspruit to get medical attention.  Dr. Don Gordon, the pioneer of this travel abroad programme had visited as many as 52 countries in Africa, then Dr. Erik Ching took over from Dr. Gordon and then the reins were handed to Dr. Kristy Maher, the hero of this story and current director of the tour. Dr. Ching and Dr. Maher shared the responsibility in 2007 and Dr. Maher has led every programme since then in 2009, 2011, 2013, 2015 and 2017.

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On every trip since 2000, we have always included a stay at Giants Castle in Kwa-Zulu Natal. The university has an athletic prowess and this was leisure time for the students who otherwise had to attend lectures whilst on tour. They would engage in full day hikes up the uMklambha-Drakensberg –an acclaimed World Heritage site, and many of the hikes would reach the Lesotho border with the height very close to 3000 metres above sea-level. It was lusciously green this year after a very good summer rainfall period and the rivers were in full flow.

It was an overcast and chilly day, but this did not dampen the spirits of the students and undeterred they started their hike that day. All of them were well prepared for hiking and hiking hampers were prepared for the students. Then they were off – in their selected groups and on their elected routes.  As the day progressed so the rain intensified and it was simply one of those dark and wet days.

And then I received a call that no tour operator or guide wishes to get. Ever! I immediately went into crisis mode and walked this critical path together with Dr Kristy right until the emergency services and ambulance were able to take over and safely accompany the student to hospital.

This is what Dr Kristy Maher, Ph.D. of the Sociology Department at Furman University writes in her blog.  http://muddyhyena.blogspot.com/2017/07/snake-bite-from-february-2017.html

I receive a text message from one of the students reporting that one of the group hiking has been bitten by a snake. The details are not clear but we learn that the student can walk and that the group are on their way back down. Our attempts to reconnect with them at that stage are futile!

On the day, this group of five students decide to take the hike to Binneman’s Hut – the highest point in the area and on reaching the hut decide to enter for respite from the rain and cold. This is where it all begins. The student is bitten on the heel of his foot. He is wearing open sandals at the time as he had changed out of his hiking boots en-route, because of discomfort, and thinks none the better of this change.

This sets off a whole chain of events, it’s a mind game for starters. Don’t panic! If he can hike down, perhaps it wasn’t a poisonous snake? What is the camp manager’s number? Is there medical evacuation? Where are the details for the travel insurance policy? What are the contact numbers to call Furman on a Sunday? With these pieces of information in place…we continue to wait.

Finally, the group has made it back to base camp. We are full of questions, looking at very tired students and trying to figure out what has happened. The student is stable. Two dark purple dots provide positive proof of fang marks, and his foot, ankle, and leg are fairly swollen. When I ask for a description of the snake (fat, grey brown pattern), knowing that in a case like this you cannot take any chances and it is time to move and we spring into action.

The camp manager arrives shortly after our call and after she sees what I’ve seen and heard the description of the snake, she confirms we must go immediately. We embark on what turns into a multi-hour effort to get to decent medical care. A group of us, including the camp manager, the snake bite victim, another student coming along for moral support, our tour facilitator and his driver and I pile into two cars, and after a 45-minute ride in the pouring rain we arrive at a rural health clinic close to Winterton.

It is a small clinic, with only a couple of nurses working, and currently without a working phone line. We describe our situation and after taking the vital signs of the victim, conclude he is stable but must be moved to the provincial hospital in Colenso.

Our concerned group piles back in the cars, and we notice that it’s getting harder and harder for the victim to transfer from the wheel chair to the car. For another hour or more we race on in the pouring rain to a larger medical facility in Colenso. Upon arrival, we enter a crowded waiting area tightly packed with plastic chairs. We’re moved back to a dimly lit, dank area with a dozen beds or so, many of them occupied. A nurse checks the victim’s vital signs, takes some blood and hangs an IV(Intravenous). Unfortunately, I must go and attend to the paperwork for admission so I miss the initial stages of the examination and don’t know what medication he’s been given. Almost immediately he gets very sleepy and cold and fades in and out of consciousness.

