*Snakebite patients in northern Bengal use this border crossing to enter Nepal on their way to the Chaarali snakebite health clinic.*

Sonia Jabbar first learned of the Chaarali Snakebite Treatment centre in Nepal when an employee at the Naxalbari Tea Estate in northern West Bengal was bitten by a cobra two years ago.
With few medical facilities in Naxalbari town equipped to deal with such cases, Jabbar arranged for her employee to be taken to the North Bengal Medical College in Siliguri, approximately 30 minutes away.
“Then her husband came running and said that he did not want her treated here and would take her to a treatment centre in Chaarali. She was fine by evening,” recalled Jabbar.
Snakebites are common in the border region of Indo-Nepal skirting the states of West Bengal and Bihar, particularly during the monsoons when the rains flush out snakes leading to conflict between humans and wildlife.
The snakebite treatment center at Chaarali is well known to Indians living in neighboring towns and villages, about 15 km from the border near Naxalbari. Yes, when snakebite happens it is the ideal treatment facility for.
While the international border between the two countries, which is approximately 1,751 km long, has multiple entry points in four Indian states, in the Darjeeling district of West Bengal, Panitanki serves as the main border crossing with an integrated check post that processes the passage of freight and traveler immigration.
Patients are usually placed on a motorbike and taken across the border, crossing a bridge across the Mechi River, which acts as a natural boundary between India and Nepal. Patients suffering from snakebite and their companions do not need passports to reach Nepal. Challan is provided by Nepalese border guards at Kakarbhitta on the other side of the river, who are familiar with the frequent passage of patients from India seeking treatment in Chaarali.
“The border guards prioritize processing their entry requests over other vehicles especially when there is a lot of traffic,” explained Rajib Shaha, 23, a wildlife rehabilitator in Naxalbari who has been researching snakes in the region for four years and has also observed the treatment administered to snakebite patients in Nepal.
Snakebite requires the specific treatment administered by trained doctors and paramedics, which is not commonly available in hospitals and medical centers, making centers like the one at Chaarali indispensable for people in the region.
“The treatment for snakebites is not taught in most medical schools in India and Nepal because these schools are based in cities. So when a patient comes with snakebite, they have to refer the patient elsewhere because they don’t have the treatment,” said Dr Sanjib Kumar Sharma, Professor and Department Head of Internal Medicine, BP Koirala Institute of Health Sciences in Nepal, who has conducted extensive research on the subject for over 22 years.
There are now 84 such centers operating across Nepal, but only two of these centers are frequently visited by Indian citizens because of their proximity to the border. The second in Damak, Jhapa district, run by the Nepal Red Cross Society, is approximately 20 km from Gauriganj, a border town in Nepal, which is the entry point for travelers passing through the village of Bairia in Bihar’s Kishanganj district.

*A neglected public health issue*

In 2017, the World Health Organization recognized snakebites as a neglected tropical disease and assigned it a high priority for large scale action and research.
Research led by Ralph Ravikar published in 2019 indicates that in South Asia, including Bangladesh, India, Nepal, Pakistan and Sri Lanka collectively constitute nearly 70 per cent of snakebite mortality in the world, the region being a biodiversity hotspot for venomous snake species.
Since most snakebite-related deaths occur in rural areas, they aren’t reflected in hospital or government statistics and accurate numbers are difficult to find. However, researchers believe that these numbers are high in South Asia. According to doctors, it is a serious issue particularly in the Indo-Nepal belt.
Experts in India and Nepal believes that long distances to medical centres, a lack of access to transport, little financial resources, a lack of awareness of treatment methods and fear push the rural poor in this region to faith healers known as ‘dhami’ in Nepal and ‘ojha’ in India.
Patients are usually seen arriving at centers sandwiched between the driver and the partner carrying the patient for the length of the journey. This method of transporting patients is the most popular and is rooted in the ‘Motorcycle Volunteer Program’ founded in Damak in 2004, which saved countless lives.
The centers at Chaarali and Damak operate 24 hours a day, seven days a week, accessible even now, when Coronavirus <indianexpress.com/about/coronavirus/> has forced international border closures.

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