ENEMIES OF PROGRESS

By J. JACKSON

FOR perhaps the first time in history, the People of the technically more advanced countries of the world feel a moral obligation to help their much less fortunate, impoverished fellow human beings in the underdeveloped areas. Of course, the feeling is not purely dis- interested. At the back of everybody's mind is always the thought that, if these people are allowed to remain impoverished, they will be lost to the Communists. All the same, never before has there been such a general, uneasy awareness that we, in the developed countries, are a small, fortunate minority, and that the normal lot of the majority of mankind elsewhere is back- breaking labour, poverty and disease.

As a result, whether of our feelings of guilt or our fear of Communism, vast sums of money are being spent on aid to the underdeveloped countries. Britain's contribution in 1961, for example, was £162 million. This may be, as has been pointed out, less than one-seventh as much as was spent in that year on tobacco, but it is nevertheless a respectable sum.

In practice, it sometimes happens that it is not always quite as simple a matter to help the underdeveloped countries as it might seem at first sight. This is partly due to the complexity of some of the problems involved, so that, if a narrow view is taken of them, the 'solution' found may, in fact, merely create other problems. In connection with one extremely important problem, as will be seen later, quite extraneous factors have almost completely prevented any- thing at all being done about it. The existence of such difficulties was recognised by the United Nations when it called the Geneva Conference on the Application of Science and Technology for the Benefit of the less-developed Areas. Since some 2,000 papers from eighty-nine coun- tries were submitted to the Conference Secre- tariat, the subject is obviously one of vast ex- tent, and in this article I shall be able to deal with only a few aspects of it.

What it means to live in an underdeveloped country can be seen in all its crudity from the figures for infant mortality. If you have the mis- fortune to be born in such a country, you may be as much as fifty times more likely, to die in your first year of life than if you had been born in a developed country. If you survive this first year, then from the time you are one until You are four years old your chance of dying Is only about thirty times as great as that of a child in a developed country. In many parts of the world, about half the children born to low-income groups of the population die before they reach the age of five.

The essential cause of most of these deaths, either directly or indirectly, is malnutrition, but malnutrition of a special kind: an inadequate supply of the necessary body-building sub-

stances called proteins. Where this protein de- ficiency child may not itself responsible for death, the y be so weakened from it that he dies from an infectious, or other, disease, which would not have been fatal if he had been well-

nourished. Since 1933, protein deficiency in children has been known, in the English-speaking world, mainly under the African name of kwashiorkor, but it is widespread throughout the underdeveloped world, and has been given many names.

Kwashiorkor is said to mean 'the disease a child gets when the next baby is born' or 'sick- ness of the deposed child.' In fact, in under- developed countries, weaning is a very dangerous stage in the life of a child. In the absence 01 any industrially-produced baby foods, breast feeding is universal and, during the first six months of life, can supply all the child's needs for protein. Even after that age has been reached. it remains a valuable, if no longer completely adequate, source of protein.

The most dangerous moment comes when the child is completely weaned, because under- developed countries suffer from a chronic shortage of foods rich in protein. These arc mainly animal foods, and animal-rearing tech- niques are invariably at a low level in such countries, or they may be plagued with animal diseases which make it difficult to keep cattle at all. Thus the small child will probably be weaned on to a diet of bulky, starchy foods, which alone are cheap and readily available.

The beginnings of industrialisation, with the movement of population from villages to cities, may make matters worse. Mothers may tend to abandon breast feeding to enable them to return to work, while they are exposed to advertising for tinned-milk preparations which they can never afford in adequate amounts. With the growth in population now taking place, less food of any kind is becoming available, and the ten- dency is to produce more of the starchy foods, because they are easier to grow. It is possible, therefore, that in spite of the general progress that is being made, the amount of kwashiorkor is nevertheless increasing.

What is urgently needed is clearly a readily available, cheap source of protein, capable of being produced on a mass scale, and within the reach of the poorest sections of the popu-

And can't even run u jumble-sale.' lation. Obvious cheap sources of protein include fish and certain vegetable foods which contain protein. Research is in progress in many parts of the world on the development of such foods.

