Surgery and Healing in the Developing World - Dartmouth-Hitchcock

Metabolic Maladaptation
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In this region, endemic hypothyroidism is both highly prevalent and profound
in its consequences on the juvenile and adult members of this affected community.
This society and its members are as severely affected as any group on earth according
to the standards of the International Council for Control of Iodine Deficiency Disorders
(ICCIDD) and should, therefore, be significant beneficiaries of The World
Health Assembly resolution at the 43rd assembly in May of 1990 to eliminate iodine
deficiency disease by the year 2000. Before implementation of this goal, however,
a survey of a very significant endemia such as that described in this Uele region
under study in the Congo could assess not only the impact of the disorder within
the population but also what might be expected to result from successful intervention
in treating this disorder.
Micronutrient repletions might not be the only thing going on in the society
during the period of this observation. But some estimation can be made as to whether
the disease, or its treatment by iodine repletion alone unmitigated by any other
introduction of micro- or macronutrient supplementation, might be maladaptive
while noting any other concurrent programs in other micronutrient enrichment,
macronutrient expansion, and general development assistance. In addition to iodine
repletion, raising the metabolic rate by iodine correction of hypothyroidism
might be mitigated by an increase in caloric intake concomitant with iodine administration.
In some isolated societies such as a few of those represented in Central Africa,
the Equatorial rain forest is an environment in which water, fuel energy and
calorie-dilute food stock are adequate and accessible, yet human energy resources
are relatively less well developed. This has led these cultures to subsist on what can
be extracted or produced locally without a good deal of their consumption being
based on tradegoods that might be brought in from elsewhere, since few exportable
unique resources are available in these environments.
Extricative industry is very limited, since the forest does not recover after timbering,
no pasturing or agronomy is productive because of the poverty of the soil
and abundance of predators, mineral resources are absent here compared with the
wealthier “Copper Belt” region elsewhere in Zaire in the Kasai Province, and fruits,
rubber or other exotica have not thrived when introduction was attempted.
There are only two native substances in the environment for which a world
market exists—one animal and one vegetable, extracted from the root of an indigenous
tree. The first is “White Gold” the ivory from elephant poaching that has
been the highest “value added” industry, and the second is “rauwolfia” the root extract
formerly used to produce anti-hypertensives. The international pressures to
devalue the ivory trade had resulted in increased intensity of poaching younger bulls
and elephant cows to keep up with the falling prices as the herd was decimated;
rauwolfia has been preempted by newer generations of synthetic anti-hypertensives
and rauwolfia harvesting is now obsolete. The collapse of these two external markets
has returned the population to the subsistence that has always been its mainstay,
with the very rare export of the only remaining forest product, palm oil, inadequate
in yield to maintain trade routes through which it can be transported.
This pattern of subsistence, particularly if marginal, has favored less complex
societies that appear to be less economically developed by Western standards. This
underdevelopment could result from deficiencies in natural resources or in human
capital and energy resources whether internal or external to the society.
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