1 April will be forever etched in the memory of 55-year-old Mitzi Hazell of Inchanga as the day her neighbours and a team of doctors rallied around her to help her cheat death, after a harrowing encounter with a 2.2 metre long black mamba.
A grateful Mitzi is counting her blessings as she talks about the incident from her hospital bed in the intensive care unit at Durban’s Netcare St Augustine’s Hospital, where she is receiving treatment. She is clear about one thing: had it not been for the support of her neighbours and the expertise of seasoned trauma doctor, Dr Kevin McEwen, she would not have been around to tell her story.
“Dr McEwen’s expertise and knowledge in snake bites saved my life, as did my wonderful neighbours who made sure I got to the hospital in a remarkable nine minutes. Our home in the Inchanga Conservancy, close to Hammersdale, is about 40 kilometres away from the hospital and ordinarily the journey would have taken around 40 minutes, time I did not have,” she recalls.
It was the second time in less than a week that neighbour, Elthea Coffee, stepped in to help get Mitzi to hospital following an encounter with a Mozambican spitting cobra. The Saturday before, Mitzi came face-to-face with a spitting cobra. On that occasion Elthea took her to the local hospital to have her eyes flushed and treated to prevent blindness after the snake spat venom into her eyes.
This time around Mitzi was checking on her prized show rabbits when she came across the highly aggressive 2.2 metre long black mamba, one of the deadliest snakes in the world, which bit her on the leg. The snake had seemingly slid into the rabbit enclosure for a little shade on a hot, 35˚C day. Elthea once again loaded Mitzi in her car, this time taking her to Netcare St Augustine’s Hospital, the closest medical facility equipped to treat a life-threating, venomous snakebite.
En route to the hospital, Andre Grové, a neighbour whom Mitzi did not even know, caught up with Elthea’s vehicle and helped drag the by now paralysed Mitzi into his faster vehicle to get her to Durban quicker. In the interim, another neighbour, Michelle Schrauwen wisely contacted Netcare St Augustine’s Hospital where a team was ready and waiting to treat Mitzi.
Partial paralysis
According to Dr McEwen, Mitzi arrived at the hospital with paralysis already having set in. “Her eyes were drooping and she was having difficulty talking. She also could not walk. When the black mamba bites it injects a highly toxic, fast-acting neurotoxic poison into the body of the victim, which goes straight to the nerves, attacking the central nervous system. One of the first signs of paralysis is drooping eyes and double vision. This is followed by difficulty in speaking as the patient can no longer use the tongue to articulate words. Difficulty in breathing follows.”
Being fully prepared for Mitzi’s arrival, the medical team immediately commenced treatment. Mitzi was given five ampoules of anti-venom serum while her vitals, including blood pressure and heart rate, were constantly monitored. “She recalls nothing of what transpired during the first few hours of the treatment,” says Dr McEwan. “She does however remember hearing my name and that I constantly asked if she could speak, open her eyes and swallow, as this would be a sure sign that the paralysis was being successfully countered by the anti-venom.”
“We were not out of the woods yet. One of the greatest risks associated with the administering of high dosages of anti-venom, which was necessary in this instance, is the ensuing anaphylactic reaction. If not monitored and carefully managed this can result in a very serious allergic reaction, similar to that which would be experienced by someone who is highly allergic to bee stings. To counter this we used cortisone, adrenaline and anti-histamine while the patient was continuously monitored.”
“It was a long Friday night for the entire medical team involved in her treatment,” remembers Dr McEwan. “Intensivist and anaesthesiologist, Dr Mark Watt, took over halfway through the night, together with specialist physician, Dr Shabbir Dawood, who continued to monitor Mitzi’s progress in the hours that followed. Everyone pulled together.”
“When I checked on Mitzi on Saturday morning, her leg was very swollen and red, while her muscles were twitching quite a bit as a result of the high dosage of anti-venom we had administered. She was shivering a great deal and was quite emotional and anxious. More importantly though, is that her condition was stable and her vitals were normal. It was clear that we had turned the corner.”
By Monday Mitzi was left feeling stiff and sore while her joints were quite inflamed. She was starting to question why the black mamba ended up in the rabbit enclosure.
“There really seems to be a big snake plague in the Inchanga area at the moment and I would like to warn the public to be careful. Black mambas can be very aggressive, when encountered. My advice to the public would be to allow such snakes to move away and not confront them. The number of snakes we are seeing at the moment could be attributable to the heat and the fact that the snakes could be readying themselves for hibernation,” she cautions.
Dealing with a snakebite
According to Dr McEwan, he has treated five black mamba bites during his 23 years as a trauma doctor at Netcare St Augustine’s Hospital. All of the patients survived what is often referred to as “the kiss of death” by what is commonly considered to be one of the world’s deadliest snakes. Before the introduction of anti-venom, a bite from the black mamba would in all likelihood have been fatal, generally within as little as 20 minutes.
In terms of advice for victims of the potentially deadly black mamba bite, Dr McEwan suggests that they be taken to the nearest appropriate hospital, which is not only equipped with a substantial stock of the appropriate anti-venom but also able to support the respiratory system and handle the ensuing anaphylactic shock. He warns those who believe that they are safe from harm when armed with an ampule of anti-venom that this may not be sufficient to save a black mamba bite victim. “Furthermore, the consequences of using anti-venom without the ability to stabilise a patient experiencing a severe anaphylactic reaction can be deadly in itself,” he concludes.
To find out more about Netcare St Augustine’s Hospital, click here.