Fish flour, which has been developed in the US, would seem to be everything that a cheap, protein-rich food should be. It has a high protein content, keeps well without needing either a refrigerator or an expensive packing, and is tasteless. It is also cheap, but only if made from whole fish, since the labour involved in gutting the fish would raise the price con- siderably

The manufacturer submitted his product for certification to the FDA (the Food and Drug Administration : this is the body which was re- sponsible for preventing the sale of thalidomide in the US). In January, 1961, the FDA com- mented that the product contained fish eyeballs, intestines, gills and scales, and came to the con- clusion that consumers in the US generally would regard the product as filthy (it must be noted that the word 'filthy' is here used in the specialised sense that it has in American food and drug legislation).

As a result, the request for certification was refused, and fish flour, as made at present, can- not legally be sold in interstate commerce (thanks to the federal structure of the US and the legislative rights of the States, the FDA has jurisdiction only over trade in products which cross a State boundary). This, of course, is of no importance in America itself, where there is no shortage of protein. Any attempt, however, to supply the underdeveloped countries with fish flour could lead to the accusation that the US Government was trying to get foreigners to eat a product considered to be unsuitable for the Americans themselves.

While one American official body has damned fish flour, another is trying to rehabilitate it. This is the Bureau of Commercial Fisheries of the Department of the Interior, which is in- terested in fish flour, not so much for the sake of the peoples of the underdeveloped countries,

as for that of the American fishing industry, for which a new and important source of income

could be made available. At the request of the Bureau, no less a body than the National Academy of Sciences has made a study of fish flour, and has recently announced its conclusion that it does not deserve to be called filthy. Fish flour, in the opinion of the Academy, is more

wholesome than many whole-fish products to

which the FDA has never raised any objection, including sardines, oysters, clams and shrimps.

To this argument the FDA has replied express- ing its unconcern, since, it says, such products were widely eaten before the FDA existed. While the sight of two government departments in con- flict may arouse a certain amount of amusement, it seems unlikely that fish flour can ever lose the label of 'filthy' tacked on to it by the FDA, and thus the peoples of the underdeveloped countries may never benefit from this cheap source of protein. Some of the underdeveloped areas of the world are also areas which suffer from a shortage of water. Here, the most obvious way of helping would seem to be by the construction of dams and irrigatiOn systems, but there are difficulties involved, which are not obvious at first sight. One of the most important of these is the fact that, unless special precautions are taken, the construction of dams and irrigation systems may result in the increased spread of dangerous and debilitating tropical diseases. Reservoirs, for ex- ample, may provide breeding grounds for the larve of the mosquitoes which carry malaria, although this can be prevented by deliberately varying the water level at certain times.

Less obvious is the connection between irri- gation schemes and the disease called bilhar- ziasis, which is caused by certain species of blood fluke living either in the urinary bladder or in the intestine. During 1958-60, a WHO Bilharziasis Advisory Team surveyed the situa- tion in fifteen African and Middle Eastern coun- tries, and found that twenty-six million people out of the total population of about 107 million of these countries had the disease. In Mozam- bique, 75 per cent. of the population was affected; in Egypt alone, about twelve million People.

Bilharziasis cannot be transmitted directly from Man to man. The fluke must pass through an intermediate stage in its life cycle, which it does In certain species of water snail. It is here that the connection with irrigation arises, since irri- gation canals can provide just the right environ- ment for these snails. For preference, the water must not flow too fast in these canals, suitable vegetation must grow in them to provide cover and oxygen, and they should be unlined or silted Up, so that the snails can bury themselves in the mud and thus survive during periods in which the canals are not used and dry out.

These conditions are relatively easy to satisfy, since, in underdeveloped countries, irrigation canals are often unlined. This means that the Water must flow through them relatively slowly, otherwise the banks will be washed away, while they provide ideal conditions for the growth of water-weeds, together with the muddy bottom needed by the snails as a refuge when the canals dry out.

