A Bureau of Investigative Journalism (London) dispatch by Paul Eccles, Andjela Milivojevic and Rachel Schraer, with additional reporting by Shafa’atu Suleiman and Laura Margottini

HE was reaching for the lamp, the last moments Kamidikolo had use of both of his arms. He had been trying to see what had caused rats to come running into his home when he was bitten.

By the time Kamidikolo made it to hospital, snake venom had already started breaking down his skin and muscle. The flesh around the bite was necrotising – dying. The process gives off a smell like rotting meat. The only treatment that could hold off the damage was snake antivenom.

Kamidikolo (60), a handyman from the south of Uganda, was given a vial of this treatment, but it couldn’t stop the trail of destruction the venom had begun to chart through his body.

In sub-Saharan Africa, the Bureau of Investigative Journalism (www.tbij.com) can reveal, patients face a “wild west” of ineffective antivenoms that are badly made, badly marketed and badly regulated. Some are about as useful as injecting water, experts said.

TBIJ tested samples of antivenoms bought in three countries, and found that some could require more than 70 vials to effectively treat some bites.

Antivenoms are often in very short supply; most facilities do not stock enough and patients could not afford – or receive – that many vials in time for it to work.

One antivenom company has been accused of fraudulent research. Another business exported an antivenom for Indian snakes to West Africa, where they knew that it would not work – an act experts called unethical and criminal.

Antivenoms are “antique” medicines that have been made the same way for more than a century: by injecting horses and sheep with snake venom and extracting antibodies from their blood. (Antibodies are produced by the immune system to fight off viruses, toxins and other dangers.)

This antique origin is one of the reasons antivenoms have avoided the regulations that now apply to many other drugs. Despite being a life or death medicine, they are not held to the same standards as paracetamol: there are no requirements for antivenoms to go through clinical trials to prove that they are safe and effective in humans.

“It’s a cowboy show out there,” said Thea Litschka-Koen, a leading snakebite expert in Eswatini previously known as Swaziland, adding: “Some of them are selling stuff that, honestly, you may as well just pour down the drain.”

 A hidden crisis

 The damage a snake bite does depends on the snake. If it’s a venomous snake, it can cause life-changing injuries – or even death.

“You get horrific wounds. And when I say horrific, I will send you pictures that make your eyes water,” said Litschka-Koen, who founded the Eswatini Antivenom Foundation. This is a charity that raises funds to treat snake bite victims.

Some snakes, like the one that bit Kamidikolo, have “cytotoxic” venom, meaning that it damages and eventually kills cells.

People who’ve survived these bites say that it feels like being injected with burning acid. A cytotoxic bite wound can cover an entire arm and chest, or a whole leg, and take almost a year to heal, Litschka-Koen said.

Other snakes, such as the West African carpet viper, stop blood from clotting and cause excessive bleeding. And then there are snakes like the infamous black mamba, whose neurotoxic venom strangles nerve signals from the brain. Victims feel their bodies shut down in paralysis.

Just how many people are affected by snake bites is a bit of a mystery. It’s a problem that often goes unrecorded. The World Health Organisation (WHO) says 5.4 million people are bitten each year. Estimates on deaths around the world range from 80,000 to 140,000. But who is most affected is clear.

“It’s a poor man’s disease. That’s the cruel truth of snakebite,” Litschka-Koen said, adding: “Those who are bitten typically live in remote, often rural, areas, mostly concentrated in south Asia and Africa. Farmers and children are among those most commonly bitten.

Including Kamidikolo, TBIJ examined seven cases where snakebite victims were left badly injured despite getting treatment. Two didn’t survive. While death is the ultimate risk, three times as many people survive and are left with permanent disabilities.

Months on, Kamidikolo still doesn’t have full use of his arm and relies on painkillers and sleeping pills. It means that the father of five children under the age of ten, who makes a living from odd jobs – fixing, building, digging – cannot work. He can no longer afford to send his young children to school.

This is a common story; Litschka-Koen has seen everyone from a respected elder to an 18-month-old girl robbed of limbs, cast off by communities, and consigned to poverty.

“Snakebite has devastating economic consequences on the individual, the family as well as the entire country,” said Litschka-Koen.

The best way to prevent these consequences is quick treatment with antivenom. With an effective dose, properly administered, chances of survival can be six times higher.

However, for people like Kamidikolo, local herbalists are often much easier to reach than conventional medical care. Even those in major urban centres may face difficulties – snakebite has little to no place on the curriculum at many African medical schools.

In wealthy countries like Australia, where antivenom is high quality and free to patients, snakebite causes just one to two deaths per year.

In many African countries, though, effective treatment has been plagued by issues for years – with 20,000 people having died from snakebites in sub-Saharan Africa in 2023. 

“We need to get a handle on it. It’s shocking that it’s taking so long. You can’t look away from the cruelty and pain and suffering,” said Litschka-Koen.

• Full report in tomorrow’s issue of The Guardian.