Wednesday, November 4, 1998

The leprosy target
By Mike Crawley in London
HOPE is fading that health workers will conquer leprosy, one of the world’s oldest diseases, by their stated goal of the year 2000.

Mission to restore vision
By Taani Pande
MADURAI: His hands are severely crippled by arthritis and he can barely hold a pen. Yet his eyes sparkle with infectious optimism.

Gold in plants
NEW Zealand scientists have harvested a crop of gold digging plants, Reuter reports.

Profile of a healthy drink

By K. C. Kanwar

BARRING water, tea is the world’s most widely consumed beverage. The tea scene, during the past 50 years, has undergone a sea change. Tea consumption in India itself from the early fifties has gone up by more than 10 times. Indians — right from the elite to the poorest of the poor — are tea drinkers, nay tea addicts. Tea is our national drink.

The evergreen tea plant, Camellia sinensis, is indigenous to India and China, though now it is cultivated in many other countries also. There are over 2000 different varieties of tea consumed all over the world and all these originate from the variants of this very plant which thrives both in tropical and subtropical climates.

In colder climates, at high altitudes, the growth of this plant is slower — not as vigorous as at low altitudes — but the flavour of the product is considerably improved. Further tea plants cannot stand long periods of the dry weather; these grow best on well-drained hill slopes where the rainfall is ample and well-distributed throughout the year.

All the three commercial variants of tea (viz green, black and oolong) come from the same source plant — Camellia sinensis. The differences among these are chiefly related to the manufactural processing. The tea most, if not all, of us in this country drink is black which includes the expensive green label. The preparation of black tea is lengthy and involves at least five major steps — withering, rolling, fermenting, drying and firing.

For the purpose, the tea leaves (the young shoot with two leaves and a terminal bud) plucked manually are spread thinly over racks for initial drying. To prevent any damage likely to be caused by high levels of the humidity in the atmosphere and the moisture content of the freshly harvested leaves, dry heated air is forced over the drying racks. Following drying, the leaves become flaccid, facilitating their rolling which leaves them curled and twisted.

During rolling, leaf cells get ruptured, thus liberating the sap which, in turn, triggers fermentation (=chemical oxidation) which changes the colour of tea leaves from green to copperish-green.

During fermentation, tea leaves acquire and also emit a peculiar aroma characteristic of the blended tea. Thereafter, with a view to destroying the fermenting enzymes, the leaves are roasted and subjected to dry hot air at a temperature ranging between 35°C — 40°C for about 12 hours, reducing the moisture content to less then 2% in about half an hour.

Finally, the dried leaves are sorted, sifted and graded for size before these are nicely packaged in airtight containers and offered for sale.

The processing of black tea is such that some aroma is volatised and a certain percentage of tannic acid is destroyed. As a rule, therefore, black tea is less fragrant and also less astringent than green tea. Instant tea available these days is also a water soluble variant of black tea.

For manufacturing green tea, the leaves are not allowed to ferment. Instead, the freshly plucked leaves on arrival in the factory are steam-heated, then rolled and fired. The demand for green tea is limited and mainly confined to China and Japan, the countries producing it. The third type of tea is oolong which is partly fermented and is hardly of any significance in world trade.

Tea has been considered medicinal ever since it was identified. Over a thousand years ago, Buddhist monks used to drink tea for a religious reason — to help them stay awake during meditation. Even today, many people use tea or coffee for staying awake. This effect is attributable to caffeine — an essential and dominant ingredient of both tea and coffee. Buddhism, having originated in India, spread to neighbouring Tibet, China and Burma and so did tea. The Dutch are credited with introducing tea from China in to Europe in the 16th century where initially, in view of its medicative potential, it was sold in apothecary shops — the forerunners of modern pharmacies. The ancient Dutch recommended tea as a remedy for minor kidney ailments, cold-related fever, chest and throat congestion infections etc.

Tea is known for soothing sore throats and relieving respiratory congestion. Even today, hot tea is prescribed to ward off catarrh/coryza and serves as a vehicle for many ayurvedic concoctions. Pharmacology recognises it as a diuretic, a muscle relaxant of choice and an overall stimulant.

The flavour of tea comes from its volatile oils, its stimulating characteristics attributable to the caffeine content and its astringency and colour related to the tannins present in the leaves. Caffeine in tea approximates 50 to 80 mg per cup of 150 ml. Tea also has theophylline and traces even of theobromine — the known bronchodilators. It also contains a good amount of tannins. Green tea, vis a vis black tea, is doubly rich in this respect.

