A bite in the dark

It was late one cold night when I climbed into bed, shivering in the darkness and tucked my hand, as usual under the soft pillow. In an instant, the most excruciating, burning pain I have ever felt, knifed through the side of my middle finger and up my arm. I sat up screaming, shaking and crying, as my bewildered husband sprung awake, wondering aloud what had happened and switched on the lights. Within seconds I was unable to move the swollen hand, my stomach ached and my heart started to accelerate as my head throbbed wildly and I felt faint.

More than a decade later, I consider myself lucky to be alive after he promptly dosed me with a potent antihistamine and other medication but the digit where I was attacked by a Belizean scorpion has never completely healed. Living in an isolated cottage with screened windows set in an abandoned, breezy citrus plantation on the beautiful outskirts of the inland capital Belmopan seemed idyllic, until I stumbled across a scorpion couple waltzing across the kitchen floor in the wee hours, and then on closer scrutiny a colony of the colossal creatures calmly curled up in comfort behind the cosy cupboards.

I gave up outdoor gardening for a while and took to wearing hard, protective gloves when I encountered more, plus a stunning coral snake that was none too happy at being disturbed from sunny slumber under his smooth stone. Glossy serpents would boldly slither up the back kitchen window with thirsty twitching tongues, waggling heads and glittering eyes while I washed dishes, attracted to the sound of running water.  Others comprising long, brave souls even hung optimistically outside the front door and below the clothes lines when the weather turned unbearably hot, and my surprised shrieks and sky leaps provided endless amusement for my young children.  

Despite spending thousands on treatment and consulting several specialists in different countries, the necrotized nail continues to flare up occasionally, and to fester and grow irregularly. I am thankful that I can still use my left hand fully, but the ugly discoloration and lingering infection are a constant reminder of our mere mortality, the power of pygmy predators and how everything can change in an unforgettable flash.

Sadly, earlier this month, in an unusual double case, two Guyanese died at the Georgetown Public Hospital where they were transferred from outlying health facilities after being stung by scorpions in separate incidents just a day apart. A sweet four-year old Mabaruma boy, Keishon Campbell and hardworking miner and well-known cricketer, Olwin Paton, 30, of Wakenaam, in Region Two succumbed leaving distraught families to wonder why. A post mortem-examination found that little Campbell died from anaphylactic shock, following the bite on the morning of August 5 while he was putting on long boots. Infants, the elderly and infirmed are most at risk from such a shock, caused by an acute allergic reaction to an antigen to which the body has become hypersensitive.

The child’s father, Ozell Campbell, and other family members are understandably upset and have since accused the Mabaruma Hospital of being responsible for his death as the provincial institution did not have the required medicines to treat scorpion stings. Campbell also criticised hospital officials for not acting fast enough to air dash his son to the city for needed attention, Stabroek News said.

Following the boy’s demise, in a letter to the newspapers, Amerindian activist Peter Persaud voiced his concern over the Mabaruma Hospital lacking proper medication for patients with scorpion stings and snake bites. “Can the Ministry of Public Health say why hinterland hospitals are not supplied with the drugs to treat patients bitten by scorpions and snakes some of which are poisonous?” Persaud questioned, with no response forthcoming.

But Paton as an adult also suffered terribly. He was reportedly stung on his foot while mining at Aranka Backdam, in the North West District and because the area is remote it was difficult to transport him out immediately to the nearest hospital at Suddie. He would pass away a full three days later with the official cause being ruled as poisoning from a venomous substance, although a relative expressed the family’s unexplained suspicions about his sudden death. Unfortunately many of the scorpions found in Central America, South America, and the Caribbean are dangerous and all belong to the medically important Tityus genus.

