“At the hospital they do not treat venom from snakebites”: A qualitative assessment of health seeking perspectives and experiences among snakebite victims in Rwanda

Snakebite envenomation (SBE) is a serious medical condition with human, animal, and environmental factors
driving occurrence. In Rwanda, the number of SBE cases reported by the medical system is far lower than
regional estimates for SBE incidence, suggesting that victims might be seeking care outside of formal medical
structures. Our goals were to describe circumstances surrounding snakebite and to explore experiences of
snakebite victims in accessing treatment. For this qualitative study, our team recruited individuals bitten by
snakes between 2013 and 2018, who sought care either from traditional healers (N = 40) or hospitals (N = 65).
In-depth interviews based on a semi-structured interview guide were conducted by telephone in Kinyarwanda.
Inductive thematic analysis was conducted by two team members. Our respondents reported similar environ
mental circumstances surrounding their snake encounters; namely, farm fields, roads, and their homes, as well as
inadequate lighting. Unsafe First Aid practices, including burning/sucking/cutting the skin and tourniquet, were
often performed immediately after bites. Respondents reported various reasons for seeking traditional or hospital
care, such as perceived cost, distance, transportation, and especially, community beliefs and treatment outcomes
of other victims. Respondents described envenomation of livestock as well as the sale of livestock to pay SBErelated medical expenses. Improving trust and use of formal medical services will require enhanced hospital
delivery of high quality medical services for SBE through improved stocking of appropriate anti-venom and
reduced delays during intake. Communities might also benefit from education campaigns that discourage unsafe
First Aid practices and address the common misperception that physicians are not trained to treat SBE.