Disregarded poison


Photos By StoryPhotos GRACE CHEN

SOMETIME in the late 1970s, Professor Tan Nget Hong from the Department of Molecular Medicine in Universiti Malaya became one of the eight panellists to evaluate the needs of a snake farm for the production of anti-venom against the Malayan pit viper, the Malayan cobra and the local species of sea snakes.

It was an exciting time for the panel members, one of whom would be Professor Stephen Ambu, formerly of the Institute of Medical Research (IMR), the goverment organisation which spearheaded the project.

“The Government’s initiative to embark on the snake farm project was to achieve self-sufficiency in snake anti-venom production. At that time, the Queen Saovabha Memorial Institute in Thailand (currently a main exporter of snake anti-venom to Malaysia) had not established itself yet.

“The polyvalent from India, which we were importing at that time, had been proven ineffective. The only reliable source of anti-venom we had then was from Commonwealth Serum Laboratories in Australia but at a cost of US$1,000 per vial, it was too expensive,” recalled Prof Tan, who has been researching snake venom properties and the behaviour of its protein enzymes since 1977.

Though he observed the mortality rate of snakebites in Malaysia was only 0.3% per 100,000 of the population, the effects were terrible to see. Not only were victims horribly scarred but left with crippling deformities.

When the snake farm opened at its current site — the Bukit Ayer Recreation Park, in Kangar, Perlis — in March 1981, it was hailed as a milestone for IMR. With help from the Kangar General Hospital, a rapid diagnostic kit for snakebites was developed. But by 1990, the IMR was forced to cease production of anti-venom at the snake farm.

“There was no money in it,” explained Tan on the reason for the closure.

Crunching the figures that had gone into the venture, Prof Tan reckons the attempt on snake anti-venom production had cost the Government a few million ringgit a year, considered an enormous sum then.

The cost, he explained, was not in setting up the farm or in the number of snakes required for production. One snake can easily yield about 100mg of venom, of which only 1mg would be injected into a horse for the production of crude plasma against snake venom.

A total of 10 snakes, milked once a day every three weeks, would provide more than enough venom for commercial production.

The major financial guzzlers lay in other aspects — maintening a horse farm, veterinarians and clean rooms for the manufacturing process.

According to Prof Tan, the centre would have needed to produce up to some 100,000 doses of anti-venom for every one of the medically important snake species a year to break even.

In Malaysia, the medically important species would include the Malayan pit viper, Malayan cobra and common sea snake (Enhydrina schistose).

But according to a study by the National Poison Centre based on data from the Health Ministry, there were only 7,881 cases of venomous snakebites admitted to government hospitals from 1999 to 2001.

For 2011, the numbers were 3,658 cases for the whole year, with Kedah recording the highest number of cases, with 836 snakebites.

And then, Prof Tan reminds that not all snakebites would necessarily deliver venom as the bite was mostly a defensive reaction.

Out of the 836 cases in Kedah, high chances are half of the victims would have no issues and of the remaining 400 or so cases, only 25% would have a real need for anti-venom treatment.

The insufficient volume of demand ultimately makes it cheaper for Malaysia to import its anti-venom.

At the moment, they are mostly imported from Thailand and price per vial may range from US$20 (RM62) to US$60 (RM186) or more.

United Italian Trading business development director Khaw Wei Ping, 34, gives an overview of the anti-venom business in Malaysia.

Her company, which distributes Australian manufactured banded sea krait anti-venom to local hospitals, imports only 100 vials in 5ml sizes throughout the year.

“If you compare the ratio of prescriptions for snake anti-venom to a mass produced drug like paracetamol, for example, you’d be looking at a ratio of 1:1,000,000.

“We understand one vial is usually kept on standby in all general hospitals. Up north in Lumut or in Sabah and Sarawak, they may stock more as the sea is close to them,” says Khaw.

But snake venom continues to fascinate.

At the Department of Emergency Medicine in the UKM Medical Centre, Dr Ahmad Khaldun Ismail, 41, may only see three venomous snakebites a year but he ensures that the pharmacy retains a par stock.

He has also formed a voluntary group in the Remote Envenomation Consultation Services (RECS), a 24-hour hotline where emergency physicians can seek advice on venomous animal bites.

Come June 4, he will be making an appearance at the Second Advanced Workshop on Marine Animal and Snake Envenomation at the Lost World of Tambun, Perak. Fees start from RM500 and some 50 participants have signed up for the talk so far.

Joining Dr Ahmad Khaldun in his cause is Tayalan Raman, 32, former Zoo Negara media relations officer and currently education officer at the petting zoo and tiger valley department of the Lost World of Tambun.

Both met in 2007 when Dr Ahmad Khaldun was investigating a snakebite case involving a picnicker who got bitten at a waterfall in Ulu Langat.

Though he plays a non-medical role in this arena, Tayalan’s mobile number is well-known among emergency physicians who rely on him to identify the species of the slithery culprits who have landed their victims at the doctor’s door.

“In their panic, some victims may not be able to identify the species so the doctors call me and I will ask specific questions like where they were bitten and what were the colour of the scales.

“From that, I can usually pinpoint the species so doctors can administer treatment,” says Tayalan.

He does not charge for his services even though he chalks up a phone bill of RM 80 every month, gleaning extra information from patients in cases when he suspects they may have been bitten by a rare and threatened species.

The data mainly goes towards conservation efforts.

Over at Monash University Malaysia, Iekhsan Othman, professor of Biochemistry and head of the Biomedical Sciences department, has embarked on researching the proteins of king cobra venom in hopes that one day, doctors would be able to heal wounds caused by antibiotic resistant infections.

To start off, the cost of extracting venom from snakes, sourced from handlers located around the country, can cost the university up to RM2,000 each time.

As for research proper, he reveals lab equipment in the university has topped the RM20mil mark, which also accommodates the inclusion of other research projects from the medical faculty.

To Prof Iekhsan, snake venom is not only good for neutralising bites.

The complex nature of the proteins found in venom also has properties for treating heart disease and hypertension.

The challenge is in identifying which enzymes are responsible, isolating them and listing them down — an exercise which requires much testing.

As for the commercial value when the results can finally be put to use, Iekshan confesses he’d rather concentrate on the integrity of the results first.

“If you think of money first, there will be a chance that people will want to skew them accordingly,” he concludes.

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