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Padma Shri: Dr Himmatrao Finds a Path-Breaking Cure for Deadly Scorpion Sting

Dr Himmatrao Bawaskar, Padma Shri awardee, conducted monumental research and work into finding a way to treat scorpion stings. He brought the case fatality rate down from 40% to 1% in India.

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In 1983, Dr Himmatrao Bawaskar was called in to treat an 8-year-old child with all the symptoms of severe scorpion envenomation — difficulty breathing, drooling, nausea and vomiting, accelerated heart rate, and muscle twitching and thrashing. With chances of survival already low, the child’s condition began deteriorating even further when he developed pulmonary oedema (excess fluid in the lungs).

If Dr Bawaskar’s research over the years had taught him anything, it was that Sodium Nitroprusside was effective in treating heart failure due to a scorpion sting. He quickly turned to the child’s father for permission to use the drug, as Nitroprusside is a delicate and dangerous medication that requires intensive monitoring.

From the moment he received the go-ahead, every minute of the next few hours was crucial. Dr Himmatrao sat by the child’s side, monitoring the drug drop by drop, minute by minute. It took four hours, but the signs of recovery were finally beginning to show — a slow rise in blood pressure, subsiding of pulmonary oedema, a drop in pulse rates.

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Around 24 hours later, Dr Himmatrao stood up to declare – “The boy has been saved”.

But in the triumph and celebration of having saved the child’s life, an important detail had been missed. Sometime during the monitoring of the drug, Dr Himmatrao was informed that he had just lost his father, and was being called home.

Two questions then stood before him: Should he be a dutiful son and choose his family? Or should he remain by his patient’s side in this critical hour?

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Ultimately, it was the latter that he chose. There were people back home who could take care of the funeral but who would take care of this child, dangling on the verge of death? Saving the child, he said, was the greatest tribute to his father.

Dr Bawaskar’s (71) revolutionary work in treating the scorpion sting has not come without such sacrifices. Long hours, corruption, superstitions, rejection, and a large gap in India’s rural healthcare system; there have been many roadblocks in the way. But none have quite managed to hold him back.

His research has resulted in a startling drop in the rates of deaths due to scorpion stings, from 40 per cent to 1 per cent. For his revolutionary work, he is being conferred the Padma Shri, India’s fourth-highest civilian honour, this year.

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dr himmatrao bawaskar
Dr Himmatrao Bawaskar is being conferred the Padma Shri this year

The antidote

Born in Mahad, a small town in the northern Konkan region of Maharashtra, Dr Bawaskar’s parents earned their living through farming. It was his father who recognised the importance of education, but the meagre salary that the family survived on meant that young Himmatrao would have to work harder than his peers to study. When not studying, he spent his time in the fields, in hotels, temples, bookshops, the brick kiln, and any other place that would help him support his education.

While pursuing his MBBS degree at a medical college in Nagpur, Dr Bawaskar saw first hand how caste played a heavy role in the way students were treated. “I topped the surgical viva and write test. My internal examiner was very impressed…but the external examiner was from the Brahmanic community,” he explained to the Times of India. The ‘Rao’ in his name was a giveaway that he was not a Brahmin. “Despite good performance, I was given low marks.”

This, combined with “poor English” left him avoiding communication with his peers, and participation in group discussions. “I could not even find a friend in my peer group. I suffered [from] depression during my second year.”

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Traumatised by his experience in the college, Dr Bawaskar chose a medical officer’s position at a PHC, rather than take up PG admission in the Nagpur college.

“When I joined the PHC of a remote village called Birwadi, I was aware of my duty towards patients,” he said, writing for DNA. “However, my seniors advised me to charge each patient over and above my salary. My illiterate patients, however, had counselled me that monthly payment was the only thing I was rightfully entitled to.”

“My principles did not resonate well with my higher-ups,” he explained. “[They] never encouraged my research, and I never entertained them for a cocktail party, or passed on any extra payment.”

