Boarders, borders

TODAY'S column deals with two health issues that are quite different, though both are important, especially for children.

I'll start out with the boarders. Some of you may have guessed what I'm referring to, but let me explain with a little story about a friend of mine, ever prim, ever proper, ever bourgeois, who went through a complete physical checkup some years back as part of the requirements to migrate to the United States. She called me a week after the tests, her voice betraying a mixture of mirth and amusement. "Mike, I can't believe it," she said. "I have worms."

OK, I can hear some of you groaning: "After ruining my breakfast last Wednesday with a column about lice and fleas, now he wants to talk about worms."

But worms are important, almost as much as polio, which is what I'll cover in the "borders" part of today's column.
Sizes and shapes

Worms are all around us ("bulate" in Tagalog). But the next time you find out you have them, you can make your infestation sound more sophisticated by saying, "Hey, I've got helminths."

Worms are even more amazing than lice. They're a huge family with thousands of species and they come in all shapes and sizes. The ones that afflict humans include roundworms, hookworms, whipworms, pinworms, tapeworms. The ones you see most often, wiggling out of the baby's rectum like spaghetti, are the roundworms. Hookworms, whipworms and pinworms are much smaller, so you can't detect them as easily. The hookworms and whipworms are quite vicious, their names telling you how they attach themselves to the intestine's walls. Pinworms are the ones that cause that infernal itching on the rectum. Tapeworms are flat and broad, coming out in segments.

Like lice, Filipino parents tend to take these worms for granted, as almost a normal part of childhood and of life. We joke about their being "boarders," but they're really much more destructive. They're parasites that can cause different kinds of malnutrition, including thinning, wasting and stunting, as well as anemia. They're not a joke, multiplying rather quickly. I've seen children with such heavy infestations that the worms crawl out from several body openings.

Heavy infestations affect the liver, which leads to the bloated stomachs you see often among children in urban poor communities. And because so many of the children in these places are pot-bellied, parents see the worms as normal.

National losses

Someone should try to compute how much these worms cost the economy in terms of cavans of rice, kilograms of vegetables, fish and meat that the worms consume. Think of the costs of treatment. There are other hidden costs we often miss: For example, when you visit many public schools, you'll notice the children seem to be so much more behaved than those in private schools. Look closely and you'll see they're actually suffering from a combination of hunger and intestinal parasitism. If they're well behaved, it's because they're too weak to be boisterous. But these quiet kids actually cost the nation: with the worms sapping the kids' energies, you can't expect them to learn too much in school.

Most worm infestations can be prevented with hygiene, although, as shown by my prim and proper friend's case, this is easier said than done. The tapeworms come from eating raw or half-cooked meat, where the tapeworm cysts may be present.

Once infected, you have to treat it with medicine. We're going to need more active campaigns to convince parents that it's actually cost-effective to treat worm infestations. Just talk about how all the expenditures on the kids' milk and food go to waste because of the boarders.

Typical medicine includes pyrantel and mebendazole, which are rather old drugs but I haven't been able to find anyone producing generic versions. No wonder so many Filipino parents don't bother to deworm themselves and their kids: the branded products are outrageously expensive.
The Department of Health has endorsed one herbal remedy: niyog-niyogan seeds. But I'm not really sure how effective these are. Niyog-niyogan is also known by its fancy name, Rangoon creeper. The plant produces beautiful flowers that are scented at night. The small seeds look like the balimbing fruit, and taste a bit like coconut, thus its name niyog-niyogan.

Polio

Now to another important child health issue: polio. It's encouraging to hear that the Department of Health is intensifying its polio vaccination campaign. Actually, oral polio vaccine (OPV) has been available in government health centers for several years now, but many parents don't avail themselves of these vaccines, which are available free, or with a voluntary donation.

The current anti-polio campaign comes on the heels of an outbreak in Indonesia. In April, Indonesia reported its first case in 10 years. Since then, there have been more than 250 cases, leading the World Health Organization (WHO) to sound the alarm. The WHO had hoped to declare polio eradicated globally, but the outbreak in Indonesia means the disease is still here to stay. Worse, there are fears that the cases in Indonesia could spread to neighboring countries, including the Philippines, and eventually spark outbreaks in different parts of the world.

The new polio outbreak shows how our borderless world can create public health problems. There are suspicions that the first polio case in Indonesia may have been brought in by someone returning from the hajj, the Muslim pilgrimage to Mecca. Another theory is that it may have been brought in by migrant workers. Some are suspicious that it may have been introduced from Nigeria.

Polio vaccinations in Nigeria have stopped since 2003 because radical Muslim clerics there spread rumors that the vaccines were part of a US plot. There's another aspect of globalization: religious fanatics have a way of sharing these rumors. Remember our own problems in 1995 when anti-family planning groups spread word that tetanus vaccines were causing abortions in our women? That year the tetanus vaccination rates dropped, together with childhood immunizations because mothers were avoiding health centers.

The Indonesians, who have launched a massive vaccination campaign, also have to deal with the rumor mills. This time around, the rumor going around is that the vaccines are prepared from monkey kidney cells and are therefore religiously prohibited.

As its name implies, OPV is administered by mouth so there's less of the fear factor in our injections-phobic country. The problem though is that you need three doses of OPV and many parents forget to get the follow-up doses. So make sure you check your records. We fear SARS and avian flu but forget that polio-which can be debilitating, if not fatal-is a serious public health threat as well.