I do not remember my first encounter with a snake. For most children growing up in rural Assam, they were a familiar sight during the monsoon months. But the familiarity did not bring nonchalance. I continued to remain terrified of them.
My mother tells this story that when I was one or two, one night, she heard a sound in the bedroom where we were sleeping. She sat up, increased the flame of the kerosene lamp and saw a snake that she has since explained as ‘alternately white and black striped’.
My closest encounter, though, was moderately recent. I went to use the washroom at home, opened the door, and something cold fell on me. It slid down my body and I instinctively looked towards the floor. Near my feet was a cobra in its alert position. I elbowed the door that I was thankfully yet to bolt. As I ran, I was reminded of my science text in school which had mentioned that snakes are cold to the touch. They indeed are.
Over time, I have developed an interest in reading about snakes and snakebites. I have joined social media groups where members seek and receive help in identifying snakes that they record on their phones and upload. Experts in these groups often also share helpful information on safety, awareness and medical issues around snakebites. I can now safely say that I am able to identify the Big Four. But more importantly – and funnily – I also now know that on many an occasion when a snake scared me, it was, in reality, a rat snake – a dark and big but non-venomous snake that is often confused with the cobra.
Even though we now have a polyvalent antivenom, snakebite treatment is still not easy. There are multiple reasons for this. Lack of medical awareness on the part of the people is concerning, but it is not the biggest culprit. When a victim is taken to a primary or community health centre, there is usually one of two things happening: the hospital does not have antivenom or the doctor is ill-equipped to treat snakebites even though it is a regular emergency.
It is owing to this inadequacy that someone like Dr Surajit Giri slowly became not only important but also critical to snakebite management in the state. Giri, an anaesthesiologist by training, works in Demow Rural Hospital, a block primary health centre in the Sivasagar district. He has treated hundreds of snakebite patients in his hospital and has guided treatment for many more over the length and breadth of the region.
Giri’s phone number is public. It is on the speed dial of many doctors and aware citizens who dread a day which may occasion calling ‘Giri sir’ for advice. If he is not able to pick up the call, there is an automated voice note regarding immediate measures that the caller will hear. They would soon be called back and guided by him in a situation where time means everything.
In addition to raising awareness among the people, Dr Giri is also involved in training doctors in health centres on identifying the snake and treating envenomation. However, it must change from being a personal mission to a sarkari one. It is baffling to think that such a life-and-death emergency that kills so many people is not prioritised by the health department.
It is because of this that when Dr Saurabh Jha, a UPenn radiologist on a sabbatical and hosted by Ashoka University, and I met to work out a possible collaboration, a play co-written on this issue seemed like the most interesting idea. Saurabh is no stranger to writing about medicine from a social and political eye. His essay on the Hadiza Bawa-Garba case was a commentary on the glaring insufficiencies in the healthcare infrastructure in the UK. Another essay on the Alfie Evans case had addressed moral dilemma.
On June 14, 2024, in my riverside village of Kathalmuri Ghat where I grew up for seven years, 55-year-old Rajani Das approached a chicken coop near the hay shed in the front yard of his home to collect eggs. He wasn’t carrying his torch. As Rajani extended his hand, a cobra bit him. A car was brought, and he was taken to the community health centre at Pathsala, about 20 km away. There are different versions that emerged later. It is understood that the doctors took time to ascertain that he had been envenomed. What transpired later has conflicting stories. But the end of the story is that yet another man lost his life, a loss that was clearly preventable.
The ‘Doctor’s Trilemma’, the play we wrote, had this incident as the starting point. Within the limitations of a short play, we tried to capture the emotional turmoil of a young doctor – probably slightly naive but fully well-intentioned – unsupported by an ailing infrastructure. There is a compounder who has seen it all – experienced, hardened, unmoved but not derelict. And then there is a crowd, appealing, hopeful, frustrated, enraged and hopeless. The conversations show us the failings of a machinery and the apathy of those with the key to it.
There were many interesting conversations that took place during the rehearsals. The Green Room (a students’ theatre society) director and actors lived the play and made it their own. This meant that they studied the region, its people and the issue of snakebites. They arranged and wore relevant costume, including the tourniquet which was a gamocha, an ethnic Assamese towel available in every household of the state.
Before the doors to the auditorium opened, I called Dr Giri, introduced myself and the play, and asked him how things will change for the better. He suggested that the biggest and most immediate step would be to train all doctors on emergency duty to be clued up about treating snakebites. It could be a gynaecologist or a paediatrician. He spoke about how immediate care is important not just for the patient, but for the distressed family members as well.
Once the curtain fell, I called him again. I heard a voicemail message explaining what to do immediately as the snake has bitten. I knew he would soon call back.
Jyotirmoy Talukdar is a senior writing fellow at the Centre for Writing and Communication, Ashoka University.
