Wednesday, January 16, 2008

Goitre amongst Foochow Women

Many Foochow women suffered from goitre in the 50's and 60's and very little awareness was created on the disease.

While some women whispered about the presence of a big swell on the neck of their relatives, others avoided looking at goitre entirely. Normally when people did not know much about something they had that odd look on the face and "you know what" glance.

Several of my relatives suffered from goitre for a long time and they sought treatment from both the general hospitals and local doctors. some were cured but some had to live with the illness and then one day I was horrified to find out that I might be growing one too. I would use my grand aunt's measuring tape every now and then to measure the size of my neck whenever I had the opportunity. It was not comfortable at all to know that goitre might be genetic, and might even be contagious!! However after a few months, it was just a false alarm. I was just growing a little more flesh on my thin neck. And I remember now that the doctor did not give me the two hands shaking test. It could have saved a lot of sleepless nights on my part.

Several years later I heard from a friend that her relative could not go for further studies because she suffered from very severe goitre which resulted in a nervous streak. I have often wondered if I really had goitre then would my education be curtailed too?

Actually , unknown to many of us Foochows in those days,the causes, prevention and cure of goitre and cretinism, now included in the more general term iodine deficiency disorders (IDD), have been known for more than half a century; yet their total eradication remains an elusive goal.

In recent years, widespread information has resulted due to international meetings such as the World Food Conference in 1974 and the International Nutrition Congress (Rio de Janeiro, 1978) and the Fourth Asian Congress of Nutrition held in Bangkok in 1983.

Medical knowledge available nowadays help us understand that iodine deficiency causes a spectrum of effects on growth and development, particularly brain development in the foetus, neonate and child, justifying a much higher priority now for its prevention and control than in the past. Apart from diminishing the toll in human misery, the prevention of IDD would mean improved educability of children, greater productivity, and better quality of life for many millions living in the iodine-deficient regions of the world. It is now clear that iodine deficiency is a major impediment to human development.

We now know that the best-known effect of iodine deficiency is endemic goitre, of which it is the chief primary etiological factor. Another major effect is endemic cretinism. In its commonest form this is characterized by mental deficiency, deaf-mutism and spastic diplegia. This is more fearful in fact.

Goitre was well known in the ancient world and has continued to be of interest over the centuries. Extensive reviews of its geographical occurrence have been published, notably by Kelly and Snedden (1960) and Stanbury and Hetzel (1980). Endemic cretinism in Alpine Europe was identified by the Sardinian Commission of 1848, and both goitre and cretinism in the northwest frontier region of India were described by McCarrison in 1908 for the first time in modern medical literature.

I remember all mothers were given iodized salts (the greenish salt) by the Mother and Child Health Care Centre in Sibu. As a young girl I did not know much about the salt and in fact looked down upon the coarseness. Actually many years later, I had to beg for a 500 gm bag from the General Hospital when I was told that my health could be improved by genuine iodized salt.

In fact unknown to us then, iodized salt was introduced into Switzerland in 1924 and has since been used in many other countries, especially in Malaysa. And many studies have been carried out since 1960 to study the effects of iodine deficiency in most of the developing countries in the world.

For myself and my children I make sure that we take about 150 mcg of dietary iodine to prevent iodine deficiency.

Please note that goitre itself can arise from causes other than primary iodine deficiency, due to a variety of agents (goitrogens). These, however, are in general of secondary importance as etiological factors.

Many health programmes are being carried out to ensure that Malaysians do not suffer from goitre. Many studies, both local and global have been carried out too to study the various causes of goitre in the remote and poorer regions of the country.

Positive attitudes towards eradication of endemic diseases like goitre in a country truly indicate the sincerity of political will and good governance.

I would not like to see so many women hiding behind a door to just have a peep at the world outside because they have goitre. How much anguish do they have to suffer because of ignorance, social alienation and humiliation.

Goitre should see more light.

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