For a Few Pennies More
Kamidi lives on the slopes of Mount Merapi in Indonesia, one of Java’s most active and dangerous volcanoes. He’s three foot tall and has the tell-tale signs of cretinism: low hair line, bulging eyes, stunted growth – all associated with iodine deficiency, common in volcanic areas. Twenty years ago, Dr. Djokomoelyanto, a distinguished Indonesian endocrinologist injected large numbers of cretins in the surrounding area with iodine-infused oil. Kamidi was one of his patients. Within weeks, as Prof. Djokomoelyanto recounts in this moving Life programme, the cretins started feeling more energetic and lively. Kamidi eventually even married – another, taller, cretin, who’d also been treated with the iodine-infused oil, and they had two normal children.
Their son Rame is of above average intelligence and the first member of his community ever to attend university. Now a chemistry major, Rame recalls, ‘If I get to become a good scientist I’d like to find ways of helping people like my Dad. When I was a child, I used to dream of inventing some cure or treatment to make my Dad normal.’ Now he’s aware it’s too late for his parents – but he’s passionate about making sure other Indonesians don’t suffer the same, avoidable fate.
According to WHO, one-third of the world’s population (some 2 billion people) are at risk of iodine deficiency disorders (IDD). IDD affects 50 million children worldwide, and 100,000 cretins are born every year. Yet it can easily be cured through the use of iodised salt – at the trivial cost of 5 US cents per person per year.
But iodine deficiency doesn’t only cause goitre and cretinism. IDD can seriously damage the brain, slowing mental responses and impairing intelligence levels. Even moderate IDD can lead to a drop of 10 – 20 points in the IQ performance of sufferers. Women with IDD are particularly vulnerable – and are more likely to have stillbirths, miscarry, or have low birth-weight babies with permanent brain damage or cretinism. According to Dr Untung Widodo, Director of the IDD Research Centre, Borobudur: “Children suffer most – they’re slower and less intelligent. Then, as adults, they will be weaker and unable to work as well . . and they’ll be less productive and won’t have the same quality of life. In fact it’s like losing a huge part of your life, never getting the chances you should have had.”
Rame’s story is vivid proof that the right dose of iodine can end the scourge of IDD. Iodised salt is the best way of ensuring that everyone gets this essential micronutrient, and Unicef and WHO have worked with many governments to introduce it. In Indonesia, salt producers are legally obliged to add iodine to salt. But when Dr Untung finds evidence of early goitre among schoolchildren, he goes to their homes and checks the salt their families use. Although labelled iodised, there is little or no iodine in it. The people are being cheated by the salt producers.
Dr Untung is outraged. “Of all the salt we tested, only one comes any where close to the legal standard. This is a very serious situation in an area where there is already a serious lack of iodine. . . We need stronger laws – and supervision to back them up.”
A recent report by the World Bank shows that the lack of essential micronutrients, including iodine, in food can lead to a drop in Gross Domestic Product of up to 5 per cent. Prof. Djoekomoelyanto points out: “That’s more than the sum of money spent on education in our country!”As Dr Gro Harlem Brundtland explained when launching the WHO campaign to eradicate IDD: “Iodine Deficiency Disorders constitute the single greatest cause of preventable brain damage in the foetus and infant, and retarded psychomotor development in young children. When elimination of IDD is achieved it will be a major and total public health triumph, ranking with small pox and poliomyelitis.”Dr Untung sums it up: “IDD is a simple problem which we know how to fix – cheaply and effectively. But for the relative cost of just a few pennies we haven’t done it. Instead our country is being held back with a much more serious and costly problem.”