Page 117 - Journal of Special Operations Medicine - Fall 2014

but protecting care providers from exposure to HIV via manufacturers that produce a reliable antivenin that is
contact with blood or bodily fluids is tantamount while effective against African species of snakes. The World
delivering care to host nation persons. Postexposure Health Organization provides a searchable database of
prophylaxis (PEP) is time sensitive and, in the event of antivenin suppliers. When available, antivenin has its
12
an exposure, must be readily available. The strains of own inherent clinical risks and adverse effects and can
HIV endemic to Africa are often resistant to typical an- be dangerous if administered to patients by clinicians
tiviral regimens used in the United States. Ready access who lack proper training or are without specific medical
to effective (PEP) medications and contingencies for ap- resources to support care of the envenomated patient.
propriate testing need to be part of medical planning. 9,10

Quest for Resources
Animal Threats
Finding appropriate medical resources is a ubiquitous
Animal contact poses substantial risk as well. In addition challenge that does not apply only to the care of snake-
to the direct threat of venomous snakes, spiders, and scor- bites. Medical resources in Africa are extremely lim-
pions and attacks by predators, animals harbor diseases ited. Many facilities earnestly strive to achieve Western
such as rabies, leptospirosis, plague, and anthrax. Africa standards of healthcare but fall short due to the con-
has the highest rates of anthrax in the world, reaching straints of scarce supplies and shortages of experienced
hyperendemic/epidemic outbreak rates. It is interesting and trained personnel. Underdeveloped and often un-
11
to note that the hippopotamus is one of the main carriers reliable infrastructure makes rendering care at Western
of anthrax, in addition to the usual livestock harboring standards an elusive goal, even for American providers.
the disease. While minimizing contact with animals is It is critical to thoroughly assess and exercise access,
part of routine practice, these disease risks must also be functionality, on-site security, and regress/evacuation
considered when conducting veterinary events and inter- from healthcare facilities within an area of operation.
acting with host-nation locals. Even slaughtered animals Cash payment is often the norm, and payment methods
pose hazards for disease transmission. should be negotiated with administrators in advance
of using facilities and resources. Discerning and under-
Snakes are a singular distinct menace. While laughable standing the underlying political and social affiliations
in most parts of America, ophidiophobia (fear of snakes) of the hospital and its leadership are essential to ensur-
is neither hypothetical nor irrational in Africa. Some of ing access to and collaboration with supporting facilities
the most lethal snakes reside in Africa, including mam- or other medical entities.
bas, cobras, and various vipers. While some snakes, such
as the boomslang, tend to avoid humans, others, like the Complementary and competing interests of medical
spitting cobra, can be very aggressive. Access to defini- personnel and organizations must be factored into as-
tive medical care is essential in treating snakebites, and sessing the dynamics of these healthcare environments.
long evacuation times and distances can be deleterious Open dialogue and case reviews between health care
and potentially fatal for an envenomated patient. Anti- professionals can help build a repository of experien-
venin is in scarce supply. There are only a few reputable tial knowledge and resources that could otherwise prove

This Is Africa: An Introduction to Medical Operations on the African Continent 109