Every year, an estimated 20,000 to 40,000 people are bitten by snakes. Around 2,700 die, mostly women and children, in the Tarai. That’s about seven deaths every day.

Yet in the rural areas, where most bites occur and health services are scarce, few know how to respond. Many follow misinformed practices that worsen outcomes.

Nationally, only 20 percent of snakebite victims reach hospital, says Milan Bajracharya, a consultant physician at Sukraraj Tropical and Infectious Disease Hospital in Kathmandu. “Around 40 per cent die at home. Another 40 percent on the way.”

In Nepal, where victims often don’t receive medical care for days, first aid becomes a vital first line of defence.

Knowledge of snakebite first aid shapes the entire health-seeking behaviour after a bite, says Bijay Kumar Shah, chair of the Choharwa Community Snakebite Treatment Centre in Siraha. “It buys time, reduces panic, and can mean the difference between life and death before medical help arrives.”

These days, rising temperatures have driven venomous snakes into the hills and mountains. This year alone, Sukraraj Hospital has treated over 350 snakebite cases from Kathmandu Valley and nearby districts.

Still, grassroots awareness programmes, such as house-to-house campaigns that could teach people how to respond in the crucial first moments, are largely absent. The government has done little, say experts.

While healthcare access is a known crisis, experts argue that first aid awareness is missing, and it is the most fixable link in Nepal’s snakebite response.

“In this silent epidemic, knowledge is the first antidote, but the government ignores it,” adds Shah.

Take the case of 49-year-old Tej Kumari Bhandari from Ramechhap, to learn how harmful the lack of first aid awareness can be.

On the morning of June 26, while clearing a spring blockage, a snake bit Bhandari in her hand. She reached Sukraraj Hospital only the next day.

In the meantime, panicked villagers advised her to tie her hand tightly. Like many others, she had heard tying a limb could help.

By the time she arrived, her hand was cold, blue, and numb. Doctors said the tight binding had worsened her case.

“I had to stay in the hospital longer because of it,” Bhandari said.

Bhandari also visited a jhakri (traditional healer) before seeking medical care.

“I was afraid I might die, so at home, my husband tied the cloth tightly,” she said. “We had no idea it could make things worse.”

Like Bhandari, over 80 percent of victims or those accompanying them don’t know what to do after a snakebite, says Dul Bahadur Sinjali, a paramedic at the Snakebite Treatment Centre in Charali, Jhapa.

Each year, the Charali centre treats 1,500 to 1,600 cases from Jhapa, Ilam, Panchthar, and Taplejung. Most follow incorrect practices that worsen the condition before they reach the hospital.

“Patients arrive with tight tourniquets made from cloth, rope, or rubber, believing it will stop the venom,” Sinjali says. “But these often cause swelling, and burst arteries, or veins.”

Bajracharya agrees. “We’ve seen patients requiring amputations due to tight tourniquets. It causes gangrene, necrosis, and delays treatment.”

It is recommended to immobilise the joint below and above the bitten area. A bandage can also be wrapped starting from the bite site, but not so tightly as to cut off circulation, adds Bajracharya. One should be able to slide a finger between the bandage and the skin.

Another dangerous practice, Sinjali adds, is cutting near the wound. “About 10 percent of patients cut their veins, causing severe bleeding.”

Delays are common. Some patients arrive in Charali only days, or even months, after the bite, when home remedies and faith healing fail.

According to paramedics, in moments of panic, people often act on fragmented knowledge—what they’ve read, heard, or what their children learn in school.

Take limb immobilisation or wrapping a bandage after a venomous snakebite, for instance. “It’s not wrong, we’ve all come across it in textbooks,” Sinjali says. “But the problem is, people panic and tie it too tightly, which does more harm than good.”

That’s why experts emphasise that textbook knowledge alone isn’t enough. “We need hands-on, practical awareness,” Shah says.

According to Bajracharya, even the simplest knowledge, like staying calm, can save lives. Panic increases movement, causing the venom to spread more rapidly.

He emphasises the need for people to understand that not all snakes are venomous, not all bites inject venom, and even when they do, treatment is possible.

Meanwhile, in the Tarai, snakebites hit poor and marginalised communities the hardest. The Choharwa centre in Siraha alone treats around 2,500 cases annually, mostly Musahar and Dalit families.

Shah views the textbook inclusion of snakebite first aid as a surface-level fix. According to him, many poor families can’t afford to send their children to school. In better-off households, children often study in cities like Janakpur or Golbazar, leaving behind elders and women with little to no access to knowledge.

Though Nepal is a signatory to the global goal of halving snakebite deaths by 2030, government action remains minimal. Health facilities in snakebite-prone regions lack not only antivenom and ICU ventilators but also awareness campaigns.

Health workers on the frontlines believe snakebite deaths in Nepal remain high because victims and families often don’t know how to respond, turning treatable bites fatal.

“We constantly regret and wonder if only they had known better. Simple knowledge could stop needless deaths. So why hasn’t raising awareness been made a government priority?” Sinjali questions.

While the Nepal Army team in Charali leads awareness efforts in Jhapa, Sinjali criticises the local government for neglecting other snakebite-prone areas in Koshi Province.

Even the Choharwa community centre’s outreach proves what works: first aid training in villages and schools, and educating those who accompany victims to the centre. Shah says that in the 16 municipalities where these programs run, harmful practices have dropped from 80 percent to just 30 percent.

But local governments in Siraha lack awareness initiatives. Health posts and Female Community Health Volunteers offer no programmes. Even the FCHVs lack such knowledge. At best, awareness is limited to occasional radio programmes.

And community centres like Choharwa alone can’t fill the gap, as they’re underfunded and overstretched.

“The government is failing to provide critical treatment resources like ICU ventilators in the Tarai, and even more basic, lifesaving measures like awareness programmes,” says Shah.

Experts urge the government to prioritise grassroots education through door-to-door awareness campaigns, regular school-based programmes, and serious investment in first aid training.

Fixing the healthcare system might take heavy investments of time and resources, but there’s no excuse for the widespread lack of basic first aid knowledge, says Sinjali. “This isn’t an infrastructure problem; it’s a policy failure”.

Unlike building hospitals, Sinjlai adds, it’s something that can be fixed quickly and affordably. “The only missing thing is the government’s will”.