Since it is easier to kill the snails than cure the disease, a great campaign for their exter- mination is now in progress in the countries affected. Yet bilharziasis is actually increasing, and the new breeding grounds for snails pro- vided by big, new irrigation schemes are pre- sumably behind this failure to control the disease. As pointed out in the report of a WHO Expert Committee on bilharziasis, there has often been inadequate liaison between the public health authorities and those responsible for irrigation, While irrigation engineers, in general, are not trained to appreciate the health aspects of irri- gation schemes. The same report states that the infection with bilharziasis resulting from irriga- tion has sometimes been so intense that expensive schemes have had completely to be abandoned. The WHO Bilharziasis Advisory Team has given figures for six African and Middle Eastern countries showing that, in the next ten to fifteen Years, they expect to irrigate areas of land large enough to support from fifteen to fifty million

people.

The team comments laconically that 'the economic, sociological and public health prospects of such developments are staggering.'

The snails which carry the flukes in their in- termediate stage are so small that it seems impracticable to try to use filters to keep them out of the canals (snails or their eggs have actually passed through turbine pumps rotating at high speeds). The only control methods avail- able, in addition to the poisoning of the snails, as now practised, involve the removal of vegeta- tion and weeds, varying the water level in reser- voirs, as in malaria control, and the lining of the canals with cement, stone or brick. This last, of course, increases the cost, as does the use of concrete pipes instead of canals altogether, a technique which is widely used in California.

Of course, the infestation of irrigation canals with water snails would not be of any importance if these canals were not also contaminated with human excreta containing the immature flukes responsible for the disease. Unfortunately, it is not easy to convince people who do not believe in the germ theory of disease that there is any advantage in using a smelly pit latrine and in giving up their aesthetically much less repulsive practices.

Apart from malaria and bilharziasis, the spread of yet another distressing and disabling disease, onchocerciasis, otherwise known as African river blindness, may also be encouraged by irrigation. This disease is transmitted by a species of fly, for which reservoirs again often provide ideal breeding grounds. There has recently been an alarming spread of onchocerciasis, which already affects some twenty million people, into areas in which it was not formerly prevalent, such as Dahomey and certain regions of Ethiopia. As a recent WHO report points out, the combination of irrigation schemes with the concentration of large numbers of people around them may give rise to very favourable conditions for the rapid spread of the disease.

Even viewed purely as a means of increasing water supply, irrigation has its disadvantages. If unlined earth canals are used, there is a loss of water by leakage and seepage. To this must be added, especially in hot countries, the water lost by evaporation. It has been estimated that, even in the US, where presumably canals with an impervious lining are widely used, one-third

He says he's musing on the great days when our ancestors ruled the buffalo, but he's really had that look on his face ever since we saw 'Only Two Can Play' at the drive-in!' to one-half of all the water diverted for irri- gation is lost before it reaches the fields it is supposed to irrigate. Loss by evaporation is par- ticularly important, naturally enough, where large water surfaces are exposed to the sun in the artificial lakes formed behind dams. It has been calculated for the lake to be formed behind the Aswan High Dam in Upper Egypt that about ten million cubic metres of water, or nearly 8 per cent. of the total storage capacity, might be lost by evaporation at the high temperatures en- countered there.

Fortunately, a method of reducing evaporation losses has been developed, partly in Australia, where the problem is one of great importance. This involves the spreading over the water sur- face of certain substances, which form a layer on it only one molecule thick. The substances used have a kind of dual character: they are partly soluble in water and partly greasy, and in contact with water the soluble part enters the water surface while the greasy part is turned away from it. Thus the water becomes covered, in effect, with a greasy film, and it is this which reduces the amount of water evaporated. The film must be frequently renewed, not only be- cause it may be attacked by bacteria or eaten by fish, but, more importantly, because it may be broken up or blown completely on to the shore by the wind. This frequent renewal, of course, increases the cost.

