Novel approaches to empower Indian communities in their fight against snakebite envenoming

印度社区推出对抗被毒蛇咬伤的新方法

Nearly 60,000 Indians die of snakebite envenoming each year. Most deaths occur in villages where a host of human and ecological factors converge to heighten the odds of encounters with snakes and subsequent bites.

每年有近6万印度人死于毒毒蛇咬伤。大多数死亡发生的地点位于村庄里，在那里，一系列人类和生态因素汇合在一起，导致人们遇到蛇且被蛇咬的几率增加了。

©Gnaneswar Ch,

©Gnaneswar Ch，版权所有

An Indian cobra. Kanchipuram, Tamil Nadu, India, November 2021.

印度眼镜蛇事件。发生于2021年11月，印度泰米尔纳德邦，坎奇普拉姆。

India’s agrarian workers are particularly affected. Their reliance on non-mechanised, low-cost farming techniques, as well as barefoot farming practices, places them at high risk of bites, especially during the monsoons, when agricultural activities and snake breeding seasons tend to intersect. Precarious housing conditions, poor lighting, sleeping on the floor and outdoor toilets are other factors associated with an increased risk of snake encounters.

印度的农业工人受到的影响尤其严重。他们依赖非机械化、低成本的耕作技术，赤脚耕作，这让他们面临被毒蛇咬伤的高风险，特别是在季风期间风险频发，因为农业活动季和蛇繁殖的季节往往会重叠。不稳定的住房条件、糟糕的照明情况、工人睡在地板上与在户外上厕所是其他增加遇到蛇风险的因素。

©Gnaneswar Ch

©格纳斯瓦尔Ch

Most snakebites in the developing world are a result of the intersection of human activities and snake habitats. In this picture, a woman works in a paddy field as a snake lies nearby, Kanchipuram, Tamil Nadu, India, November 2021.

在发展中国家，大多数毒蛇咬伤事件是人类活动和蛇的栖息地发生冲突的结果。图为2021年11月，印度泰米尔纳德邦坎奇普拉姆，一名妇女在稻田里劳作，旁边躺着一条蛇。

Empowering communities through knowledge and practical interventions is a low-cost and sustainable approach to the problem of snakebites in India. In recent years, the Poison Control Centre at the Christian Medical College (CMC), in Vellore, South India, has been closely involved in empowering village communities in and around Vellore with regard to snakebite prevention and first aid.

在印度，通过传播相关知识并实行实际干预措施，来增强社区的保护能力，是解决毒蛇咬伤问题的低成本且可持续的方法。近年来，印度南部韦洛尔基督教医学院（CMC）中毒控制中心一直密切参与增强其地区及其周围村庄的社区在毒蛇咬伤方面的预防和急救能力。

Health facilities equipped with snake antivenom and critical care support are often located at considerable distances from the places where snakebites occur. Due to this, and other cultural factors, many Indian snakebite victims often resort to traditional therapies. These can further delay access to effective treatment and can often cause harm to the victim.

配备有抗蛇毒血清和紧急护理支持的保健设施往往距离毒蛇咬伤的发生地过远。由于这各原因以及其他文化因素，许多印度被毒蛇咬伤的患者往往诉诸于传统疗法。这会进一步拖延获得有效治疗的时间，并往往会对受害者造成伤害。

©Meenakshi SekarA village visit by the CMC Vellore team - raising awareness about snakebite prevention and first aid. , Gudipala Mandal, Chittoor, Andhra Pradesh, India, September, 2018

©Meenakshi SekarCMC 基督教医学院的韦洛尔团队对村庄进行走访，以提高人们对预防毒蛇咬伤和急救的认识。，古迪帕拉·曼达尔（Gudipala Mandal），奇图尔，安得拉邦，印度，2018年9月

Most snakebite patients admitted to CMC come from villages in and around Vellore. Outreach programs in these communities are usually complemented with awareness-raising for snakebite patients and their families during their hospital stay.

大多数被送入基督教医学院的毒蛇咬伤患者来自韦洛尔及其周围的村庄。在毒蛇咬伤患者及其家属住院期间，社区会开展外展服务以提高他们对此的认识。

This is followed by home and village visits, conducted by a team of nurse-educators, medical-trainees and doctors. The focus of these visits is on identifying the risk factors that make snake encounters more likely and alerting communities to the environments most frequented by medically-important species. The visits also teach appropriate first aid and other simple measures to prevent snakebites. Educational material comprises of printed leaflets with clear information, mainly in visual form with minimal reliance on text. During sessions on first aid, the emphasis is placed on using common materials that can be found in most Indian households.

