2nd PART:
ConCiencia
45th years of the Clodomiro Picado Institute
ConCiencia
45th years of the Clodomiro Picado Institute
Before starting, let me give some data about Costa Rica as it will help to understand more the dialogue between the presenter and Dr. Jose Mª Gutierrez.
They are very advanced in green measures, sustainability and community medicine.
I've been looking at the census done in 1927, a year after Dr. Clodomiro Picado promote the regulation against snakebites.
These are the figures:
Total Population: 471.524 habitants. (Urban population: 88.608 habitants, Rural popularion: 382.916 (81.2%)
Links:
http://ccp.ucr.ac.cr/bvp/censos/1927/index.htm
https://www.cipacdh.org/pdf/Resultados_Generales_Censo_2011.pdf
DrJMG: Yes, in fact it was an
important Community Health problem as it was in all the Latin American region. The
statistical data in those times were not very clear but the estimated numbers
were about five hundred, six hundred snakebite accidents… (seems quite small but related to the total population of the country it is a considerable number of accidents)
P: per year…
DrJMG: Per year, in the
country
P: Oh, that is a lot, of
course…
DrJMG: In fact, when the
minister Aguilar Peralta decided to politically support this project, there is
a moment where an ex-director of the Butantan Institute in brought to the
country to make an evaluation of the problem itself and also to assess if it was really necessary
to develop the snake anti-venom here, at local level, and the adviser conclusions
where it was really necessary, that there was an important problem and also that
the country was meeting all the scientific and technological requirements to move
forward with this project.
P: Nowadays, what is the
number of snakebites?
DrJMG: It is similar, is
very interesting, same figures, the absolute number continues to be between
five and six hundred snakebites…
P: but now the
population is bigger than before…
DrJMG: Yes, if we talk in
terms of incidence, then the incidence was bigger (see figures at the end 1927 census compared to 2011) and furthermore, the health
resources were not so available as today, making the delay time to treatment for
this people much bigger and sequels were also more severe as a result of it.
P: Let us talk about
this diversification of the research… what other contributions have been done
by the Instituto Clodomiro Picado to the research in our country and obviously
internationally.
The “Instituto” has
always work as a collective, isn’t it?
It is a place where
there is a team of people, nowadays we are seventy (she and he) work colleagues
that function in unison, each of us in our workplace, each of us fulfilling his
duty and at the same time, sharing a collective perspective view where there
are many communicating vessels between sections, lots of dialogue, lots of reciprocal
support on different things, and all of this allows this collective project to
have a very enhanced capability to tackle a problem.
P: You have others
elements obviously important as it is academic teaching and social action… and
manufacturing, we should not forget that…
DrJMG: Yes, manufacturing
is a component of the “Instituto” from the beginning, in fact the “Instituto”
started as a manufacturing centre. The other activities where added afterwards.
Manufacturing numbers have been rising, at the beginning about 10.000 vials of
snake anti-venom were produced per year, enough to provide for Costa Rica
requirements and later on we started providing anti-venom for all Central
America region, about 60.000 vials, and at present more than 100.000 vials of
snake anti-venom are manufactured per year, which allows us to help solving the snakebite problem in Colombia, in Ecuador, currently in Peru… as well as in
very far away places like Nigeria, Mali, Burkina Faso, Papua New Guinea and we
are starting a project in Sri Lanka (see previous post on Hypnale hypnale!), then… the production has developed a
lot, due to the huge professionalism and capability of the production colleagues
(she and he) and also due to the inputs coming from research to improve and innovate
on the manufacturing process.
P: Do you know, approximately,
how many persons have been benefited from the anti-venom?
 |
| Echi-Tab anti-venom for Nigeria developed at ICP |
P: Academic teaching and
social action… do you have students there… learning from all of you…
DrJMG: Exactly, all the
investigators at the “Instituto” are teaching at the University of Costa
Rica, many at the Faculty of Microbiology and other in other schools and
faculties. The undergraduate teachings are of course given at the faculty and
we also have a very important program for graduates, and we also received undergraduate
and graduate students for the thesis and PhD works. I would like to say as acknowledgement
and homage, that many of the academic developments of the “Instituto” had been
developed by their students, that carried out PhD studies of a very good level,
guided by the investigators (she and he) of the “Instituto”, contributing in
these way to this collective creation that is the Instituto Clodomiro Picado.
