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Zimbabwe: Stealth Often Works With Public Health Issues
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 Published by the government of Zimbabwe |
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The Herald (Harare)
COLUMN
10 May 2008
Posted to the web 12 May 2008
Harare
One of the ways health may be affected, for good or ill, is by processes or actions that the individual, or even the community does not immediately associate with disease or "going to the doctor".
When I, in 1971, was the then City Medical Officer for Salisbury, nothing explicitly was said to the secondary school girls about the real target of the rubella injection -- their as yet unborn offspring, and their risk of serious Congenital Rubella Syndrome (C.R.S) with hearing, heart, and sight defects. Remember, this was in 1971 when we did not mention sex to pre-pubertal girls.
We continue to do the same thing for all our babies -- the seven childhood illnesses we routinely immunise against. Many of the mothers and the community as a whole think, rightly, it's a beneficial act.
Smallpox was eliminated as a human disease by WHO in 1978 using vaccination as the method.
Poliomyelitis will soon go the same way as smallpox by the same method -- a disease known only to history.
GERMS
In 1843 a man traveled from Massachusetts to Buffalo suffering from typhoid, and infected the small hamlet of New Boston.
Nothing at that time was known about epidemiology or the way in which infectious excreta contaminated the well, which was the main water supply of the village, by the index case using the outdoor privy of the small hotel where, after two weeks, he died.
Out of the total population of 43 people more than half (28) had typhoid. Ten died. But the Stearns family, who were not allowed to use the well, had no typhoid.
Doctor Austin Flint examined 9 patients with the local practitioner and did one post mortem autopsy, and declared the disease to have been caused by person to person contact -- "contagion".
His findings were published in the American journal of Medical Science in 1845. The villagers rightly suspected the water.
They wrongly thought it was maliciously contaminated with a poisonous chemical. Dr Flint sent samples for analysis, and found no chemical in the water from the well.
William Budd's theory of the contamination of drinking water as a cause of typhoid fever, was established in 1870.
Austin Flint, who by then was the first president of the American Public Health Association (APHA), corrected his findings in a speech in 1873 to the APHA.
WATER
In Bangladesh the government developed 33 000 tube wells because the people were drinking contaminated surface water and getting diarrhoeal diseases.
A health worker in Dhaka told me that for some months of the year her garden produced fish not flowers, and she and her husband had to catch a boat to work.
The tube wells, which were supported by a grant from UNICEF, were completely free from organisms -- in other words the water could be drunk, it was potable.
One would expect that, since the centre for International Diarrhoeal Diseases is in Dhaka.
What they failed to do was to test for heavy metals including arsenic.
This was surprising, since the Ministry of Mines knew that the ground water was contaminated with arsenic in the whole region; but that information never reached the Ministry of Health or the Ministry of Water Development.
Arsenic is a colourless, soluble, tasteless and odourless poison. It also is never excreted from human body -- in other it accumulates until it causes disease and finally kills the victim.
As a result some 10 000 people suffered from arsenic poisoning. This was a complete reversal of what it was intended: viz to raise the health of the people in the country side.
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GOLD
Irian Jaya, Indonesia, has the largest deposit of gold in the world. It also contains a large amount of copper and other minerals.
The mine is located some 14 000 feet (4 200m) above sea level, and so there is no malaria there. But the main village where people stay is about 40 miles (65km) from the sea, at about 1 200 feet (360km) above sea level, and that village has grown exponentially from under 500 to well over 35 000 people in fifteen years.
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