Life in the Democratic Republic of Congo (DRC) is often defined by invisible power with little sympathy for the country’s citizens. Poor living conditions rarely change as elections are determined by a corrupted system of rule emanating from the capital, Kinshasa. Mass displacements occur at the hands of multiple armed groups, while the Ebola virus threatens to ravage and further isolate some of the world’s most vulnerable populations.
Behind this push and pull of the chaos caused by these illusory factors, a rarely glimpsed but ever-present threat exists on the periphery of everyday life in Congo.
The World Health Organisation (WHO) reports that globally between 81,000 and 138,000 deaths are caused yearly by snake bites and envenomation. With the habitats of the deadliest venomous snakes often overlapping with the tropical and subtropical climate of the global south, the issue overwhelmingly affects less privileged, rural populations who lack access to adequate health infrastructure.
In Africa, snakebites have been noted as a neglected health crisis by the WHO and Doctors without Borders (MSF). A bite from a viper, cobra or mamba can kill in a matter of hours, or leave a victim suffering life-changing injury. Common symptoms include tissue necrosis, intense pain and nausea; beyond symptomatic treatments, specialized antidotes are needed to counteract the venom.
The DRC, with its vast swaths of equatorial forest, rural populace and extensive reptile biodiversity, is a prime case study for this crisis. The forests that provide the perfect habitat for vipers, mambas and cobras are as inaccessible as they are biodiverse, with the thick bush making timely medical intervention a remote possibility.
The view from Kinshasa
"The river is the gateway to finding many of them,” says François Nsingi, a technical assistant with the University of Kinshasa’s Center for Anti-Venom, as he inspects plastic boxes that hold specimens of DRC’s venomous snakes. The Congo River and its tributaries are a key habitat for them, he says, with snakes hunting for fish and birds along the banks.
Nsingi was trained by Marcel Collet, a Belgian herpetologist, and keeps snakes for use in Congo’s struggling anti-venom program — a severely underfunded entity. He says that around Kinshasa, snakes are rare, but heading down to the waters of the Congo and deeper into the bush, the interaction between snake and human is common and fraught with issues. Death after a bite isn’t a sure thing, but Nsingi says that without knowledge of basic treatments, people can pass easily: “They panic and scream rather than calming down, finding water and anti-fever medicines.”
In his collection, a visitor can see the snakes endemic to the Congo River basin: tiny Atheris bush vipers in colorful shades; the unsettling bulk of an African puff adder (Bitis arietans), responsible for a large percentage of bites across Africa; and a forest cobra, which watches Nsingi’s movements warily with its distinctive hood flared.
“We have all the species and resources” for the local production of anti-venom, he says, which could help tackle the issue of envenomation and save lives. Congo’s snakes could certainly be a vital medical resource in a blue-sky scenario of advancement and lifesaving achievement. Other nations with similar concentrations of venomous animals, such as Mexico, India and Costa Rica, have moved to the forefront of venom research and antidote production.
Standing in the way of anti-venom production is the failure of Congo’s state infrastructure. Ministries, public employees and civil servants all face financial shortfalls and late or unpaid wages.
In the office of the anti-venom center, Sophie Bokuta, the secretary of operations, explains the reality of local scientific work: “At this time we don’t have the money to produce serums or to distribute them around the country … we are researching some international funds to get work back ahead and raise the Congo office up.”
International collaboration is key to combating snakebite mortality. The slim quantity of anti-venom available in Kinshasa is imported from Mexico. “We don’t have a lab for our own deep work and testing, so we use opportunities for research trips,” Bokuta says. “[We also] take samples of our resources and send them abroad to have them analyzed.”
The center hasn’t received its funding for 2019, so Nsingi now keeps the collected snakes at his home. He also earns a side income catching stray vipers in embassy gardens and displaying them for the occasional tourist. He raises them in his family home with a doting care few others in Congo have. “Most people see snakes and think they are evil or demons,” he says of perceptions about the reptiles. “We need to spread information about snake behavior and how to act if you come into contact.”
