UNAIR NEWS – Maha’s cell phone rang again, who knows how many times. Apparently, the call came from Dr. dr. April Poerwanto Basoeki, Sp. An., a colleague who served at Dr. Soetomo, Surabaya. The senior anesthesiologist contacted him after finding a pregnant woman in critical condition due to a ground snake bite.
The snake bite not only causes severe bleeding, but also takes the fetus’s life in the womb. Hearing the news from dr. April, Maha then decided to go to Surabaya to help the handling process as well as provide training to Dr. Soetomo doctor’s team.
“The case occurred around the end of January. At that time, with a team of doctors, I asked for Anti-Snake Venom (ASV) from the Ministry of Health because the price was quite expensive. Thankfully, we can finally save our patients, “said Maha.
Career plan changed because of psychologist’s advice
The experience of handling snakebite in pregnant patients is just one of hundreds of cases handled by Dr. dr. Tri Maharani, M.Si. Sp. Em. However, they become her routine nowadays. She often has to travel to various cities to help her patients.
How come? In the world, there are only 53 doctors with expertise in the field of emergency medicine, especially the toxinology subspecialist who is capable of handling cases of snake venom or other dangerous animal bites. The woman from Kediri was one of them, also the only expert from Indonesia in that field.
It is ironic actually, considering geographically, Indonesia is an area that is a natural habitat for snakes. Until now, there are around 360 types of snakes, including 77 poisonous snakes scattered across the country, such as Java and Sumatra.
According to data collected by Maha since 2012, snake bite cases in Indonesia reached 130 thousand per year. The number then increased to 135 thousand people in 2016. Of all the cases, 728 of them were victims of poisonous snake bites, meanwhile, the death toll reached 35 people.
“Indonesia as a snake’s nest has only three types of ASV to treat the bite of a Javanese cobra (Spitting cobra), a welang snake (Banded krait), and a ground snake (Malayan pit viper). That means there are still dozens of other snakes that have not been covered. Therefore, genomic and molecular research is needed. The process is not easy, ” she explained.
Maha’s actions in the field of handling dangerous animal bites started from her journey during her tertiary education. After completing her studies at Faculty of Medicine (FK) Universitas Brawijaya, she chose to continue her master’s education (S2) in the Immunology Program, Postgraduate School, Universitas Airlangga, in 2001.
“At that time there were not many students because it was relatively new. From the seven students in the class, it was only me who was a doctor at the puskesmas, the rest were lecturers and general practitioners, “said the Head of Emergency Department, Daha Husada Hospital, Kediri.
Maha said, her choice of studying Immunology led her to meet with Prof. Dr. Fedik Abdul Rantam, drh., and Prof. Dr. Yoes Prijatna Dachlan, dr. M.Sc. Sp.ParK (K). From the two professors, she gained a lot of knowledge which has been useful for her career as a doctor as well as a toxinologist.
“There was a memorable experience for me. When other students already had a thesis title, I hadn’t. Then, I was asked by Prof. Fedik, who was once the founder and head of Immunology Program, “Would you like to continue my research on Borna virus in patients with Manic Depressive Disorder (MDD)?” I answered, yes, ” she explained.
In developing the research, Maha had to look for blood serum from 100 MDD sufferers. Although it was not easy, she finally succeeded in completing her thesis and master’s study in 2003. Through that research, she also succeeded in presenting facts about mental disorders caused by immunological problems, Borna virus.
With her graduate diploma, Maha decided to take a doctoral education (S3) in the Clinical Pathology Program UNAIR. However, the plan changed after she underwent a psychiatric test with a psychologist in order to fulfill the doctoral degree requirements.
“So, I was accepted into Clinical Pathology and paid for my tuition. But instead, the psychologist said, ‘Are you sure you want to be here? I am sure you can, but for the next life phase it would only last for a year. Because, according to the test results, you are adventurous, it is not suitable if you only looked at feces, blood, and urine. You must meet people, ” she recalled.
Sure enough, in 2007, Maha finally chose to follow the advice of the psychologist and changed to pursue a specialist emergency training program at FK Brawijaya University. Due to the education system change, she also had the opportunity to take a doctoral study at Biomedic Program in the same campus.
“Somehow, in the end I registered an emergency specialist. Even though the cost is expensive, the school is old, and I don’t have any idea what this field is like. If as clinical pathology specialist has obvious financial. A few years later, I realized that the psychologist’s words were true, “said Maha and then laughed.
During her doctoral education, Maha was sent to Belgian University of Leuven in 2011 to undergo a Sandwich like Biomedic PhD Program in Hypertension at the Gashuisberg Hospital Department. Since then, she has been active in honing her abilities in the field of handling snake bites through her educational background.
“In the past, I felt that my education was unclear. However, I later realized, if you want to handle snake bites well you must have basic immunological and emergency science, because it is classified as an emergency problem. In addition, we must also understand biomedicine because it involves the provision of ASV, “said Maha.
For her dedication in handling dangerous bites, she often won a number of awards. Moreover, Maha is currently trusted as one of the advisors in the World Health Organization (WHO) as well as contributors to the snake bite case guide book.
Maha also feels happy because she can help the process of handling the victims and provide training to the team of doctors and the public throughout Indonesia. She also claimed, had several times spared her salary to buy ASV supplies.
“The ASV price is not cheap, it can be in the tens of millions. Sometimes you have to buy abroad, such as Thailand, Bangkok or Australia. Therefore, I am upset when contacted by foreigners who ask for ASV for personal gain. The only parties allowed to obtain ASV are doctors or hospitals because there is medical accountability, “said Maha.
Way of Indonesian community to deal with snake bites
For Tri Maharani, the main enemy handling snake bites in Indonesia is a myth. Because, some people believe in shamans or other mystical things, rather than going to see medical personnel. As a result, the victim’s condition will get worse, even worsened, because it is handled with the wrong method.
If you are bitten by a snake, there are some things you should not do. Do not suck the victim’s blood, because the snake venom does not spread through blood vessels. Furthermore, do not tie, massage, or make the victim panic to avoid contraction in the victim’s muscles. If contraction occurs, snake venom can easily spread throughout the body so the victim’s condition will get worse.
“If mishandled, victims can be amputated, and even die. It’s best to take it to the doctor immediately before it’s too late. Until now, there is no medicine that can prevent snake venom than ASV. Because, the snake venom contain protein, so it must also be bound with protein that is only found in ASV, “added Maha.
Seeing the handling of snakebite victims who are still poor, Maha urged the government to be more vigorous in conducting research, making handling guidelines, providing disseminations to all medical personnel, as well as providing curricula on the field, especially for medical academics. (*)
Author: Nabila Amelia
Editor: Khefti Al Mawalia
