In 1980 the United Nations General Assembly launched the International Drinking Water Supply and Sanitation Decade. Ambitiously, it was hoped that Third World governments and International Aid donors would massively step up their investment from a current annual level of $6-7 billion to something like $80 million a day—a four- to five-fold increase—to provide clean water and sanitation for all by 1990. Such a sum may seem immense but bears comparison with the daily global expenditure of $250 million on cigarettes and more than $1,400 million on arms.
Whatever its intentions it is clear that the International Drinking Water Supply and Sanitation Decade will fall a long way short of its target: within the profit system’s structure of priorities the necessary funds are just not there. The recession and the cuts in public spending have added to the problem by hitting overseas "aid” from the developed to the developing countries. Nevertheless, the basic needs to which the campaign has attempted to address itself remain pressing indeed.
In the "Third World”, three out of four lack adequate waste disposal facilities while more than half the population lack reasonable access to safe water supplies. These difficulties are particularly pronounced in the rural areas. Partly this is because it is more convenient and cheaper to supply densely populated urban areas but partly also because of government sensitivity towards the rapidly growing numbers of city dwellers who wield more political clout than their relatively atomised rural cousins. It is not uncommon for people—usually women and children—to walk ten or fifteen miles each day simply to fetch water from the nearest available source. Yet the alternative in many cases is to resort to an unsafe water source nearer at hand: according to the World Health Organisation, about 80 per cent of all diseases in the Third World—and about 25 million deaths—are related to inadequate water and sanitation.
Prominent among these are the diseases caused by parasitic infestations. These are mainly concentrated in the tropics, for climatic and economic reasons, and affect literally hundreds of millions of people. Parasites may range in size from tiny single-celled organisms to stomach-turning intestinal horrors exceeding 40 feet in length. What they all have in common, however, is that they live on or within some human host with debilitating, even deadly, consequences.
For example, there are at present, out of a world population of 4½ billion, about 3 billion cases of infection by parasitic worms. Of these, the dreaded hookworm accounts for just under a third—932 million people—causing widespread iron-deficiency anaemia and a reduced ability to withstand other diseases. Hookworms are transmitted through contact with the faeces of infected individuals. The larva;—Nature’s entryists—bore their way through the skin of feet and via a complicated route reach the small intestine where the worms feed on the mucosal tissue as a result of which the host loses a certain amount of blood.. According to the New Scientist (8 March 1984). on the basis of an individual hookworm causing a leakage of 0.15 ml of blood daily, "one parasitologist estimated some 20 years ago that the daily blood loss due to hookworms was equivalent to the total exsanguination of about 1.5 million adults, representing a loss into the gut of about 3.75 tonnes of iron per day"! If one takes into account also the impaired absorption of food due to the damage done to the intestinal lining—not to mention the physical presence of the worms themselves which impede the digestive process—the amount of nutrients lost as a result of hookworm infestation can be quite significant indeed.
This example illustrates an important point that can be made about the general pattern of disease in the world today—its close correlation with the problem of malnutrition. It is not simply that most cases of malnutrition happen to occur in precisely the sort of unsanitary environment most conducive to the spread of disease. This, we can clearly see, is no coincidence: both hunger and poor sanitation are symptomatic of the same thing which is the economic poverty of the victims of this double onslaught. But more than this, the relationship between disease and malnutrition is in fact a synergistic one. In other words, the occurrence of one exacerbates the other and vice versa so that when they occur together the damage done is greater than had they occurred separately. As James Grant. Executive Director of UNICEF explained, malnutrition:
. . . is inextricably interlocked with the illnesses and infections which both sharpen, and are sharpened by malnutrition itself. Perhaps as many as half of all cases of severe child malnutrition, for example, are precipitated not primarily by the lack of food but by intestinal parasites, fever and infection—especially diarrhteal infection—which depresses the appetite, burns the energy, and drains away the body weight of the child. The net result is that every day of this last year more than 40,000 young children have died from malnutrition and infection (The State of the World's Children 1982-43).