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Besides corruption, the PHC made him privy to another problem that was crippling the village’s fragile healthcare system — scorpion stings. Superstitions inhibited timely intervention, and, coupled with inadequate resources and the date of past cases, left a herculean task before Dr Bawaskar.

Armed with a stethoscope and a sphygmomanometer, Dr Bawaskar dove in to pull the problem apart bit by bit. First, he conducted research using the Mesobuthus Tamulus, the most lethal scorpion, found in parts of Karnataka, Andhra Pradesh, the Konkan region, Tamil Nadu, and Gujarat. “At that time, most areas such as Konkan and Bellare had a 30-40% fatality because patients developed pulmonary oedema,” he recalled.

He spent many sleepless nights monitoring patients, taking note of even the subtlest of changes in their conditions, and ascertaining common symptoms. His observations led him to one conclusion — the immediate cause of death in most cases was pulmonary oedema.

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Meanwhile, Dr Bawaskar felt the need to widen his horizons to deal with the mammoth task ahead of him. Donning the role of a student once again, he enrolled in Pune’s B J Medical College for his MD in Medicine, where he mastered advanced techniques and intensive care.

With his newfound knowledge, the doctor prepared a study of 51 cases of scorpion sting and sent it to an Indian journal. Here, he was met with rejection, citing “English writing not good enough”.

‘Himmat’wala

Unwilling to give up, he approached The Lancet, a renowned peer-reviewed medical journal, with the same study. A week later, he had his response — the paper was accepted and published in the journal in ‘82, titled, ‘Diagnostic Cardiac Premonitory Signs and Symptoms of Red Scorpion Sting’. In this paper, he wrote about his understanding of how the sting caused heart failure similar to a refractory heart failure, for which Nitroprusside was an effective cure.

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From hereon, something had changed in the way scorpion bites were being treated across India. Earlier, death was considered an obvious result of the sting. But with Dr Bawaskar’s work, patients now had a shot at living.

In 1986, he made another groundbreaking discovery — the use of Prazosin, a blocker medication used to treat BP, could significantly improve treatment of sting victims. He conducted a trial with 126 patients, and all of them survived.

The paper was published in The Lancet, and gained international recognition. Dr Bawaskar spearheaded the spread of the treatment across India, and from a case fatality of 40% in the 70s, deaths in 2014 stood at only 1%. He has been credited with working out the most effective combination to treat scorpion bites — anti-venom and Prazosin, which relaxes blood vessels. This was a result of decades worth of hard work, repeated clinical trials, seminars, workshops and lectures, many of which were funded from Dr Bawaskar’s pocket.

Today, Dr Bawaskar has made Mahad more than just a small Indian town — it is now the birthplace of a pioneer, a man of perseverance, who is a global name for his contribution to medicine. Over the years, he has published over 60 papers across India as well as the world and has also pioneered other areas of study, including chronic lifestyle diseases in rural India; treatment of snake bites; increased levels of lead in petrol pump workers, Ganpati idol makers, women using lipstick and surma; using scorpion venom to treat Brugada Syndrome; and more. He is also an ardent advocate of tackling corruption in the field of medicine.

Elated by the government’s decision to felicitate him with the Padma Shri, Dr Bawaskar said the award was an encouragement to work many more years in the field. “I thank my patients in and around Mahad, which 40 years ago was a small, remote place. Superstitions prevailed among the people there but they trusted me. Once I earned their respect, they supported me with resources and more people from the medical fraternity joined me,” he said.

Dr Bawaskar’s name is telling of his abilities. When chasing the ever-advancing fields of science, technology and medicine, the ‘himmat’-wala’s feet remain firmly planted in his roots, and he knows that progress is only that when everyone can move forward together.

Sources:
The Lancet
The Print
A Crusade Against Scorpion Sting: Life and Works of Dr Himmatrao Bawaskar – Ajinkya A Kale
Prazosin in management of cardiovascular manifestations of scorpion sting
Times of India (1)
Times of India (2)
DNA

Edited by Yoshita Rao

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