‘Snakes every day’: Into the equatorial forests
Mbandaka, 580 kilometers (360 miles) upstream from Kinshasa in Équateur province, is a busy trading port. The shouts of traders plying items brought in from the forests are drowned out by the loud staccato of the ramshackle engines on the boats that carry goods downstream to the urban markets of the capital.
Away from the dockside hustle, the land quickly gives way to DRC’s vast jungles, sublimely hushed and peaceful after the bartering and backfiring outboard motors of the town. Here, the winding rivers and dense forests that sustain rural livelihoods are key locations to witness the lifestyles that bring the most risk of snakebite mortality and to see the depth of the challenge in creating an anti-venom distribution system.
The still calm of the Ruki River, a tributary of the Congo that leads to Salonga National Park, is broken by shouting from the fishermen in several of the canoes that thread a path along the river; they gesture up toward the huge tree canopy overhanging the banks.
A mamba has been spotted too close for comfort to the riverside village of Eala; perfectly camouflaged among the thick trees, it’s a few meters away from hanging directly above the apprehensive inhabitants.
The mamba is dislodged by a fisherman using a broken branch. Its graceful body loses grip and the snake drops awkwardly into the water, where fisherman Patrick Atelo impales it with a ndongo, a spear with multiple small prongs for catching fish.
Atelo has fished the river for years. “We meet snakes every day, crossing the river,” he says, adding that they mostly aren’t aggressive toward people. “They don’t attack unless they feel in danger … you get bitten by accident if you step on his tail [or you find] them in your nets.” The mamba writhes and attempts to reach the men with its open mouth, its anguished hisses audible even over the cacophony of euphoric shouts from the canoes. It dies, unable to land a strike.
Unless threatened, the snake killed by Atelo would have posed little threat to his village, as Congo is home to the mottled-green Jameson’s mamba (Dendroaspis jamesoni), a species that lacks the notorious aggression of the black mamba (Dendroaspis polylepis) of East Africa.
However, with a highly neurotoxic venom that can kill in three hours unless three to four bottles of expensive anti-venom can be administered (costly and inaccessible to most even in Kinshasa, and completely unattainable in the equatorial bush), this mamba, and the countless other snakes encountered daily, pose an outsized risk to fishing communities. A single bite could have life-altering consequences for an entire family if a death threatens to reduce total income and daily work.
With the mamba dispatched from its perch, the village returns to work. Even with a slight wind across the river, the close humidity and quiet of the equatorial environment lends the activities of the day a hypnotic feel. Seeing the perfectly camouflaged snakes of Congo in branches or bushes requires a sharp eye and high state of alertness, and, with much work in rural provinces consisting of intensive labor such as fishing and farming, an individual whose attentions are elsewhere, sluggish in the heat, is at high risk of accidentally encountering a snake.
Daily life in an envenomation hotspot
“The first time I was bitten by a snake, I had great pains which climbed to my heart,” says Monique Dongo in the garden of her home in Mbandaka. “The poison affected my whole body, I could barely remember who I was.” Dongo owns farmland and was bitten while inspecting her property — a reminder that this health issue doesn’t just target the poor. Living in snake habitats puts those from all walks of life at risk.
Dongo lived through her experience with envenomation but relates a more somber story: After fishing in the river, her brother’s young son began to vomit and faint, passing away a few hours later. “He didn’t even notice the bite,” Dongo says of his mystery symptoms. “When we checked his legs we saw two marks from the snake teeth.” For an outsider, the beauty and peace of the forests in Équateur province is overwhelming, but for lifelong inhabitants, a walk in the bush is the daily commute to work, where being on constant high alert for snakes is an unrealistic and overcautious proposition.
However, the forests of DRC are the perfect environment for snakes hunting for prey. Deeper in the bush, with trails becoming tight and barely defined, the undergrowth at head height, it’s hard to imagine spotting a puff adder underfoot, indistinguishable from the leaf litter. In the waterways and their marsh banks, a cobra may silently enter a fishing trap in search of an easy meal, only to be discovered when fishermen retrieve their unexpected catch. The dense and lush environment heavily favors the ambush tactics of snakes, and while birds, mammals and fish may be their intended prey, humans also live in synergy with the forests here, making encounters and bites inevitable.