Seeing the condition of the hospital we immediately begin the long and arduous process of negotiating with the insurance company to get our patient transferred to a private hospital. The closest one is in Pietermaritzburg, a further 2-hour plus drive away. When the doctor arrives, he assures me that they have stabilized him, and when asked if we should transfer to a private hospital he agrees that it is better as their hospital lab is not working because there is no electricity and there really isn’t much they can do for him there.

The only place I can get a cell signal is in the parking lot, in the pouring rain. The insurance company keeps promising to call me back in 5-10 minutes and they don’t, so I must call them again. We’re mired in insurance negotiations and at one point, when they ask me again if the transfer is “medically necessary”, I “throw my toys out of the cot” (a great Southern African phrase to indicate I lose it) and scream, “Yes, it is medically necessary! There’s no electricity for the lab to run the blood work and there’s blood on the floor”

They finally conceded that a transfer is appropriate and we begin again to negotiate how to make this happen. They put me in touch with a “local coordinator” who will arrange the ambulance transfer. He’s not particularly helpful in that he has a local number that I can’t call back – when I try to call, it is a dead number. I wait. Time is passing. People coming and going in the emergency room.

When I’ve finally given up on the insurance company to coordinate an ambulance, I call a private ambulance company myself to try to arrange transport.  As we’re trying to figure out how to arrange payment, an ambulance shows up to get us.

The snake bite victim and the Professor are loaded into the back of the ambulance and send his comrades back to the camp to take care of the rest of the group. The EMT (Emergency Medical Transfer) checks his vital signs again and looks quite concerned.

The EMT continues to rub the chest of the victim to make sure there is a response. The victim is such a nice young man that each time we wake him, he immediately apologises, “I’m sorry. I’m sorry.” When he stops doing this, I start to get even more nervous. My anger towards the insurance company for delaying our transfer seethes. At some point along the way, we pull off the side of the road and the EMTs exchange places. The new man seems highly competent. I exhale a bit.

We finally make it to the hospital and get transferred into a two-bed trauma bay. More paperwork. The EMT is very kind and not only gets me to the half-asleep administrator who tries to check me in but he stays with me to try to answer the questions that are not designed for patients from out of the country (our address from the USA confuses her greatly so we end up simply telling her that we live in Giant’s Castle). When we’re finally finished with that, the EMT walks me back to the trauma bay.

We are finally moved to the male ward which brings you to the start of this entry (on the cold hard floor). When I’m am eventually kicked out of the ward I reluctantly move to a tiny lounge, one floor up. I have promised his parents I wouldn’t leave him but the staff won’t let me stay, so I have no choice. I grab the pillow and blanket I have taken from an empty patient bed and curl up on a love seat. It’s one of the longest nights of my life.

The following morning at around 07h00 the Specialist arrives, the ante-dote is administered and within 2-hours the situation calms and the patient’s vital signs improve, the situation becomes more normal and we begin to think more clearly.

Now for the long slow recovery.

The long and the short of it is that the snake was a Berg Adder. Both neurotoxic and cytotoxic, the victim suffered some vision problems (double vision and an inability to focus) for a week, he lost his sense of taste temporarily, and had swelling in his foot, ankle and leg for a long time after (he was in a wheelchair for a while, then on crutches and still in a compression sock to reduce swelling even when we returned to the States – a couple of months after the incident). We stay three nights in the hospital and then fly to Cape Town to join the group (thanks, British Airways for upgrading us inexpensively to First Class and letting us wait in their “lounge” complete with gourmet food and wine bar. Now, that’s the way to travel!

He transitioned for a further 4-weeks in the wheelchair and when he finally converted full time to crutches, he donated his wheelchair to a rural hospital in Namibia who are in great need of additional resources.

I have been very fortunate to have worked so closely with these tours and I have met some of the most amazing students and their academic Professors. I admire what is achieved in the 14-weeks that they are on tour and can only tell you that with their spirit of adventure they achieve a tremendous response from those they meet during their travels and the friends that they make and the memories that they make, live on in people’s minds.

 

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