FORTY YEARS after the development cure for leprosy this affliction still disables more people than any other known to man. Worse still — only four million ofthe estimated 15 million sufferers are receiving any treatment.
This is largely because leprosy, once prevalent throughout Europe, is now confined to the Third World and the poorer parts of developed countries. In conditions of malnutrition, poverty and overcrowding, the human body’s resistance to disease is often diminished People who might otherwise have fought off leprosy before any clinical symptoms became apparent find that their natural defences let them down.
Children are more at risk than adults; nearly five million sufferers are under 14. Not only are they more likely to be in prolonged physical contact with a source of infection but they are also the most common victims of malnutrition.
Once established, leprosy bacilli multiply in nerve fibres, preferring those in cooler areas of the body such as the hands, feet and face. Eventually nerves can become so damaged that the person may lose both sensation in, and the ability to move,the affected part. Most of the resultant crippling is not, as is commonly supposed, due to fingers and toes mysteriously dropping off but because of injury from hot or sharp objects which the person is unable to feel.
Leprosy also blinds at least threequarters of a million people, mainly through paralysis of the eyelids. Unable to see, feel, smell or taste, a badly afflicted person may have to suffer sensory isolation. What can be even more distressing, however, is the social ostracism.
In India, for example, despite government efforts to improve matters, someone contracting leprosy might be sacked from their job, stopped from going on public transport, forbidden to give evidence in court, prevented from marrying or, if they are already married, forced into a divorce. It is therefore hardly surprising that there may be little alternative to joining the ranks of beggars waving distorted limbs.
Despite this, the future is bright There are good prospects for having a vaccine in about 12 years time, but of more immediate importance are the latest advances in therapy with drugs. Conventional treatment with ‘dapsone’ (DDS) usually takes three to four years to effect a cure and there is an increasing problem of leprosy bacilli becoming resistant to it Recently, however, the World Health Organisation has given its seal of approval to a new treatment regime using a powerful combination of drugs. This will enable 80 per cent of patients to be cured within just six months. The other 20 per cent will have their terms of treatment reduced from life to about two years.
Dorothy and Alastair McIntosh
Heads down in Honduras
READERS OF the January NI (NI 107) have heard the philosophy of Gustavo Alvarez, then a Colonel in the Honduran Army. People, he said, should be told that they are poor and they are going to stay poor— otherwise they ‘get ideas’.
This seems to be a view that finds favour in Honduras. Alvarez was subsequently promoted to General and is now commander of all the armed forces. He has been prominant of late in international diplomacy and accompanied President Suazo Cordova to Washington for the signing of a mutual assistance treaty. According to Latin American Newsletter this may entail the tripling of US military assistance.
The United States sees Honduras as a bulwark of democracy and freedom in the area ajudgement that usually bodes ill for the country and people concerned At least 100 people have disappeared so far this year as the military repression is stepped up and more and more people are staying at home at night
Another good reason for keeping out of sight is that a major component in the recruiting drive for the army is the pressgang In Honduras — as in neighbouring Guatemala — young men can be picked up as they are walking along the street and may never be seen again.
A fishy story from Africa
From Food for Beginners by Susan George and Nigel Paige, just published by Writers and Readers Publishers Co-operative.
CIGARETTES are being purchased secretly from market stalls and street vendors in the developing world for a survey backed by the World Health Organisation. The survey, by the Addiction Research Foundation in Toronto, is prompted by the widespread suspicion that cigarettes sold in the developing world have higher levels of tar, nicotine and carbon monoxide than those in the West.
‘We are testing cigarettes on every continent,’ says Roberto Masironi, an official of WHO; ‘About 50 brands are involved in this first operation’. The results are expected by late 1982.
‘Why the tobacco industry would want to sell cigarettes with these higher levels in developing countries is a matter for speculation,’ says Masironi. ‘If they are doing so, it might be for one of three reasons — one, deliberately to keep smokers hooked by giving them more nicotine: two, it might simply be cheaper to produce high level tar cigarettes; or three, it might be that they are dumping stocks they can no longer sell in the developed countries because of stricter legislation.
An analysis of four international brands carried out by the National Cancer Control Centre of the Philippines Department of Health revealed startling facts in 1977. While the same cigarette brands manufactured in the Philippines yielded an average of 31.75 milligrams of tar, in the UK they yielded only 15 milligrams, and in the US, only 17.5 milligrams. The brands tested were Kent, Kool, Marlboro and Chesterfield.
