Cause of Death

Published: Friday, March 11th, 2011.   Categories: Analyze & OpineColumnists


She went into cardiac arrest as she was carried into the clinic. The men carrying her said she had been bitten by a snake. We put everything on hold and rushed to assist her. There was no pulse and she was having difficulty breathing. Epinephrine was administered. A non-specific anti-venom was injected. Endless chest compressions were started and her heart started beating again. The team worked on her for five hours, after which, she died.

Her husband rushed out, wailing. We stared at each other in muted shock. Her relatives waiting outside the clinic started crying. The screams were not loud but still deafening. The medical staff swiftly made their way out of the room. Some were weeping. I was staring at her, still in disbelief. Her right arm was hanging off the examination bed. Her eyes were closed and her mouth was gaping. She looked lifeless. It was the first death at Nyaya’s Health Center.

Jason Andrews, one of Nyaya Health’s co-founders, was still in the room, his eyes welling with tears. I asked him if there was anything we could have done to save her. Did we lack equipment? Did we lack a particular medicine, an antidote? Did we allow her death by not raising enough money?

Jason wondered about her chances of survival even at the most plentiful institutions of the world. She had been bitten by Krait (Bungarus), which is about 15 times more poisonous than a cobra, and arrived at the clinic eight hours after being bit. She had several factors working against her that had drastically decreased her chances of survival, even if she had come to the kind of US institutions where Jason and I receive medical training.



A Krait snake, which is extremely poisonous and relatively common in Achham (photo courtesy of


It was not a reassuring thought. Was the poison her killer or was it the fact that her nearest medical care center, Nyaya’s clinic, was an 8 hour walk from her home?

We went outside to speak with the family. As rehearsed when learning to deliver bad news, I told the weeping husband that he had done everything he could have to help her – he had carried his wife on his back through mountains for hours. I told him her death was not his fault. The deadly poison was the cause of death.

Other family members started consoling him. We asked how a nocturnal snake had bitten her. The snake had attacked her at 3 a.m. when she was sleeping in a temporary shed in the woods. We wondered why she was sleeping in the woods. Dr. Jhapat Thapa, Nyaya’s physician and an Achhami native, explained: it is not uncommon in Achham and its neighboring districts that women bring the family’s cattle to the woods and stay there for weeks during the monsoon season. The caretakers stay in temporary sheds in the middle of thick vegetation while the cattle feed day and night on the lush foliage following several months of starvation due to the dry winter. Dr. Thapa told us about his childhood days when he had also spent several nights in such sheds. They are bamboo structures with walls and floors of hay. Injuries, falls and snake bites are known – and (helplessly) accepted – prices for feeding the cattle.

We called the phone nearest to their home so the woman’s relatives could be informed. They would have to walk overnight to reach Sanfe Bagar for her cremation ceremony the next morning. The family members began to collect materials for her cremation at a river bank a few hundred meters from our clinic. Next, we had to fill out her Death Report. Cause of death was going to erroneously say cardiorespiratory arrest secondary to neurotoxin from krait bite.

She died because she was bit by an extremely poisonous snake. She died because it takes 8 hours to reach the nearest health center from her home. She died because she was forced to risk her life by living in the woods so her starving buffalo could get food.



Nyaya Health is a volunteer-run 501(c)3 organization, so 100% of donations go directly to medical training, delivery and service. Thanks to the generous support of donors like you Nyaya Health is able to provide free medical services to the poor and marginalized in Nepal.