Diario las Américas Newspaper, June 5, 1955, Page 26

VIC Only a few years ago, the dread tropical disease yaws afflicted one third or more of the rural popula- tion of Haiti along with mil- lions of other people around the world, In some areas of the island republic, yaws had been prevalent for so long that people had dome to accept it as more or less inevi- table Today, all that is changed The disease has virtually disap- peared from the country Some inseet- borne maladies, as yellow fever, have been ired out of entire countries by elimination of the bugs, but never before has a disease been wiped out on such a scale by treating its human v Yhe Haitian Min- istry of Public Health is accomp- lishing this feat through an inten- campaign conducted in coop- eration with the Pan American Sanitary Bureau and the World Health Organization (which the Sanirary Bureau represents in the Western Hemisphere) and _ with financial help from the UN Inter- national Chindren’s Emergency Fund The first real chance to make a major onslaught against this scourge came after World War !1; the perfecting of the new anbibiotics provided the weapons and the formation of WHO and UNICEF made possible interna- tional health action not. merely in terms of quarantine, as_ before, but on a scale of mass treatment. Mass yaws campaigns under the technical guidance of WHO are in progress in Indonesia, Thailand and the Philippines, too, but they have not reached the same stage as in Haiti because of the vastly larger populations involved. Yaws, also known as “frambesia” (from the French framboise, rasp- berry) and pian, the common French name, usually breaks out with a raspberrylike, discharging protuberance. Unless treated, the disease may progress through a var- iety of eruptions and ulcers, and in advance stages may eat through the flesh, causing loss of a finger, toe, or nose. Painful lesions on hands or feet make the sufferer un- able to work, sometimes even- to walk and he becomes completly dependent. Although not in itself a killing disease, yaws imposes a heavy economic burden, limiting production and hamstringing de- velopment. such cl tims. Slve It is not a venereal disease, but the organism tht cause it, a tiny, cork-chewlike spirechete known as Thep nema _ pertenue, indistin- guishable under the microscope from the one that causes syphillis. Some investigators have even sug- gested that an attack of vaws may give a person some immunity from syphilis, but the symptoms and courses of development of the two diseases are quite different 1S Intection is believed to be caus- isually ed by direct contact be- 3 George C. Copton Reprinted from AMERICAS, monthly magazine published by the Pan American Union in English, Spanish and _ Portu- guese. tween individuals, the microor ganisms passing from the open sores of a diseased person to a new victims skin. They gain entrance much more easily -- perhaps only if there is a serateh, abrasion, or other wound, so shoes and ade- queate clothing help prevent con- tagion. Barefoot and barelegged people working or playing in bush country are therefore particularly exposed to infection. Flies may al- so play a role in spreading the disease. It is not inherited, but if parents have it, the children are very likely to catch it from them, Infection from animals is most un- likely, since the organism does not thrive in them. Contagion via eat- ing and cooking utensils, towels, or other objects is probably very rare, since in the open air the ‘erms live only a short time. But stepping or sitting where a person with the infection on lis feet has just rodden may be enought to pass it on. Yaws is a strictly tropical disease, flourishing in hot and humid clim- ates. Primarily it affects rural com- munities, especially where there is poverty and poor sanitation. The likelikhood of catching it in a city is cut down by the better sanita- tion, Adequate clothing, paved streets, and lower injury rate there. Rlaiti’s rugged, mountanious ter- rain not only makes a journey in- to town for treatment very diffi- cult but also aggravates the sanita- tion problem in the countryside, since water must often be carrried a long distance up steep slopes in a jug on the farmer’s head. The in- fluence of custom and ideas of comfort — as well as of economy apparent in the matter of shoes. For a long time, everyone entering Port-au Prince has been required to wear them, but the farmers would don the footwear only at the city limits, after plod- ding many miles barefoot from the home with produce for market. In this Hemisphere, yaws is also found in Jamaica,. Trinidad, and some other Caribbean islands and in the Guianas, Venezuela, Colom- bia, Peru, Bolivia, and Brazil. There is a low incidence in Central Ame- rica. It occurs in many parts of Africa, in some areas in India, and in Burma, Ceylon, Thailand, Indo-China, southern China, For- mosa, the Malay Archipelago, In- donesia, the Philipines, and the South Pacific islands. Very likely it was originally introduced into this Hemisphere from Africa via the slave trade — is Before and after: Indonesian boy’s face shows little trace of yaws sores two months after penicillin treatment, ORY in Haiti How a. Crippling Disease was Wiped Out Halfway around the world, in a remote section of Thailand, yaws is playing a grim role in an unusual drama. An American Museum of Natural History expedition recent- ly reported success in rediscover- ing the pygmy-like, primitive tri- bal people called Phi Thong Luang. But only six men, one boy, and one woman remained. Tigers had eaten the other women and children. The boy had a bad case of malaria and the woman was covered with yaws. The expedition leader, Robert Weaver, treated her with what peni- eillin he had, and she showed im- provement but was not cured when they had to leave for more sup- plies. A rendezvous point was agreed on, but later examination of aerial photographs showed some fifty spots that met the tribesmen’s description, and-floods slowed down renewed search. Without