“At the hospital they do not treat venom from snakebites”: A qualitative assessment of health seeking perspectives and experiences among snakebite victims in Rwanda

Uniting behind a common goal: Collaboration between traditional healers and allopathic health care workers to improve rural snakebite care

“…From a geographical point of view, THs are on average more readily accessible than health facilities. Their relative proximity is best reflected by the fact that 37% of all patients who consulted THs in a Rwandan study reported that the TH came to their home following the bite ( Schurer et al, 2022 ). A community survey in Sri Lanka found seeking allopathic healthcare was associated with travelling longer distances than receiving aid from THs ( Ediriweera et al, 2017 ).…”

“…It is important to acknowledge, however, that consulting THs and hospitals are not independent pathways to care-seeking, but that both care modalities can be sought after one another ( Ediriweera et al, 2017 ; Steinhorst et al, 2021 ). In judging the available data, it must therefore be borne in mind that THs are frequently blamed for the delayed presentation of snakebite patients to allopathic health facilities ( Schioldann et al, 2018 ; Alcoba et al, 2020 ; Schurer et al, 2022 ; Sloan et al, 2007 ; Wood et al, 2009 ). Regardless of the sequence of care-seeking, the data shows that many patients can in fact reach THs within the ‘golden’ first hours following their injury-a critical time period in which life-saving interventions can effectively be instituted ( Quick et al, 2014 ).…”

“…Hospital-based healthcare can be immensely expensive, relative to the financial means of snakebite patients, particularly if antivenom, surgery and prolonged admission is necessary ( Brown, 2012 ; Kasturiratne et al, 2017 ; Magalhães et al, 2020 ). Meanwhile, healers are often said to charge little to nothing and offer alternative methods of payment, such as paying in kind or in labor, that are favorable to patients ( Schioldann et al, 2018 ; Chuat et al, 2021 ; Steinhorst et al, 2021 ; Schurer et al, 2022 ). Even if patients prefer hospital-over traditional care, the costs remain a decisive variable in the care-seeking decision process.…”

“…Qualitative research has identified that the alignment of THs with the beliefs, traditions and cultural and social values that prevail in the societies to whom they cater is a major determinant of health seeking behavior ( Schioldann et al, 2018 ; Steinhorst et al, 2021 ; Krah et al, 2018 ; White, 2015 ). In many of the societies where snakebite envenoming is endemic, the occurrence of a snakebite is fraught with mystical-spiritual connotations ( Schioldann et al, 2018 ; Chuat et al, 2021 ; Steinhorst et al, 2021 ; Arias-Rodríguez and Gutiérrez, 2020 ; Schurer et al, 2022 ; Owuor et al, 2005 ). As a result, snakebite envenoming is frequently not perceived as a purely biomedical phenomenon, meaning spiritual interpretations often weigh heavily on the treatment-seeking process.…”

“…This is particularly relevant in the setting of snakebite envenoming, in which patients often struggle to afford prolonged hospital admissions ( Schioldann et al, 2018 ; Harrison et al, 2009 ; Steinhorst et al, 2021 ; Arias-Rodríguez and Gutiérrez, 2020 ; Brown, 2012 ) and in which long-term follow-up, especially with regard to disability and morbidity, is notoriously challenging ( Aglanu et al, 2022 ; Brenes-Chacon et al, 2020 ; Jayawardana et al, 2016 ; Kasturiratne et al, 2021 ). Many patients and THs see promise in therapies offered at the hospital, most notably antivenom ( Chuat et al, 2021 ; Vaiyapuri et al, 2013 ; Steinhorst et al, 2021 ; Schurer et al, 2022 ). Strengthening collaborations with THs could spur a larger proportion of patients to seek care at the hospital for urgent and life-saving measures, while possibly relying on the less costly services of THs during their recuperation period.…”