Poverty and Disease

Now we have the challenge of non-communicable diseases – but we are in a better position to face them. If we don’t, we will have to deal with what could be termed the ‘impoverishment’ that comes with affluence

As our country has developed there are many things that we have taken for granted. Clean drinking water is one of them. We just have to open the tap and it comes rushing forth on a practically 24/7 basis. Of course when there is a drought situation prevailing or post cyclones there is some constraint, which is short-lived, and everything is done to restore the supply back to normal as soon as possible. We never stop to think about those who are not as lucky.

About two million children die every year around the world from water-borne diarrheal diseases because they don’t have clean water to drink or wash with. And even if they do, a lack of soap can also contribute to this avoidable mortality. I was listening to a BBC report from Cambodia the other day, in which a doctor at a children’s hospital was commenting on this issue and how an innovative solution was found. In fact, an arrangement was made to collect left-over soap cakes from the many tourist hotels that were situated “a stone’s throw” from the world famous Angkor Vat site. They were then simply processed to rid them of germs and distributed or sold at nominal rates to households in the villages, and people – children in particular — were encouraged to use them for washing hands especially after using the toilet.

In an earlier article (‘Poverty: what it meant, and means’) two weeks ago, I wrote about some of the conditions prevailing in the 1950s/60s when absolute and relative poverty were prevalent. Many people did not have running water in the house, and had to collect water from la fontaine, the public fountain. People would reach there with their pails and stand in line, in the morning and late afternoon. Sometimes there would be fights – mostly verbal, fortunately! – as some individuals would try to jump the queue.

There was a public fountain in Farquhar Street, Curepipe Road, where we lived, a little distance away from its junction with Abbe Laval Street. As kids we would at times go there for the fun of it, and as we had running water at home we did not have to use the public fountain. But in Galea Road, Castel, where my nana (maternal grandfather) stayed, there was no running water in his thatched house, and when we visited we found it fun to go and collect water from the public fountain not far away – and listen to some village news while waiting.

On the other hand, in Midlands village, where my cousins had their maternal grandparents and I visited too, I distinctly remember going down to the riverside to collect water, which was then boiled before use for drinking and cooking. This gets rid of bacteria and viruses (when boiled for at least 15 minutes), but there are some diseases caused by parasites that cannot be eliminated by boiling. In this case the waterways must be cleaned mechanically and people advised to protect themselves when they go to the rivers.

For example, in West Africa in particular, a disease called river blindness used to affect the eyes of millions of people who frequented the rivers contaminated by a worm that entered their bodies through the skin of the legs, whence it travels to the eyes. A systematic public health campaign led by the Carter Foundation has reduced this scourge to mere hundreds with hope that it will soon be a thing of the past. In Mauritius, La rivière Citron in Pamplemousses was notorious for harbouring a snail that carried a parasite which lodged in the human bladder and eventually caused the infected person to pass blood in the urine. Here also, a successful public health campaign resulted in getting rid of this problem, so that we are now free of bilharziasis as the disease is known.

Today we are all familiar with non-communicable diseases or NCDs such as diabetes, cardiovascular diseases, cancer, etc., which are associated with what is called our bad lifestyle, essentially eating the wrong kind of foods (fast food), not doing enough exercise, abusing of alcohol and smoking tobacco. The late 1970s and post-1980s generation are totally unaware of the burden of communicable or infectious diseases and their morbid consequences – along with high death rate, and often early death – suffered by those who preceded them.

The main cause was poverty, and poverty meant: inadequate housing and overcrowding, poor hygiene and sanitation: inadequate water supply and primitive toilet facilities; insufficient income; malnourishment and undernutrition. House yards were of bare earth, and children went about (many even to school) and played barefoot. There were all kinds of infectious diseases such as gastorenteritis, worm infestations such as hookworm and roundworm, typhoid fever, whooping cough or pertussis (la coqueluche), measles, malaria, respiratory infections and diptheria which was invariably fatal, tuberculosis, skin infections such as scabies (la galle). One common heart condition was rheumatic heart disease; it was triggered by a specific throat infection and affected the heart valves that could in turn result in heart failure and death because there was no adequate treatment.

A document titled Health of Slaves, Indentured and their Descendants in Mauritius (2011) produced for the Truth and Justice Commission under the leadership of Dr J Mohith, former Chief Medical Officer and Executive Director of the Mauritius Institute of Health gives a comprehensive and detailed account of the health situation and its development in our country from our historical past. On page 94, we read as follows:

‘The last quarter of this period corresponding to the 1950s and 1960s will be remembered for the bold and scientifically sound health measures taken by the health authorities. These initiatives were translated into programmes that proved to be very effective at the community level. These included malaria control programme, the tuberculosis control programme and the vaccination programme against diphtheria, pertussis, tetanus, poliomyelitis and tuberculosis.

‘In addition an innovative, people-centred family planning programme received wide acceptance from the population. The successful implementation of these programmes made Mauritius complete its epidemiological and demographic transition. Furthermore, diseases like amoebiasis, helminthic infections, gastroenteritis and enteric fever were eliminated by public health engineering works that ensured safe disposal of human waste through a sewage system development, and provision of safe water supplies.’

We must salute the pioneers who toiled to create the enabling atmosphere conducive for the developments that were subsequently brought about and made our country a healthy and safe place to live in. Now we have the challenge of the NCDs – but we are in a better position to face them. It’s up to us, individually and collectively. If we don’t, we will have to deal with what could be termed the ‘impoverishment’ that comes with affluence.

For, paradoxically even as our life expectancy increases because of better living conditions, living longer brings with it the downsides of old age. Not only do we develop infirmities, but one of the many dimensions of living longer, especially if one has lost one’s spouse, is loneliness and social alienation, not to speak of increasing difficulty to look after oneself as all faculties gradually – but sometimes brutally too – wind down. With the added reality that in these days of the nuclear family, children (if any) prefer to live away (if they are not already overseas), and to be self-centred. And these realities are mentally and emotionally harder to bear that physical disease. Something to reflect and be proactive about…

RN Gopee

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