This book review is courtesy of Mike Swan Herp Books

Venomous Bites and Stings in Papua New Guinea - A guide to treatment for health workers and doctors – Editors David Williams BSc, Simon Jensen FACEM, Bill Nimorakiotakis FACEM, Ken Winkel PhD FACTM Published by Australian Venom Research Unit University of Melbourne, Parkville, Victoria 3010, Australia ISBN 0-975 7937-0-5 358 pages, PB

The book review is by Chris Curry BMedSci(Hons) FACEM DTM&H Clinical Associate Professor, University of Western Australia Visiting Professor, University of Papua New Guinea Emergency Physician, Fremantle Hospital, Alma St, Fremantle, Western Australia 6010, Australia Tel 61 8 9341 3750. Fax 61 8 9431 3751 Email chriscurry1@compuserve.com

Envenomation by snakebite presents a huge but largely unmeasured problem in Papua New Guinea. In the Intensive Care Unit at Port Moresby General Hospital (PMGH), snakebite contributed 73 ventilated patients and 4 deaths in 2003, 95 ventilated patients and 9 deaths in 2004. One quarter of ventilated patients were there because of snakebite. PMGH serves only the National Capital District and environs for acute care. Eighty five percent of the people of PNG live in rural areas remote from an ICU. Taipans and death adders are the dominant envenomers. Fatality rates can only be guessed at but in some regions are known to be 100% for paralysis. The human cost is beyond estimation.

David Williams is an unusually dedicated individual who is making this one cause his life’s work. He has already committed years to studying (and handling) PNG snakes and is the world’s foremost authority on them. He is now establishing a snake house and venom unit in the School of Medicine and Health Sciences (SM&HS) at the University of PNG and is undertaking a PhD with the Australian Venom Research Unit (AVRU) at the University of Melbourne. Collaborators from AVRU include Bill Nimorakiotakis (‘Nimo’), emergency physician and Deputy Director, and Ken Winkel, Director. Simon Jensen is an emergency physician who has contributed substantially to the Master of Medicine, Emergency Medicine, program at the SM&HS since 2003. His practical clinical involvement at PMGH has triggered an intense interest in improving the management of envenomation. From these editors comes a book of 358 pages that is a world leader.

Contributing authors number a further sixteen and include national practitioners and international experts. It provides a wealth of information for the interested. The book is extensively illustrated both with photographs and with drawings that are of practical use. Much of the scientific detail is beyond practical use by care providers in PNG, who in rural areas are predominantly health extension officers (HEOs) and nurses in Aid Posts and Health Centres. However, the chapters on management are presented with this audience in mind and are clear, concise and comprehensive. The emphasis is on first aid and care in the absence of laboratory resources and the sophisticated technologies of hospital and ICU. Major points, myths and traps are highlighted, and there is a ‘tool-box’ utility about the format of what to do.

These chapters will have wide practical application. To promote this, the authors have run two courses, the first at PMGH in 2004 and the second in Madang in 2005. It is hoped to expand the dissemination of the book’s contents by running a three day course twice each year. The last two of the twenty chapters deal with bites and stings of some of PNG’s other animals, including spiders, scorpions, bees and wasps, and marine envenomers such as stonefish, stingrays and jellyfish. The book is written for PNG and is intended primarily for care providers there. It will be of use to the visiting Australasian emergency doctors, who at time of writing numbered twenty six and are increasing. However, the book will also appeal to a wider audience.