At Aswan, it appears that the Egyptians are aware of the problem and of this method of dealing with it, though the high temperatures of Upper Egypt may make the handling of the chemicals more difficult. Experiments are now in progress, however, and Abdel Aal el-Medani, of the Ministry of Public Works, who is in charge of them, has estimated that the value of the water saved would be as much as five times the cost of the chemicals and the equipment used for spreading them on to the water.

The increasing population of the under- developed countries and its effect in generally reducing food supplies were mentioned earlier. In fact, this increase is now at a rate of 2 to 21 per cent. every year, while the annual rate of economic growth of these same countries is only about 3+ per cent. Even if, as envisaged under the Development Decade of the United Nations, this annual rate of growth could be raised before 1970 to 5 per cent., a great deal of this growth would still be taken up merely in keeping pace with the population growth, and the real rate of improvement in standards of living would be correspondingly less. The question of population growth, and consequently of methods of con- trolling it, is thus fundamental to the whole question of assistance to the underdeveloped countries, yet it is one about which surprisingly little has been done. Greenwood, writing in Science, the American equivalent of Nature, says that opposition from Catholic countries has pre- vented the giving of advice or assistance on birth control to be provided as part of technical aid schemes sponsored by the United Nations.

In its early days of power, the Kennedy administration appeared to be reversing Eisen- hower's policy of refusing even to acknow- ledge the existence of the problem of population growth. In introducing the Alliance for Progress, Kennedy did point otit that the rapidly growing population of South America made development difficult. More recently, however, the administration's wariness about the whole subject was shown by its refusal to release without 'editing,' a Public Health Service report on fertility which, according to Green- wood, probably contained a recommendation that more research on the development of improved methods of contraception should be carried out. The reason for this wariness seems fairly obvious: it is not so much that both Kennedy and Celebrezze, the Secretary for Health, Education and Welfare, are themselves Catholics, as that the Catholic vote is too im- portant a factor in American politics to be antagonised.

In fact, only one country has so far dared to take action. This is Sweden, which plans to make assistance with birth control a major part of its foreign aid programme. Of course, by American, or even British, standards, the amount that Sweden can afford to give as aid to under- developed countries is ludicrously small: only about £8 million last year. With such small re- sources at their disposal, the Swedes have chosen the type of aid which they believe to be most essential, and which it seems that they alone can give. The Swedes, in fact, believe that it is almost futile to try to promote economic development without also trying to reduce births, and that the problem is so acute that it is utterly irrational to do nothing about it.

The Swedes started their first birth-control aid programme in Ceylon in 1958 under a semi- official body, but since then it has been taken 41 charge by the Swedish Agency for Inter- national Assistance. In 1961, a programme was started in Pakistan, while a request for similar assistance has also been made by the Tunisian Government. The total cost of the two pro- grammes actually in operation is only about £120,000 each year. The scale of the Ceylonese Programme can be seen from the fact that one Swedish doctor was sent to Ceylon to see whether local public health staff could be trained to put it into practice, In Pakistan, three Swedish teams Were sent out, each consisting of one doctor and one nurse.

The results obtained so far are, not surpris- ingly, somewhat inconclusive. But what is important is that a start, however small, has been made, and that the countries concerned have not been in the least shy about asking for assistance of this kind. It is only un- fortunate that it seems that Sweden must remain alone in this field. No fewer than eighteen Nobel prizewinners, at a conference in New York re- cently, sponsored by the Planned Parenthood Federation of America, said that 'clearly, the urgent, indisputable need today is for intensified action to decelerate population growth.' No doubt President Kennedy would remain deaf to such a statement, even if it were supported by all the Nobel prizewinners of the world, The will to help the underdeveloped countries is there, and help is being provided on a scale never before seen. It seems a pity, when such help is so badly needed, that any of it should be wasted, whether as a result of the ineptitude of government departments, inadequate appre- ciation of all the aspects of a problem or, worst of all, totally irrelevant political considerations.