I have been practising medicine in an under-served rural setting since 1976, and have published around 109 papers in PubMed-indexed journals — including The Lancet, BMJ, NEJM and several tropical medicine journals — on scorpion and snakebite cases causing acute life-threatening conditions. I have researched in detail, with restricted resources, the acute clinical effects of envenomation and management of scorpion and snakebite cases [1, 2]. In Mahad, the fatality rate due to refractory heart failure arising from autonomic storm evoked by scorpion venom was previously 30% [3]. Since the advent of prazosin and scorpion antivenom, it has dropped to less than 1% [4]. Similarly, fatalities due to snakebite poisoning have been reduced from 18% to 5% [5].

In India, one victim of snakebite dies every five minutes. Farmers, labourers, hunters, migrant population, and snake rescuers are more prone to snakebite. Mortality due to envenomation is considerable in the rural and semi-urban population. These victims report to primary health centres and are then referred to civil hospitals or medical colleges, where newly posted and resident doctors have not seen and treated snakebite before [4]. I took on the training of doctors in peripheral institutions by arranging a meeting at each tehsil, all over the Konkan region and surprisingly enough, the fatality rate due to stings and bites was reduced [5]. Early administration of antivenom arrests the progression of snake venom toxicity [6, 7].

Delay in diagnosis of snakebite contributes to fatalities, because of poor knowledge regarding diagnosis, use and dosage of antivenom and the role of adjuvants like acetylcholinesterase inhibitors, calcium gluconate, tranexamic acid, indications regarding the use of ventilators including BiPAP, in the treatment of snakebite. Nowadays, a few read medical journals with authentic information, because of easily available superficial information on Google and the internet which is available with one click. The majority of students and medical faculty are happy to be Googleites. This results in irrational, non–protocol management.

I have often received phone calls late at night requesting help in the diagnosis and management dose of antivenom and prazosin to treat envenomation. Considering this urgent need of doctors in peripheral hospitals, I prepared PowerPoint presentations including case studies and arranged talks at my own expense on weekends at rural locations in the region, and there was a remarkable reduction in fatalities due to stings and bites, and no phone calls from the nearby areas during the night hours.

Unfortunately, undergraduate medical curricula do not include scorpion sting and snakebite and scant space is given to them in the medical text books. I was surprised to receive emergency calls from residents of medical colleges from places as distant as Mumbai, Pondicherry, Chennai, and Kurnool during the night hours, regarding management doses of antivenom and prazosin for stings and bites. Hence, I decided to train final year MBBS students, and residents of medical colleges on this topic.

Irrespective of their being voluntary, my attempts at training medical students were thwarted. These depressing incidents demoralised me and killed my desire to share a scientific approach to the management of life-threatening snakebites and scorpion stings. Even the publication of my chapter on scorpion and snakebite was held up for three years, as the editor was more interested in a foreign author who has never seen and treated scorpion sting cases! Scorpion and snakebite accidents are frequently faced by farmers and labourers, so I decided to focus on lectures at rural medical colleges, especially to final year medical students, interns, and residents, with no obligation for teachers to attend.

The results are seen in the following two experiences:

• In 2010, I approached my classmate, the director of medical education and research (DMER), to arrange my talk at one of the first rural medical colleges established in the state. On reaching there in time, I asked for the Professor and Head of department and found he had apparently cancelled my talk since I had approached the DMER instead of contacting him. He felt that I had tried a backdoor entry. That was a big disappointment.

• Again in June 2022, my friend — the DMER — contacted the Dean of a medical college, who refused to arrange a talk, on the trivial ground that there was no good hall at the medical college. After repeated appeals, the Dean finally agreed and arranged a lecture at the medical college, which was attended by almost a hundred students and faculty members, who gave me a standing ovation after the detailed presentation. Surprisingly, the Dean was present and did not even offer me a glass of water after my talk. Furthermore, I had been late by 30 minutes for the talk due to the long journey, so he sent me a sarcastic message that I should “follow institutional protocol”.

Sadly, this goes to show how even over the past twelve years, there has been no improvement in the casual and egotistical attitude towards getting and sharing life-saving knowledge. Further, there is a deep-rooted prejudice in several medical colleges that no authentic medical research is done in the private sector. On the other hand, I have been invited thrice to deliver lectures to medical students at the GS Medical College and KEM Hospital, Mumbai, where the incidence of such poisonous bites is possibly rare.

Himmatrao Saluba Bawaskar ([email protected]), Bawaskar Hospital and Research Centre, Mahad, Raigad, Maharashtra, INDIA.