1. Snake bites NAV JIVAN HOSPITAL TUMBAGARA, SATBARWA POST PALAMU DISTRICT, JHARKHAND

2. Where are we . . .

3. How to reach NJH . . . • From Kolkota: 12 hours by train to DTO • From Ranchi: 4 hours by road: 135 kilometers • From Delhi: 12 hours by trains to DTO – rajdhani/garib rath • Nearest rail-head: Daltonganj (DTO): 35 kilometers

4. HOW BUSY WE ARE . . .

5. Snake Bites . . .

6. 2012 (Jan-Dec) – Alleged snake

7. SYNDROMES

8. Snakes brought . . . • 5 (out of 127) • 4 alive ? ? ?

9. Mechanical Ventilation

10. Haemodialysis • All bites with deranged whole blood clotting time. • Nearest dialysis centre – 135 kms away • Transport facilities – safe only in daytime • Extreme poverty

11. 4 deaths

12. Facilities we have . . . • Can do only clotting time. • Anaesthesia ventilator • No blood bank. But if donor is available, we have facilities to bleed the donor and donate it immediately.

13. When do we refer . . . • We give all patients an option to go to higher centre. • 135 kms away • Poor road and transportation facilities • Patients on respiratory arrest . . . No choice • Viper bites . . . All efforts to refer

14. Issues of concern – unknown bites