Published by the government of Zimbabwe
10 May 2008
column
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.
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.
The mining company, which is a joint venture between the Indonesian government and the American private company called Freeport, spends US$3 million a year on controlling mosquito breeding in that village.
As a result malaria dropped from 85 percent of the population when it was 600 people to less than 7 percent now that the area has been taken over by the mining company who now employ and house all the staff of the mine -- some 35 000 -- at Timika.
However, US$3 million a year is a lot to spend on one disease for 35 000 people, and the government of Indonesia has to take over the control of health in that area.
MALARIA
In Africa where malaria is a problem in many countries and kills about a million people a year. Roll Back Malaria (R.B.M) has recently introduced insecticide impregnated bed nets to control malaria. It goes without saying that you cannot do night fishing under a bed net however large it may be (but of course, you can use the net to catch fish).
There are a lot of other nocturnal activities that you cannot do under a bed net. It is of little surprise therefore, that people in Africa do not value the bed net in the same way as it is in Geneva even when it is supplied subsidised, or even free, by the RBM programme.
More recently RBM has introduced a new treatment for malaria, the Chinese remedy called Artemesin. It remains to be seen if the sufferers from clinical malaria do any better under that treatment than they do at present under Chloroquine or Sulphur-pyrimethamine treatment.
Getting to the treatment in time is a major logistical problem in many parts of the world and Africa is no exception.
Zimbabwe has long known the importance of keeping drugs intended for prophylaxis separate from drugs intended for treatment, but the latest strategy, is described as "an exciting new scientific finding" is just that it consists of treatment for children under one year old in endemic areas of malaria.
It was tried in the 60's in Malawi using Chloroquine, a quarter of a tablet given everytime the child came for immunisation.
Some scientific observers say that Chloroquine administered in this way hastened the development of resistance to treatment by the drug, and certainly Malawi is one of the high prevalence areas of Chloroquine -- resistance today.
The programme is being financed by the Bill and Melinda Gates Foundation.
RBM has had little effect on the total malaria cases.
IODINE
Adding iodine to salt without altering its taste or texture is a very effective way of preventing goiter and preventing cretinism -- a major illness of new born infants and young children that affects the development of the brain.
Zimbabwe has over the past 13 years added iodine to table and stock feed salt with a dramatic decline in the incidence of goiter and cretinism, but every stakeholder has to be part of the programme.
So the manufacturers of salt have to source their product from iodated salt producers, and the population have had to be trained to use refined salt rather than rock salt, which in parts of this country, notably Chipinge was traditional.
l To be continured
The success of this story is now a matter of history, but its sustainability depends on all the stakeholders ascribing to the programme. Already the amount of iodine has been reduced, because the Japanese who provided the potassium iodate have raised its price relative to the cost of salt.
Fortunately the level of iodine was too high which meant we had a few cases of hyperthyroidism in Zimbabwe. So reduction of the percentage of iodine added to salt is not affecting the health of this nation to any great adverse extent.
PELLAGRA
Pellagra was known for about 300 years as a disease entity of communities in Europe. It was thought to be infectious or contagious because it affected all people in those communities, was associated with itching and discolouration of the skin and, like leprosy, led to severe complications and even death in an epidemic form.
Dr Joseph Goldberger was born in Hungary, but he worked for several years as an infectious disease expert for United States Public Health Service in the years 1900 to 1912, especially amongst new immigrants to America from Eastern Europe.
He became convinced that diet, not an infectious organism, was the cause of pellagra. He carried out a lot of experiments in the deep United States where pellagra had recently been identified, using diets which he made himself. He fed the diets to groups of volunteers including prison populations and his own researchers. As a "Coup-de-gras" he even injected his own blood from a pellagra victim! His wife remained well.
He proved that pellagra was, like scurvy, a disease caused by deficiency in the diet of poor people. Eight years after he died nicotinic (B2 Vitamin) deficiency, was discovered to be the cause of pellagra. Nicotinic acid is in eggs, meat and milk which the poor people of USA could not afford. It is also in brewer's yeast, which Goldberger used to cure pellagra.
BREASTFEEDING
Every mammal feeds its newborn young from especially designed secretory organs and the secretion is known as milk. Humans were of a different opinion, so the breast became an object of sex not food. Synthetic milks, which increase the GDP of countries of the developed world, took over. Dating from about 1925, the expected consequences of the developing world having to buy these expensive breast milk substitutes from companies in the developed world was seen. One estimate for Mali, one of the poorest countries in Africa, indicates that it will have to increase its GDP by 23%, if all the women were to feed their babies with safe artificial milk.
The advent of HIV/AIDS poses a dilemma for primordial breast feeding understanding. HIV can be transmitted from Mother to Child by breast milk; however, even in the developed world where choice is not constrained by money, this has been shown conclusively to be an overstated situation. Of course, those who wish to sell their formulae have latched on to this observation.
As a result Zimbabwe in its leadership capacity has promoted breastfeeding by passing strict laws and regulations on the use of artificial substitutes of breast milk. We are at present challenged by transnational dairy companies because our law is very explicit and does not accord with the easy going Botswana and Namibia laws, let alone the business fraternity in South Africa who are making very bold attempts at circumventing our laws because they are not the same as in Zambia or South Africa. SADC Laws apply to them, not Zimbabwean law.
BLOOD PRESSURE TREATMENT
A prominent singer for the New York Metropolitan Opera lost his singing voice and therefore his lucrative job. For two years after a very embarrassing performance in Canada he was unable to sing as he used to. By chance conversation with an amateur singer who was also a family doctor he found out why he had lost his voice. It was because he was being treated for high blood pressure with a substance known as an ACE inhibitor, one side effect of which was the alteration of the voice box.
He changed his treatment , recovered his singing voice and also his profession.
Thus health can be affected without directly addressing the health system in a major way throughout Zimbabwe and the world.
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