Providing Antivenom Treatment Access to All Brazilian Amazon Indigenous Areas: ‘Every Life has Equal Value’

Abstract

Snakebites are more frequent in the Brazilian Amazon than in other parts of Brazil, representing a high cost for the health system since antivenoms are only available through medical prescription from central municipal hospitals in most cases. The need for a cold chain and physicians usually restricts access to the only effective treatment of a snakebite, the antivenom. The complex topography of the rivers contributes to delays in treatment, and consequently increases the risk of severe complications, chronic sequelae and death. Thus, decentralization of antivenom treatment to primary healthcare facilities in the interior would increase access by indigenous population groups to proper healthcare. To standardize and evaluate the decentralization to low complexity indigenous healthcare units, we suggest the (i) development and validation of standardized operational procedures, (ii) training of professionals in the validated protocol in a referral health unit, (iii) implementation of the protocol in an indigenous healthcare unit, (iv) assessment of perceptions towards and acceptability of the protocol, and (v) estimation of the impact of the protocol’s implementation. We expect that antivenom decentralization would shorten the time between diagnosis and treatment and, as such, improve the prognosis of snakebites. As health cosmology among indigenous populations has an important role in maintaining their way of life, the introduction of a new therapeutic strategy to their customs must take into account the beliefs of these peoples. Thus, antivenom administration would be inserted as a crucial therapeutic tool in a world of diverse social, natural and supernatural representations. The information presented here also serves as a basis to advocate for support and promotion of health policy initiatives focused on evidence-based care in snakebite management.

Crotalus Durissus Ruruima: Current Knowledge on Natural History, Medical Importance, and Clinical Toxinology

“…In the Amazon, the distribution of the snakebite burden is disproportional among indigenous and non-Amerindian populations. In the state of Amazonas, the prevalence is 7.5 times higher among Amerindians ( 114 ). Indigenous people’s way of life, and their daily subsistence activities, involve daily interaction with snakes, without personal protective equipment, thus increasing the risk of snakebites ( 114 ).…”

“…In the state of Amazonas, the prevalence is 7.5 times higher among Amerindians ( 114 ). Indigenous people’s way of life, and their daily subsistence activities, involve daily interaction with snakes, without personal protective equipment, thus increasing the risk of snakebites ( 114 ). Regarding the area of occurrence, 93.0% were reported in rural areas; 24.3% of the snakebites were related to work activities.…”

“…Amerindian ethnicity was also independently associated with the risk of severity, it is necessary to consider the main challenges with cultural, social, and economic disparities between Amerindians and non-Amerindians to understand this association. Firstly, Amerindian villages have their own and very verticalized health system, presenting a low performance in treating snakebites resulting in a higher frequency of long-term disabilities and deaths in these groups ( 114 ). Moreover, traditional therapeutic practices within the community involving healers such as shamans, those with knowledge of medicinal plants, and animal-based medicines are often provided in the villages ( 152 ).…”

“…Moreover, traditional therapeutic practices within the community involving healers such as shamans, those with knowledge of medicinal plants, and animal-based medicines are often provided in the villages ( 152 ). This has a consequence in the time to medical assistance, and the use of deleterious procedures is not discarded ( 114 ). Bites in lower limbs were independently associated with milder envenomings.…”

“…The need for a cold chain and physicians to prescribe antivenoms usually restricts access to effective snakebite treatment ( 161 ). However, as presented above, C. d. ruruima envenomings are reported mostly in Amerindian populations, and it is necessary to consider challenges related to cultural, social, and economic disparities between Western and indigenous cultures, contributing to late medical care among the latter ( 114 ). In Roraima, some Yanomami sanitary districts have antivenom available for mild to moderate snakebite cases ( 162 ), but in the other indigenous groups, referral to urban areas is needed.…”