Related
to social action, I would like to say that the major component of
the social action are the snake anti-venoms by themselves, is there any better
social action that saving the life of a human being?...
but we also have an element of continuous education based on activities like the prevention of the snake accidents in several communities in our country and outside our country too and for specific vulnerable population. We have also a very important element which is directed to specialized training of the health professionals to treat this pathology through symposia, hospital activities, visiting health centers etc.
Related
 |
| Dr. Clodomiro Picado paper toy, by Ana Carolina Fernández |
but we also have an element of continuous education based on activities like the prevention of the snake accidents in several communities in our country and outside our country too and for specific vulnerable population. We have also a very important element which is directed to specialized training of the health professionals to treat this pathology through symposia, hospital activities, visiting health centers etc.
P: Could we say Chema, that
there is an area where do we have a higher incidence of snakebite accidents in
Costa Rica?
DrJMG: Yes, this is quite
well studied and relates to the regions common habitat for the “serpiente
terciopelo” (Velvet snake - Bothrops Asper). The more vulnerable region is the South Pacific and also Caribbean
regions and some in Central Pacific.
 |
| "Serpiente Terciopelo" Velvet snake Pit Viper - (Bothrops Asper) |
P: All the cases related
to “terciopelo” …
DrJMG: Most of the cases
related to “terciopelo”, that is a very common snake on that regions. At the
same time, those are regions where the poverty index in very high so, there is
an overlap between the snakebite and poverty. In fact, researchers for other latitudes
qualify snakebites as a poverty disease
(Snake envenoming: A Disease of Poverty. R.A. Harrison et at. PLOS, Dec. 22 2009)
and this is an element that invites too
to the involvement of social science researchers to try to understand this
relationship between poverty, environmental conditions and this health issue.
P: Snakebite from “terciopelo”
is the most frequent… in second place… what do we have?
 |
| Tamagá. (Porthidium nasutum) |
DrJMG: Very Very left behind, and this is not very well known because sometimes the people do not identify properly which is the snake responsible for the bite… it could the “tamagá”, it could be the “bocaracá” … but very far away from all of them is the “terciopelo”, in all Central America and part of South America.
 |
| Bocaracá. Yellow eyelashes snake (Bothriechis Schlegelii) |
Here finishes the second part.
Third part of the program
the interview continues with Dr. Alberto Alape Jirón, the actual director of
the Instituto Clodomiro Picado and also investigator and professor of the Faculty
of Microbiology, University of Costa Rica. Next post!
Playing with numbers:I'm taking 550 snakebites/year (between 500 and 600)
Census 1927
|
Snakebite
Incidence
|
Census 2011
|
Snakebite
Incidence
|
|
Total Population
|
471,424 (100%)
|
116.6
|
4.301,712
|
12.8
|
Rural Population
|
382,916 (81.2%)
|
143.6
|
1.170,841
|
46.9
|
Incidence: Snakebite accidents /year/100.000 habitants
|
||||
Incidence: number of new
cases in a period of time, usually one year, referred to the total population and expressed as a ratio.
Data about mortality. Found this nice article. Clearly mortality decreases after 1970, after the foundation of the Instituto and the local anti-venom started being produced. Also very important, the access to hospitals improved notably after 1980.
Toxicon. 1997 Nov;35(11):1639-43.
Snakebite mortality in Costa Rica.
Abstract
The mortality rate due to snakebite envenomation in Costa Rica was estimated from 1952 to 1993. The highest mortality was observed during the 1950s and 1960s, with the highest rate of 4.83 per 100,000 population in 1953. In contrast, a rate of 0.2 per 100,000 population per year was estimated from 1990 to 1993. The most conspicuous decline in mortality occurred after 1970. The highest mortality rates were observed in the provinces of Limón and Puntarenas, especially in regions where tropical rain forests had been transformed into agricultural fields. The lowest mortality was in the province of Guanacaste, where tropical dry forest predominates and Bothrops asper (terciopelo), the most important poisonous snake in the country, is not abundant. The majority of fatalities occurred in the age groups from 10 to 19 years old. Males were more affected than females in a ratio of 3.6:1. Before 1980 most fatal cases did not receive medical attention in hospitals, whereas after 1980 the majority of cases with fatal outcome were attended in hospitals.
ॐ लोकाः समस्ताः सुखिनो भवन्तु ॥
Om Lokah Samasthah Sukhino Bhavantu
May all beings everywhere be happy and peaceful.
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