In short, the elimination of disease cannot be effectively tackled in isolation. But by the same token, progress in combating disease can contribute to the solution of other problems—like malnutrition—that impinge on it. In Grant’s words:
A cats cradle of synergisms link almost every aspect of development . . . in an endless pattern of either mutually reinforcing or mutually retarding relationships which can minimise or multiply the benefits of any given input (ibid).
Some of the world's most serious parasitic diseases—and the prospects of eradicating them—were investigated in a thoroughly absorbing Horizon documentary, The Conquest of the Parasites, shown on television recently. Interestingly, a reference was made in this programme to the hugely successful campaign launched by the UN in 1967 against smallpox—the last natural case of which was recorded on 26 October 1977 in Somalia. It is curious how often the example of smallpox is cited (particularly by the supporters of the United Nations) both as a source of hope and a practical model for campaigns against other diseases. But—as the programme hinted—such faith overlooks certain important factors such as the nature of the disease itself which favoured the successful outcome of the campaign against smallpox. It can be easily identified and speedily contained by vaccinating the surrounding population and thus systematically eliminated in a relatively cost effective way. Such factors do not apply (or at any rate, not with the same force) in the battle against the intractable parasites.
The problem with parasitic infestations is that they are largely rooted in the social landscape of poverty, a poverty that is part and parcel of the normal workings of world capitalism. Take, for example, schistosomiasis or Bilharzia, as it is otherwise known—a wasting disease endemic in about 70 countries and affecting roughly 200 million people (mainly children). The infection cycle passes through humans and certain kinds of freshwater snails which act as intermediary hosts. The eggs of the schistosome worm, which leaves the body in urine or faeces, must be deposited in waterways. Once hatched, the larva; have at most 26 hours to find a host snail in which they can mature and multiply asexually, producing many more larva;. These later leave the snail and penetrate the skin of people wading in water. Inside the human host the worms live in the veins of the bladder and bowel where they mate, producing eggs that enable the cycle to be repeated.
For schistosomiasis to be brought under control it is necessary to break this cycle at some point. One way is to eliminate the snails on which the larvae depend. But this is not as easy as it may sound. In an experimental programme carried out in Sudan's vast Gesira irrigation scheme, health workers spent about five years in one particular village attempting to eradicate the disease. One of the measures taken was to clear the irrigation canals in the area of snails. At first this proved very successful and by 1977 no more cases of schistosomiasis were reported. But subsequent investigation revealed that “92 per cent of boys and all but two of the girls in local schools were reinfected . . .These snails had somehow managed to invade the area again” (Guardian, 12 August 1983).
Ironically, economic development in the form of newly-built dams, reservoirs and irrigation projects can actually exacerbate the problem by encouraging the spread of snails. The ripples caused by such development can be registered in places as far away as the Hospital for Tropical Diseases in London (where this hapless writer once had to spend a few days). As the Observer Magazine pointed out in an article on the famous “Hotel Tropicana” (as the Hospital is nicknamed): “Every time a new dam is built in Africa there is a feedback in the increase in cases of schistosomiasis” (26 November 1978).
It is possible to treat the victims of this disease. One newly-developed drug. Oltipraz, has had an 80 per cent cure rate, but at $8 for a course of four tablets it represents a considerable outlay to an impoverished farm worker in Sudan. There are cheaper treatments but whether they are as effective is another matter. But in any case treatment is no substitute for prevention. As long as the necessary preventive steps are not taken, the possibility of re-infection and thus the need for re-treatment will remain. Clearly, the most important of these is the provision of adequate sanitation — a step which tends to come up against the familiar economic barrier of the profit disincentive. Yet without proper sanitation the waterways will remain often the most convenient, and sometimes (as on the Gesira plains) the only private, place to do what Nature bids.