A major battle ss shaping up in developing countries between multinational tobacco giants and a small but growing consumer movement over a threatened smoking epidemic, says Charles Morrow, who was until recently WHO’ s director of information at its headquarters in Geneva ‘It is going to be a battle which far surpasses the infant food controversy in the number of lives it will affect and the dollars at stake.’ Third World governments and international organisations like WHO are going to be caught in the middle.
The seven tobacco companies — British American Tobacco, Imperial Tobacco, RJ. Reynolds, Philip Morris, the South African controlled Rupert/RembrandT/ Rothmans Group, American Brands and Gulf and Western— that control the world market for manufactured cigarettes have begun to feel seriously threatened by the levelling off of smoking in wealthier countries, says Morrow. Per capita consumption of cigarettes amongst adults over 18 years steadily went down in the US from a high of 4, 148 in 1973 to about 4,000 in 1978. In the UK, per capita consumption has since 1975 been going down by three to four per cent per year.
According to Morrow: ‘Internal correspondence from the multinationals based in the United Kingdom, which was obtained by WHO officials, has shown that industry has adopted a two pronged strategy to protect their profits. First, they would proclaim their willingness, in developed countries, to go along with voluntary restraints on advertising and promotion while stoutly resisting legislative controls. They would continue to write the rules of the game. Second, they would greatly expand marketing and sales efforts in the Third World, where they are unhampered by bothersome restrictions.’ Per capita cigarette consumption in the developing world rose from 539 cigarettes in 1960—64 to 685 in 1972 and is expected to rise rapidly to 830 by 1985.
‘But even in wealthy countries,’ Morrow points out, ‘politicians have found that there is little credit in anti-smoking campaigns. Joseph Califano, popular Secretary of Health, Education and Welfare under President Carter, was widely believed to have been fired because of his singleminded attack on the tobacco companies. Sir George Young, Junior Minister of Health in a recent Thatcher cabinet, was quietly removed during a bitter battle with the U K tobacco industry on toughening up a voluntary code on cigarette marketing.’
In developing countries, as farmers get hooked on to growing tobacco, governments are becoming heavily dependent on tobacco-based revenues, something the industry is always quick to point out. When health warnings were proposed in the Philippines, the tobacco barons there immediately reminded the government that cigarette and tobacco taxes contribute 47 per cent of government revenue.
But more and more societies are beginning to pay the price in terms of health. In ten cities of Latin America smoking was recently held to be responsible for 20 per cent of all fatalities. In East Africa, where lung cancer was a rarity, the disease is now on the rise. In India, the number of smokers suffering from chronic bronchitis is three times that of non-smokers and cancer is also on the rise. Recent US studies show that even non-smokers who live close to smokers can get cancer.
Ujjayant N. Chakravorty, CSE
ISRAEL’S occupation in 1967 of the West Bank, Gaza Strip and Golan Heights was ostensibly a matter of self-defence. But in fact there were sound economic reasons for that war— the control of a large unskilled labour force, a protected market of 1.5 m people and considerable water resources.
The West Bank produces 850m. cubic metres of water annually yet only 14 per cent of this is consumed by Palestinians themselves. The remainder is pumped across into Israel or consumed by the Jewish settlers for their water—intensive agriculture and for their swimming pools.
But one 01 the primary reasons why Israel will never voluntarily tolerate an independent Palestinian state on the West Bank and Gaza Strip is that they now constitute Israel’s biggest foreign market, larger even than the United States. No produce is allowed into the West Bank from neighbouring Jordan and all consumer goods are either made in Israel or bought through Israeli middlemen from abroad. Since 1967 the West Bank and Gaza’s economy has become dependent on and subservient to Israel’s.
The West Bank has few natural resources and it has to import 75 per cent of the raw materials needed for its small industrial sector. It is effectively a protected market for Israeli goods, aided ironically by Jordan’s refusal to import anything from the West Bank that is made with Israeli materials, in accordance with Arab boycott rules.
Encouragement is given to Arab farmers to grow crops that are required by Israel’s economy. Tomatoes and sesame from the occupied territories are sent to Israeli tinning and bottling factories and are grown at the expense of traditional crops. This gives the Israelis more control over the livelihoods of more Palestinians.