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David Warrell

David Warrell David Warrell
14 Jun
2015
David Warrell is a professor and International Director of the Royal College of Physicians and Tropical Medicine. A long-standing member of the RGS-IBG medical cell, he co-edited the Oxford Handbook of Expedition and Wilderness Medicine

I became interested in expedition medicine when I was personally involved in a student expedition to Lake Chad, an activity that would now be impossible due to Boko Haram. I was involved in a student project from Oxford University to look at the prevalence of Bilharzia in agricultural workers.

Snakebite has been a very great interest of mine since the 1970s. I was working in northern Nigeria. I was working on bites by the most important species there, the saw-scaled viper.

Primarily, I went there to research meningitis, which is an annually occurring event in the dry, cold season in the whole meningitis belt. As part of my work as a hospital physician and teacher I came across numerous cases of snakebite and was appalled to find so little was known about the species of snakes responsible, and also that there was a lack of specific treatment.

The problem with snakebite is that it stimulates very little interest in the UK where we have one venomous species and relatively few bites. But it is a major cause of rural deaths in places like India and the Sahel region of Africa.

After Nigeria I expanded my interest toThailand and began my engagement with Myanmar. I also worked in Sri Lanka as a substitute because India was difficult to get into for bureaucratic reasons. Then, more recently, I worked in Latin America, Brazil, Ecuador, and Peru.

There’s a lack of well-designed community-based studies on snakebite worldwide. One a couple of years ago was originally designed to examine the impact of tobacco on the Indian population. The researchers designed a scrupulous, random study in areas with populations of about 1,000. The cause of death was determined through verbal autopsy where you contact friends and neighbours of the certified dead. This can be a sensitive issue and difficult when dealing with a disease like malaria, but snakebite is more melodramatic and is more likely to be remembered.

The India study showed, to enormous surprise, that 50,000 people died in the country from snakebite in 2005. Snakebite accounted for 0.5 per cent of all deaths among children.

Snakebite is often an agricultural disease confined in rural populations, usually farmers, herders and plantation workers. A second common theme is that it achieves its peak influence during or after the annual rains, which is to do with changes in the snake’s activities.

Most bites are inflicted on legs and ankles. Footwear is an obvious solution, but if you’re a rice farmer and wear boots into the flooded rice field, they are likely to be sucked off your feet as soon as you take a step.

Educating communities about the risk related to different habitats is important, but behaviour is also a factor in the instance of snakebite, for example, walking home after rain, or having some light after dark. It sounds elementary, but carrying a light makes a real difference and it’s now possible with access to lower cost batteries.

If you sleep under an insecticide mosquito net it also has a proven nocturnal protection against kraits in Asia and spitting cobras in Africa. There must also be an emphasis on local education. Patients must not follow the tradition of going to the local herbalist or witch doctor, and should be taken to somewhere where they can receive Western-style healthcare.

At the moment I’m in Myanmar. We’re collaborating with local physicians to develop a programme of post-graduate education for local doctors to pass UK examinations, and also develop speciality training in their chosen field. This will involve inviting doctors to the UK for two years of training in an NHS hospital.

The difference between an expedition and a journey is that an expedition is planned. Taking accumulated wisdom from institutes like the RGS–IBG and events like Explore 2014 makes for a richer experience.

The whole concept of the expedition arises out of the recognition of a challenge, such as collecting meteorological data. The notion of an expedition might make it tempting to do it in the style of the 19th century dilettantes and just rush off, but these days it is incumbent upon an expedition to find out as much as it can beforehand to minimise any risk.

 

CV

1939 Born in Singapore

1974-1975 Lecturer and Consultant Physician, Royal Postgraduate Medical School London

1987-1993 Chairman of the AIDS Therapetic Trials Committees

1994 Appointed Honorary medical advisor to the RGS-IBG

2004 Companion of the Order of the White Elephant

2011 Published Venonous Bites by Non-Venomous Snakes

2014 Co-edits Oxford Handbook of Expedition and Wilderness Medicine (3rd Edition)

This article was published in the June 2015 edition of Geographical Magazine

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