Many families in Équateur province have similar experiences to Dongo, of bites and relatives lost to a chance encounter in the forest. For Jacques Kombongo’s family, who live closer to the fringes of the jungle, tragedy struck when his 12-year-old cousin came across a snake and believed it was a toy.
There’s no immediately visible trauma, as with a sweeping outbreak of virus or disease. Snakebites are rarely reported to health clinics, and envenomation continues this ambient “slow burn” of injuries and fatalities in rural populations.
‘This helps people to heal’: Tradition and modernity collide
If snakebites are an inevitability of daily life in rural Congo, then the health response should be accordingly substantial. But it’s not so simple. Envenomation often occurs in isolated locations, on river tributaries and overgrown bush trails. Health clinics are few and far between, so the logistics of transporting a victim for aid are difficult.
To put things in perspective, if Patrick Atelo had been bitten by the mamba lurking above Eala village, he would have needed to cross a river by canoe, walk down several bush trails to reach a main road, then find and pay for a motorcycle driver to take him to a clinic. All while suffering the rapid onset of intense symptoms.
This lack of accessibility to clinical care means that many Congolese turn to traditional medicine. When Dongo was bitten, her colleagues took her to a traditional healer. “They took a razor and made small cuts,” she says. “I don’t know the name of the medicine but it was a powder they placed [it] in my wounds.”
Blandine Yoyani is one of these healers. In her living room, she shows a handful of burnt powder. “This helps people to heal,” she says. “This treatment can also be given before they are bitten, to immunize from snakebites.” Traditional remedies are a complex terrain to critique, as many of the residents of Équateur swear by their effectiveness. Perhaps justifiably, given the poor access to health care and the fact that clinics in most of DRC lack any specialized anti-venoms, care of any sort is to be appreciated.
However, many of these remedies, such as making cuts, and constricting the wound, can be harmful and differ wildly from best practices. Yoyani’s motives are perhaps more transparent when talking about her business of selling cures in the bush: “In the villages I treat many people, I make a lot of money by the time I travel back to the city.”
Local clinicians are aware of the missing medical services in this space.
Anuarite Nyaboleka, a doctor at the University of Mbandaka clinic, says people believe in the traditional remedies and prefer them to hospital care. Theoretically, if the correct antidotes were available, lives could be saved, especially in isolated locations such as Bikoro, a town where Nyaboleka was previously posted, 120 kilometers (74 miles) from Mbandaka, where snakebite injuries and mortality are high.
But the impression of snakebites as an inevitable part of rural life remains a factor, with most of the DRC facing larger and more visible health issues that require funding; Nyaboleka says most of her time is spent treating typhoid and malaria, leaving envenomation as a low priority.
Mobilizing against crisis
The WHO compound in Mbandaka has been quiet for several months. After the end of a rapid outbreak of Ebola in early 2018, the local team, headed by Guy Kalambayi, has settled back into dealing with the conventional health issues affecting Équateur province.
“It was the first time we had [a] crisis in this area,” the doctor says of the viral infection. “Organizations released resources and finances very quickly to mobilize against the disease.”
The swift handling of the Ebola outbreak in Mbandaka was a relative success in dealing with a tropical health crisis. Twenty-nine people died, but the region avoided the tragic mass casualties of the 2014 West African outbreak and the current outbreak in Congo’s eastern provinces.
“Our good support removed most challenges,” Kalambayi says. “We could store the medicine in good conditions, we had transport and logistics all available.”
Functional infrastructure and logistics to deal with specific health issues can be created, even in disconnected rural Congo. The role of the populace itself is also crucial, Kalambayi says: “The population quickly understood how to behave during the Ebola crisis. They respected the rules … and accepted the treatments.” With successful campaigns informing semi-connected populations, knowledge of best practices was spread along with vaccines and care.
However, this successful blueprint for dealing with a tropical health crisis can’t simply be adapted for envenomation. “We don’t have any data on snakebites,” Kalambayi says, noting that the tough forested terrain and sparse populations mean snakebites are rarely recorded and statistics are unreliable. Without data, he says “we can’t submit a request for any anti-venom or medicine. If we had facts … then we could resolve the situation.”