June 22, 2006

 Iodine is a micro nutrient which should be included in the food chain for proper physical and mental development. The most effective channel for consumption is through iodised salt, but not everybody pays attention to the daily dietary requirements, taking the number of people suffering from Iodine deficiency disorders worldwide to nearly one billion, reports Shehar Bano Khan

For two years, 20-year-old Naziran has been rubbing her swollen neck with a black balm sold by a local hakim in Depalpur, who says that the inflamed condition of her neck is from inhaling the smoke from coals while cooking! Her neck’s stubborn resistance to benefit from the balm has made her think about alternative treatment.

Diagnosed with goitre at a very young age, Naziran’s family preferred the hakim’s daroo (as medicine is known in Depalpur by the locals) over regular medical treatment. By the time Naziran’s throat had swollen to a level of high discomfort, her parents had exhausted the usual means taken up by local villagers, last of which was taking Naziran to a spiritual healer. It was not until the government sponsored campaign to raise awareness against this condition called goitre began that she was taken to a medically certified doctor. “I feel better now but wish we’d gone to a doctor earlier,” says Naziran.

Goitre –– a condition of enlarged thyroid –– is not an uncommon illness in Depalpur, one of the tehsils of district Okara, which is located nearly 110 kilometres southwest of Lahore with a population of 1.14 million. Caused by iodine deficiency in diet, the WHO (World Health Organisation) has marked goitre one of the most serious health hazards across Pakistan.

In a 1993 Unicef survey 70 per cent of the population was estimated to be at the risk of Iodine Deficiency Disorders (IDDs). Despite a rigorous campaign by the Unicef in the late `90s to arrest the deficiency, only 20 per cent presently use iodised salt, making iodine consumption here one of the lowest in the region. In India, it is estimated that 70 per cent of the population uses iodised salt and the consumption in Bangladesh is 78 per cent.

In one of the campaigns conducted by the Church World Service-P/A (CWS-P/A), a non-governmental organisation working to eradicate IDD in Punjab, it was discovered that 84 per cent of the people in Depalpur had goitre, making the tehsil fall within the dangerously high goitre zones.

Iodine is a micro nutrient which should be included in the food chain for proper physical and mental development. The most effective channel for consumption is through iodised salt. However, not everybody pays attention to the daily dietary requirements, taking the number of people suffering worldwide from IDDs to nearly one billion.

Iodine is necessary for the synthesis of the thyroid hormones, triiodothyronine and thyroxine, usually referred to as T3 and T4 in medical jargon. In the absence of iodine, these hormones cannot be made which forces the pituitary gland to release the thyroid stimulating hormone (TSH), which tries to increase the synthesis of T3 and T4, causing the thyroid gland to grow in size.

“Goitre is curable but if left unchecked, it can become cancerous. Typical symptoms of goitre in children include a low IQ level and in women the lack of iodine deficiency can cause miscarriages and stillbirths. Children who are born iodine deficient can get cretins, a condition of irreversible mental and physical impairment,” explains Dr Tahir Manzoor, in-charge of Unicef’s health programme in Pakistan.

For the people of Depalpur, the iodine related illness of goitre, curable by a pinch of iodine in salt, is an incomprehensible concept. “How is Naziran’s neck condition related to salt? We’ve been using salt in our food. I don’t understand how this thing called iodine is the reason. I think hakim sahib is right. It’s the smoke from the coals we use to cook food which has caused the swelling. Look at her! At 20, she’s still unmarried and I don’t think anybody would want to marry a girl with a swollen neck,” says Naziran’s mother, Muneera resignedly.

Owing to the low literacy rate in severely afflicted places like Depalpur, raising awareness to consume iodised salt is a task many organisations would rather keep away from. In 2001, the CWS-P/A, along with a local organisation Punjab Lok Sujag, decided to bring IDDs into its net of social development programmes and launched a campaign targeting 22 villages in Depalpur alone. Results revealed that every third person shared Naziran’s condition of goitre. Around two per cent suffered from a severe case of ‘third degree goitre’ and 88 per cent of children, between the age group of six to 10 years, had moderate to severe iodine deficiency.

“You know how these NGO funded projects are. The government is only interested in taking money from the donors and doesn’t care about the implementation of the programme. I know for a fact that funds to cure iodine deficiency came from Unicef in the late `90s. Even now the sole distributor of iodine to Pakistan is the Unicef.

“A few years later the Punjab government lost interest in the project. That’s why we still have a high goitre rate in Pakpattan and Depalpur. The government’s contention for not paying much attention to the illness is that compared to other lethal diseases goitre is not such a big issue. Nobody dies from it!” says an employee of the Punjab health department.

A major part of the problem is that legislation on Universal Salt Iodisation (USI) and national IDD does not exist. The federal government has not outlined an appropriate method to prescribe iodisation on a national level, leaving the job to be done by the provincial governments.

“The Unicef is the sole provider of iodine to Pakistan but the provincial governments have not done anything to set up a system to make iodine available to salt processors. The single point for distributing iodine in Punjab is Lahore. It is difficult for people to come all the way to Lahore for that. Even though the draft is ready for nationwide salt iodisation, the Punjab government is not interested in passing the legislation because iodisation is not an important issue,” says Tahir Mehdi, national coordinator for the Punjab Lok Sujag.

Dismissing the salt iodisation programme in Pakistan as a failure would mean a loss of faith for many in Depalpur, whose goitre condition is gradually improving with medication. Hameeda scoffs at Naziran’s mother’s naiveté for not taking iodised salt. “She’s tried the local hakim’s daroo (medicine) for two years, why doesn’t she try a cheaper way of dealing with Naziran’s problem by using this salt with, what do you call? Oh yes, iodine! It’s much cheaper and effective,” says she, a proud mother of six goitre-free children.

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