protec- ment for syphilis was discovered, it was inevitable that it would be tried for yaws as well. Dr. G.M. Findlay first used a’crude prepar- ation of penicillin on this diesease in West Africa in 1943. But re- peated injections over a period of days were necessary to maintain envugh of the antibiotic in the tis- sues to destroy the organisms. Lat- er development of procaine peni- cillin in an oil base with aluminum munostearate, which remains ef- fective in the body for three days, made possible the “one-shot” tech- nique that speeds up mass treat- ment At the beginning only the nost adventurous came in for treat- ment. When their neighbors saw how their lesions were healing, they arrived in growing numbers — on donkeys or on foot, walking on the sides of their feet because of the sores on their soles, sometimes even dragging themselves along the ground. Women brought their ba- bies. By the middle of 1952, this project had cured a hundred thou- sand cases, at a cost to the institu- te of $388,503. The campaign organization was set up directly under the Minister of Public Health, with considerable administrative autonomy and was headed by a Haitian director who planned operations in consultation with the WHO-PASB specialists. Seventy-nine treatment men were recruited — many of them chauf- feurs who had lost their jobs when the International Exposition closed down — and trained to re- cognize the lesions, administer pen- icillin, and keep records. Ability to drive and to ride a horse was essential in order: to reach every PAG. 14 HEMISFERIO Explaining the disease and cure to country “people is important step in eradication program. remote eranny of the land. The success of these nonprofessional treatment terms meant a great sav- ing in technical personnel and much wider and quicker coverage than could have been achieved with doctors alone. It also set. an ex- ample for other countries where medical personnel is scarce, To check on the effectiveness of the treatment, a control center was established in the isolated com- munity of Bainet. General medi- cal service for all diseases was pro- vided in order to win the coopera- tion of the villagers for follow-up studies. Because of the high pre- valence of yaws in the area, po- ple flocked eagerly to the clinic, and rapid cures again helped to attract more. Awarding the pa- tient a small bar of soap on each post-treatment visit kept him com- ing back, since from the farmers viewpoint soap is scarce and ex- pensive in the country. Infectious yaws cases were given red identi- fication cards, non infectious cases green ones, and cases other than yaws white ones. Since only the red-card holders received the soap, there was some exchange and bar- tering of cards to gain this ad- vantage, but the staff managed to keep identities straight nonethe- less. So that as many patients as pos- sible might be reached in the short- est time anyone with yawslike sym- ptoms was treated as a “case” of yaws and given a six-hundred-thou- sand-unit penicillin injection. Any- one who had family or other rela- tions with a “case” was considered a contact and given a three-hun- dred-thousand-unit dose. This is essential in an eradication cam- paign, since contacts may have the disease in a latent stage and not show symptoms until much later. In effect, this meant treating practically the entire rural popula- tion. While larger dosages are ne- cessary to cure syphilis, these in- jections were sufficient to afford the additonal advantage of mak- ing any syphilis sufferers nonin- fectious, At the start of the mass program in the Departement du Sud, the “daily clinic” method was used. The people of each area were told to meet at certain spots on given days to be examined and treated: ge ee Up to October 27, 1951, 66,738 people were treated this way, 54.9 per cent of them as “cases”. Popu- lation figures were not available in the beginning, but the 1950 cen- sus returns showed that only 62.5 per cent of the people in the treat- ed zone had been reached. For this reason, the “house-to-house” me- thod was adopted in place of the clinie system; permitting coverage of 97.7 per cent of the popula- tion in the areas where it was used. First a mapping and publicity team would visit a zong two or three weeks before planned treat- ment to interview government and church authorities and leading citi- zens, persuading them to spread the x thawte hie pian “4 stay in their homes on a given day through the fields, the team made the same announcement to the farmers and drew maps to guide the treatment teams. These, made up of eight or nine men, would then visit every home in the as- signed area, treating everyone pre- sent and keeping count of who was away. Combining the totalg under the clinic and house-to heuse systems, 3,501,450 people were treated down to the end of 1954, 1,279,564 of them as “eases.” Surveys made a year or more after treatment in sections where used showed an incidence of only 03 per cent; in the central part of the Department du Sud, where the clinic method was first used, the figure reached 1.1. per cent. Last year, the teams went back to the southern region, to cover the worst area house-to ouse. Average incidence throughout the coun- try now is probably no more than one half of one per cent. To stamp out the remaining infections, the country has been divide into some seventy-nine zones, with an inspec- tor permanently on duty in each to seek out active cases as early as possible. This bold attack on a major scourge of mankind has not only relieved intense human suffering, but has also lifted a-crushing bur- den from the national economy. Moreover the experience gained in such programs is a big help in building permanent, all-around health services where they have never before been available. If the Haitian example is followed with perseverance and devotion in the other affected lands, we may see the day when yaws can be crossed off the world list of debilitating and crippling disedses. | * * DOMINGO 5 DE JUNIO DE 1955