The three other major parasitic diseases examined in the Horizon documentary were trypanosomiasis, filiariasis and malaria. Trypanosomiasis — or sleeping sickness — is essentially a disease of Africa south of the Sahara. It is transmitted from one person to the next through an insect vector, the tsetse fly. The trypanosome parasite also infects cattle (causing the disease Nagana) and game animals who serve as a reservoir for the parasite. The eradication of the disease is chiefly geared to the destruction of the tsetse fly. usually a “scorched earth” policy that requires cutting back foliage alongside rivers where the fly has to breed. However, a new method of control may make this unnecessary: trials in Upper Volta and the Ivory Coast using insecticide-impregnated strips of cloth have reduced the tsetse population by 99 per cent in a matter of months. There have also been attempts to devise some means to destroy the parasite itself which the tsetse fly carries, but these have met with little success: the trypanosome is notoriously adept at outwitting the vaccines developed so far. The eradication of trypanosomiasis is important not just on grounds of health. It will also increase significantly the agricultural potential of sub- Saharan Africa by opening up quite sizeable parts of it to farming.
Like trypanosomiasis, filiariasis is transmitted through water related insect vectors — the mosquito and the blackfly. It is a disease which focusses its attack on the poor, for it typically occurs in heavily populated areas with inadequate sanitation which favours the breeding of vectors. Filiariasis affects about 300 million people and comes in two main forms: elephantiasis (250 million people) which causes an enormous swelling of the limbs and onchoccrsiasis or river blindness (30 million people). The latter variety takes its heaviest toll of victims in the Volta basin where some 65.000 square kilometres of fertile river valley have been vacated because of the disease. No words can express more forcefully why once vibrant villages have been turned into empty husks than the pathetic sight in the Horizon documentary of a human chain of blind people led by a young child.
One of the biggest killers in the world is malaria, a disease from which 800 million suffer with 150 million new cases recorded each year. The disease is transmitted through the female anopheles mosquito which sucks the blood of an infected individual containing the plasmodium parasite, which is passed on to others it bites. The campaign against malaria is one of the oldest of all mass campaigns. In the two decades following the Second World War, malaria's toll was drastically reduced by mammoth anti mosquito drives. In the 1970s, however, the disease staged a comeback especially in South and Southeast Asia and Central America. Partly to blame was increased resistance to both drugs and pesticides like DDT (it is said that the Vietnam War greatly facilitated the mosquito’s acquired resistance to such chemicals). But in the Mediterranean, malaria was eliminated except in parts of Turkey — a fact which has been widely interpreted as suggesting a link between the disease and the level of economic development.
New drugs are being developed which could destroy the parasites in malaria victims, thus breaking the transmission cycle. In addition, it is possible that a vaccine may now be developed though a lot of research has yet to be done before this can be said for certain. As for controlling the mosquito population, one of the latest proposals being examined is to release millions of sterilised mosquitos into high risk areas. All such developments will require a substantial injection of resources — according to one estimate about $2 per person a year. But as the New Internationalist (March 1984) put it, “In many countries such as India. Pakistan and Ethiopia this would be more than the per capita health spending for all health services”.
This is not to say that a disease such as malaria will never be eradicated while capitalism continues. Such a view would be absurdly dogmatic: it is possible that some technological breakthrough may be sufficiently cost effective to permit a repetition of the success in the case of the smallpox campaign. Our point is simply that capitalism acts as a drag on the process of technological discovery and implementation where there is little or no prospect of profit. Indeed, as the WHO noted in 1975, the global research budget for the six major tropical diseases was a tiny $30 million. Animal parasitology, on the other hand, presents a very different picture: cattle, it would seem, are more valued for their meat than the lives of human beings.
Meanwhile, the number of people living in a state of “absolute poverty” is rising relentlessly. All the summit meetings, all the wringing (not to mention washing) of hands in public places, all the reports, have been to no avail. With every passing year it becomes more and more obvious that nothing short of a revolutionary transformation of society will serve to wrench the mass of humanity out of the debilitating cycle of deprivation and despair. Paradoxically. it is those who want anything less who are the worms in the gut.
Robin Cox
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