The Doctor Who is Dedicated to Saving Snakebite Victims

KOMPAS/JOHANES GALUH BIMANTARA

Tri Maharani

Dozens of snake species in Indonesia have lethal venom. Of the nearly 120,000 physicians in Indonesia, one doctor, Tri Maharani, has dedicated her life to saving the lives of those who have been bitten by venomous snakes – lives that are often ignored.

Maharani was leading a training session about emergency measures in Palu, Central Sulawesi, when a physician from the PKU Muhammadiyah hospital in Bantul, Yogyakarta, called her last July. The hospital was welcoming a patient with a snakebite, a 7-year-old child. The child was bitten by a green snake with a red head (Trimeresurus albolabris), one of the snakes whose antivenom is made in Indonesia.

“The kid came across a snake when he was playing. He did not know it was venomous. His parent incorrectly administered first aid, using a bandage [to stop the flow of blood],” said Maha, Maharani’s nickname, in Bintaro, South Tangerang, on Tuesday (7/8/2018).

The head of the Kediri, East Java-based Daha Husada Hospital emergency unit instructed her staff to send the antivenom, which she imported from Thailand, to Yogyakarta.

Within four hours, three vials of green snake antivenom reached the PKU Muhammadiyah hospital via railway transportation.

After receiving the antivenom, known as SABU, the patient recovered in three days. Without the antivenom, which was given for free, the patient would have died.

Maha also visited Bantul to check on the condition of patients in Bantul and lead a training session for physicians on how to treat patients with snakebite.

Departing on Friday (13/7) on a train, she arrived in Yogyakarta at 6 a.m., providing training at 8 a.m. and going home to Kediri on a bus in the afternoon, arriving at 3 a.m. on Sunday. She used her own money to pay for all the transportation tickets.

It was not the first time she spent her own money to save snakebite victims. For five years now she has traveled to several places, from Aceh to Papua, anytime there is problem in the treatment of snakebite victims.

The antivenom that she provides for free is not cheap. The green snake antivenom, for example, costs around Rp 3.6 million per 10 milliliters.

Indonesia has been able to produce polivalen antivenom for the cobra (Naja sputatrix), banded krait (Bungarus fasciatus) and viper (Agkistrodon rhodostoma). The polivalen antivenom can be applied for the victims of different snakebites but its effectiveness is less than that of the monovalen antivenom.

In order for her to be able to make an unscheduled visit, Maha does not work at more than one hospital and does not work at a home clinic. Doctors usually do that to earn a money.

Her material sacrifice is based on the view that a human’s life is priceless. Anytime she saves one’s life, she is satisfied. “People are needed who are willing to spend time, energy, money and loss. When I do that I feel at peace,” Maha said.

150,000 incidents

With all her sacrifices, Maha has saved hundreds of lives. Maha has also actively collected data on snakebite cases in Indonesia, because there is no state institution that does that. In 2016, she estimated there were 135,000 incidents nationally. The number increased to 150,000 in 2017.

She made the estimate based on cases reported to her. As many as 728 cases involved the consultation of Maha in 2017 and 35 of them resulted in deaths. There were 15 fatalities due to cobra snakebite, because Indonesian antivenom does not work for this snake.

What made Maha sad was the fact that the dead victims were at a productive age or the breadwinner in their family. Of the 35 fatalities in 2017, for example, 29 of them were under the age of 50.

Maha started on the path toward becoming a physician in junior high school. She was influenced by her parents’ work at a military clinic (DKT) in Kediri. Her father Imam Hambali was an army and dentistry worker and her mother R. Ngat Sri Atni was a nurse.

The youngest of three children, Maha continued her education at the Medicine Faculty at Brawijaya University in Malang, East Java, in 1990. Maha became a physician in 1998. After fulfilling her childhood dream, Maha had no particular career plan. Even when she undertook her immunology master’s at Airlangga University, Surabaya (2001-2003), an emergency specialist program at Brawijaya University (2007-2011) and doctoral degree on biomedicine at Brawijaya University (2008-2014), she did not fully understand why she studied what she did.

By studying immunology, she developed an understanding of how to determine the proper antivenom for a particular snakebite. Her journey allowed her to cross paths with Ahmad Khaldun Ismail, a lecturer at the Medical Faculty of Kebangsaan University, Malaysia, who studied about snakebites. Maha attended various events related to snakebite cases in different places.

With all her dedication to snakebites, she started to become recognized globally. She was invited to speak in more than 10 countries and became the temporary advisor for the World Health Organization in Southeast Asia (WHO SEARO), including in drafting the guidebook for snakebite treatments.

Currently, she is active as a review adviser for the WHO Snakebite Envenoming Working Group (SBE-WG) for 2017-2030. In order to reduce the mortality rate from snakebite, Maha co-founded Remote Envenomation Consultancy Services (RECS) Indonesia in 2015 and Indonesia Toxinilogy Society (ITS), whose members are consultants on snakebite or poisoning from other animals.

Tri Maharani

Born: Aug. 31, 1971

Job: Head of emergency unit with Daha Husada Hospital in Kediri, East Java

Education: Medical Faculty, Brawijaya University (1990-1998); Doctoral program on Biomedicine at the Medical Faculty, Brawijaya University

(2008-2014); Sandwich Like Program, PhD in Biomedicine in the

Hypertension Department, Gashuisberg Hospital, Medical Faculty at Katholieke Universiteit Leuven, Belgium (2011)