随后一个由护理教师、医疗实习生和医生组成的小组进行家访和乡村走访。访问的重点是确定更有可能遭遇毒蛇咬伤风险的因素，并提醒社区居民注意主要医学种类生物最常光顾的环境。在访问中还教授当地居民适当的急救方法和其他简单的措施，预防蛇咬伤。教育材料包括印刷的小册子，里面内容明确，主要以视觉形式呈现，对文字的依赖程度最低。在急救课程中，强调宣传的是使用的大多数对抗毒蛇咬伤的普通材料在印度家庭都能找到。

© Anika Salim, Sakthivel Vaiyapuri, University of Reading

© Anika Salim，Sakthivel Vaiyapuri，雷丁大学

An educational pamphlet on snakebite prevention in the regional Tamil language.

用泰米尔语编写的预防毒蛇咬伤的教育小册子。

The “Snakebite Survivors’ Meet”, organised every year by the CMC Poison Centre, is a novel approach to empowering and engaging communities in preventing snakebites, exploring the role of peer educators in this process. The Meet brings together victims of snakebite envenoming and acts as a forum in which participants can share their personal experiences of dealing with the consequences of a snakebite with others who may have been similarly affected. Participants are also trained in snakebite prevention and first aid through simple didactic and hands-on sessions. They are encouraged to volunteer as peer educators in their communities to help disseminate relevant information in a locally-contextualised manner. The Centre continually interacts with peer educators to support them in this role.

每年，由基督教医学院中毒中心组织的“毒蛇咬伤幸存者会议”是一种新颖的宣传方法，旨在增强社区应对毒蛇咬伤的能力并参与其中，探索同伴教育者在这一过程中的作用。会议作为一个论坛，汇集了曾经历毒蛇咬伤的受害者，在会上，与会者可以分享他们的个人经验，处理方法与其他人受到此类遭遇的影响与后果。参与者还通过简单的教学和实践课程接受毒蛇咬伤的预防和急救培训。我们鼓励他们在自己的社区中担任志愿者和同伴教育者，以因地制宜的方式帮助传播相关信息。中毒中心不断与同伴教育者互动，并支持他们发挥这一作用。

Since 2019, the Meet has been conducted virtually, as a result of conditions imposed by the Covid-19 pandemic. The online mode has proven advantageous, however, since it allows participants to join from their homes at a mutually convenient time, after working hours, thereby saving transport costs and preventing the loss of a day’s wages. As a result, snakebite victims from relatively distant villages have also been able to access these sessions. Participants from 30 villages around Vellore were able to attend the event in 2021.

自2019年以来，由于新冠肺炎大流行影响加重，会议一直在网络上开展。然而，线上模式证明是有利的，因为它让参与者在下班后适应彼此方便的时间，在家里就地参与，从而节省交通费用且不会损失掉一天的工资。因此，那些来自相对较远的村庄的毒蛇咬伤受害者也能够参加这些会议。来自韦洛尔周边30个村庄的参与者能够参加2021年的活动。

Shaping young minds

塑造年轻人的思想

Children have a vital role to play in public health education. The CMC Poison Centre focuses on school visits, during which child-friendly illustrations and concepts of prevention and first aid are used to educate primary and secondary school children. The Poison Centre has been able to reach nearly 3,500 school children over the past two years.

儿童在公共卫生教育中发挥着至关重要的作用。基督教医学院中毒中心的重点在于学校访问，在访问期间，人员使用适合儿童的插图与预防和急救概念来教育小学和中学儿童。在过去两年里，3 500名学童已经接受了来自中毒中心的教育。

© Daniel Sundar

©丹尼尔·桑达

Engaging young minds: a school education session in progress at Vellore, Tamil Nadu. September 2018

吸引年轻人的注意力：在泰米尔纳德邦的韦洛尔举行的一次学校教育会议。二零一八年九月

The main lessons of this outreach and education work are very simple. Snakebite envenoming is eminently preventable. But snakebite mitigation can only be achieved if communities affected by snakebite are actively involved in its prevention.

这一推广和教育工作的主要目的非常简单。毒蛇咬伤所产生的毒液是完全可以预防的。但是，只有被这一问题波及到社区积极参与预防，才能减轻毒蛇咬伤的影响。