Fighting TB in Mauritius

Mauritius Times – 60 Years Ago

By Peter Ibbotson

It is welcome, but overdue, that the World Health Organization (WHO) has sent a team of specialists to Mauritius to help the fight against tuberculosis (TB). It is true that deaths from TB are fewer progressively from 1949 to date, but the incidence of TB in the island is increasing. The number of cases reported in 1955 was 26% higher than in 1954: 368 cases, one a day, in 1955, reports the ‘Yearbook of Statistics of Mauritius’. TB is of course a disease commonly met with in underdeveloped and colonial countries; its incidence is always accompanied by widespread malnutrition and anemia; this latter caused 457 deaths in Mauritius in 1955.

In January, an international conference on TB was held in New India. Dr PV Benjamin, a noted Indian physician, presided over this conference and gave some startling figures. In the countries of Western Europe, the annual death rate per 100,000 inhabitants from TB is as follows: France 37; Switzerland 23; UK 20; Sweden 15 and Holland 9. At the other end of the scale come the high death rates of 350 per 100,000 in Pakistan and the Philippines; 247 in Panama, 231 in Haiti and 207 in Morocco. In France, there are 10 hospitals beds for every 10,000 victims of TB, but only three in Algeria, two in Tunis and still fewer in Morocco.

India under colonial rule suffered badly from TB. Before independence, over 2,000,000 people contracted TB each year and half a million died. But since independence, India has undertaken mass campaigns against TB. Over 28 million people have so far been vaccinated, and by 1970, 170 million will have been vaccinated. The government admits that TB is still a grave problem, but it is tackling it with energy.

Vaccination is only one weapon in the war against TB. Another weapon and very potent weapon is better feeding. There is a disease of worldwide occurrence which has many names. Says the UNESCO Courier, “In Central America it is called Kwashiorker, in South Africa Infantile Pellagra. In Jamaica it is called Fatty Liver Disease or Sugar Baby. The French once called it Dystrophie des Farineux, and the Germans Mehlnahrsschaden. In the Belgian Congo it is sometimes called M’Buaki, in India Nutrition Dystrophy or Nutritional Oedoma Syndrome, and in Latin America Distrophia Pluricarencial Infantile. These names and dozens of others in different languages all mean the same kind of sickness in young children — protein malnutrition. Today FAO and WHO and other UN agencies are attacking this worldwide problem.

Protein malnutrition simply means that the children are not getting enough to eat of the right sort of food. The best source of protein is meat; and few Mauritian children get meat to eat. How many labourers and even artisans can afford to buy meat for themselves and their families when prices are Rs 3.00 to Rs 4.50 for beef, Rs 4.00 to Rs 4.50 for goat and mutton; Rs 4.00 to Rs 6.00 for pork (all per kilogram).

A diet of little salt fish and a lot of rice is all that most workers’ families can afford; and such diet of salt fish and rice is deficient in protein. In fact, the diets of most workers’ families is deficient and does not provide a balanced intake of protein, calcium, iron, vitamins which are essential to good health and proper growth. Malnutrition leads to TB, so does bad housing. And malnutrition and bad housing are found wherever the workers do not get enough wages to enable them to eat and house themselves properly.

Few people in Mauritius can be said to be fed and housed adequately. Many workers have to live in tin shanties; or straw huts packed round with dung. Many cannot afford more than one meal a day. Many children have to go off to school breakfastless; or perhaps with a small bottle of milkless tea inside them. Many a man goes to work with not enough food in his stomach to sustain him for his work-shift. When he comes home, he still does not have enough to eat properly to build him up, after using a day’s energy, ready for another day’s work.

Yet there are people in Mauritius who are well-fed. Too well-fed, some would say. Indeed, it is a fact that different social groups in Mauritius, as elsewhere, are not equally fed. This inequality means that there is consequent inequality in the matter of health. Yet all people are equal as persons. The inequality as individuals means that some are getting more that their just share of the wealth of the country, while many are being denied a fair share. It should be the job of the government to iron the inequalities of wealth and health and nutrition, but this involves a social change.

Yet a man is a social animal and it should be the duty of the more fortunate members of society to ensure that the less fortunate members are helped to avoid the evils arising from the mal-distribution of wealth.

We were reminded in the Speech from the Throne, “No man is an island”; in other words, no man can live for himself alone. All men must help others, especially the less fortunate.

As the eminent French doctor and scientist Professor Andre Mayer has pointed out, “The quality of the diet depends largely on income. In a poor nation or group, the diet will contain less meat or milk than in a wealthy group… Meat and milk are expensive foods, sometimes inaccessible to the poor. In the case of milk, this can be serious.”

How far are milk and meat inaccessible for the Mauritian workers? Father Dethise revealed the family budget of a “well-paid” worker with Rs 176 a month for himself, his wife, and their nine children. How much meat and milk does this family consume? Two pounds of meat, five pounds of fish (some fresh, some salt), and 30 pints of milk – a month. Is that enough for good health? Of course not. That family lived mainly off rice: 7 pounds every day.

Another family budget concerned a husband and wife and three children, who could afford 120 pints of milk a month, 9 pounds of meat and 12 pounds of fish. Their diet was just “satisfactory” according to the Health Department – but when we recall the few Mauritian families have only three children, and few workers can afford Rs 134 a month of food alone (as the man could), we realize how few families can be having satisfactory diets.

Vaccination and WHO teams and BCG campaigns are only scratching the surface of the problem of TB. What is needed is an all-out campaign to raise living standards of the people. Wages must be raised so that people can afford the kind of food they should having. Better housing must be provided; I have in a past article showed the connection between bad housing and bad health. And more strict measures to prevent the sale of adulterated or dirty food are needed.

I suggest a five-point programme which, if adopted, would do much to raise the standard of living and combat TB.

1. Full employment, at proper wages. Until employment for all is possible, unemployment benefits must be provided.
2. Adequate houses must be provided at rents which the workers can afford.
3. Overcrowded houses must be eradicated. People in overcrowded houses must be rehoused.

It would be a good thing to have an island-wide survey of housing: number of houses, number of rooms, number of persons per room, etc., then we would have an idea of the size of the housing problem.

4. Drastic measures to reduce the sale and consumption of rum and locally made wine which is often made from acidic fruits in unhygienic conditions. I recommend the WHO team to sample the local wines and test their fitness for human consumption.
5. No cooked foods, cake, bread, etc., should be exposed for sale and shops stalls, markets, where it is exposed to dust and vermin.

For the children, I would add a sixth point. Every child should be provided with a breakfast on arrival at school. This meal should be free, and should be based on the “Oslo breakfast” provided free to all Norwegian schoolchildren. A balanced meal at school, to start the day, would benefit the children physically as well as putting them in a better condition to benefit from their schooling.

But the biggest single advance would be, of course, for the workers to have decent wages to be able to feed and house themselves and their families properly. It is however doubtful if this advance can be achieved except under the Socialist Government; so that the Mauritius Labour Party has a great responsibility towards the people of Mauritius. The 1958 elections will give the Party the opportunity to grasp their responsibilities; the people of Mauritius will surely afford the Party that opportunity.

* Published in print edition on 17 April 2020