Scorpions are arachnids or eight-legged invertebrates like spiders, ticks and mites that date back almost half a billion years. Easily adapted to a range of environments they can now be found on all continents except, for now, but probably not for long, Antarctica. From less than a third of an inch to the nine-inch long West African harmless emperor scorpion and the fatal Middle East “death stalker” or the lethal Israeli/Palestine yellow scorpion, they stand out for a curving segmented tail with the infamous stinger. Yet scorpions are shy and not often venomous since under 50 of the nearly 2000 recorded species are known to be capable of killing a human. Reactions can run from localised skin problems to catastrophic neurologic, respiratory, and cardiovascular collapse.

Recently researchers at the Human Genome Sequencing Center, at Baylor College of Medicine announced spiders and scorpions evolved from a shared ancestor 400M years ago, which made new copies of all of its’ genes in a key and infrequent process called whole genome duplication.

Featuring a small, but versatile cross-linked protein chain, the group of complex molecules that make up the scorpion’s toxin is perfectly shaped to block critical channels and stop ions from entering muscle cells, prompting paralysis and eventual death. Since each scorpion has its’ own unique blend, with different levels of toxicity, developing antivenin can prove costly, painstaking and risky. There is no universal antivenin available and only around 22 types of scorpion anti-venom are listed in the United States (U.S). But in 2011 the Food and Drug Administration (FDA) for the first time approved one cocktail, Anascorp specifically for the treatment of the North American “centruroides” scorpion stings, based on pioneering work by the National Autonomous University of Mexico, a global leader in developing a new generation of treatments for toxic bites including from black widow spiders. For every person killed by a poisonous snake, 10 are felled by a scorpion with 1000 deaths in Mexico alone annually where they treat an astounding 250,000 cases as against 250 serious U.S stings.

Fascinated scientists are learning that venomous proteins can be used in human medicine, including for brain tumours possibly through nano-technology, with a small peptide isolated from the Brazilian yellow scorpion yielding promising anti-microbial and anti-cancer properties. In neighbouring Brazil, the Butantan Institute is already tapping synthetically designed DNA to produce coral-snake antivenom. Produced by immunizing horses with the venom and collecting the serum, this method is hampered by low yields from coral snakes, and the fact they are hard to rear in captivity. Since 2003, the sole FDA-approved coral snake antivenom was discontinued.

New approaches are therefore urgently needed, including revised treatment protocols, and perhaps locally targeted antiserum created by bright, young, enquiring minds here in Guyana. Studies show that mortality decreases wherever the management of poisonous stings is anticipated and prepared for by health and related authorities.

Keishon was buried in Mabaruma last Saturday, thanks to the Regional Health Officer (RHO) and the owners of the aircraft, ‘Wings of Humanity’ who arranged for the child’s body to be speedily flown back to his hinterland home for a proper funeral, Persaud disclosed in a fresh letter this week. Slamming the $30,000 “pittance for death expenses” given by the Ministry of Indigenous Peoples Affairs, and the likelihood of a “poor burial” in Georgetown for more Amerindians who may expire at the main hospital, Persaud urged “that we respect Guyana’s indigenous people both when they are alive and when they die.”

We would have a second indelibly close encounter in Belize when our daughter was pricked in her school shoe by an angry, tiny black widow spider which she awakened while enjoying music in the car, tapping her feet, fortunately cushioned in thick socks. Her father raced back home with much weeping and wailing from the back seat, and we quickly administered Benadryl and analgesics, and kept her and the small red spot under close observation.

It was her seventh birthday and the experience taught us to always keep appropriate medication at hand. We hurriedly moved to a second house in the heart of Belmopan, but the scorpions there were even bigger, blacker and more abundant, coolly crawling out from the subterranean depths through a huge hole – undiscovered behind the washing machine for months – straight into the primeval recesses of our fearful psyches. Pest control and the ghost busters were summoned urgently. Another puncture this time from a Belizean tick would cause her to get a rare and life-threatening allergy, and remind us as we celebrate each milestone, of how fragile, life really is.

 

ID remembers to shake out shoes and clothing, although she often forgets to check under pillows. She has learnt to be careful with spiders and to brush off a scorpion instead of slapping it.

 

 

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