Nutritively, tea contains only about one Kcal/cup if sugar is not added. Though it just has traces of vitamin B complex, it is rich in a variety of flavonoids — the potent antioxidants.

Biomedical researchers are finding much more than what has been known before in this beverage. Tea, it is felt, might help reduce the risk of a number of major chronic and deadly human diseases such as a stroke, a heart attack and, hopefully, even cancer. This has certainly boosted the resurgence of interest in this common man’s drink.

Healthy effects of tea emanate primarily from its polyphenols including flavonoids, some of which are unique to this commodity. Flavonoids are a group of aromatic oxygen containing heterocyclic compounds which are antioxidants of merit preventing free radical damage known to contribute to an ever-increasing list of over 50 human ailments.

Recently, a report from Ohio (USA) claimed that drinking green tea may help reduce the risk of cancer since it is rich in catechin, a type of flavonoid with a very high oxidation, state, that blocks the enzyme urokinase frequently associated with human cancer. Both green tea and black tea are rich in flavonoids in general and contain a special flavonoid (EGCg), a highly potent antioxidant. Flavonoids are also known to increase the tensile strength of the capillary walls and decrease capillary permeability in experimental animals. This, in particular, is considered effective in preventing strokes.

In one Dutch study, men who drank four or five cups of black tea daily had nearly 70% reduced risk of a stroke compared with those who drank two cups or less. Another 1993 study reported that increased consumption of black tea corresponded with fewer fatal heart attacks. "The key protective factor does to be the flavonoids", says John Folts, Director, Wisconson Medical School Coronary Artery Thrombosis Prevention Research Centre. According to him, black tea flavonoids prevent "blood platelets from clumping, thus avoiding the dangerous clots that lead to almost all heart attacks and strokes".

Over 20 studies on animals have indicated that tea may prevent certain cancers including those of the digestive and respiratory tracts and also of the skin. In these studies too, polyhenols in tea are thought to be the major disease-preventing ingredients. Weisburger asserts that "along with eating plenty of fruits and vegetables, drinking tea may turn out to be a cheap and practical way to reduce the risk of certain cancers".

According to researchers at Cleveland (USA), applying green tea was up to 90 per cent effective in preventing sunburns leading to skin cancer. This view has recently been strengthened by a team of researchers working in Adelaide (Australia) who discovered that mice given tea rather than water cut their chances of developing skin cancer by half in the experiments where groups of tea-drinking and water-drinking mice were exposed to higher levels of ultraviolet light. According to team leader Ivor Drosti, "tea has a high level of polyphenol antioxidants called flavonoids that protect the skin from harmful rays (ultraviolet)".

Antioxidants, even otherwise, are the active ingredients in most sun creams also termed as sunscreens. Many workers feel that green tea in future could be an ingredient of choice in the sunscreens.

Some workers think that caffeine in tea lowers blood cholesterol levels. Tea also lowers blood pressure. But how it is achieved is yet to be theorised.

Tea, rich in fluorides, strengthens the tooth enamel and helps prevent tooth decay. According to Japanese experts, tea prevents dental plaque formation and kills oral bacteria that cause gum diseases.

How much tea needs to be consumed to be maximally effective is a moot question. Weisburger considers that four or five servings a day, perhaps, provide the maximum advantage. Others are of the opinion that even fewer servings would help.

Researchers are not yet sure as to whether adding lemon or milk to tea makes it less or more beneficial. Also, it is not yet ascertained as to whether decaffeination removes tea’s health benefits. Iced tea or hot tea, scientists feel, are equally beneficial.

If consumed on an empty stomach, tea causes acidity in many people. It should be preferably avoided immediately before and after major meals since it is rich in tannic acid which impairs digestion as well as absorption of the nutrients.

Prof K.C. Kanwar is a former Chairman of the Biophysics Department of Panjab University, Chandigarh.

The leprosy target

By Mike Crawley in London

HOPE is fading that health workers will conquer leprosy, one of the world’s oldest diseases, by their stated goal of the year 2000.

The World Health Organisation (WHO) set the turn of the millennium as the target date for reducing the prevalence of leprosy to one case per 10,000 population, a figure that epidemiologists say would mean the disease is no longer a public health problem.

In 1991, when the target was announced, the overall prevalence in the 32 countries where leprosy is endemic was 11 per 10,000. The most recent statistics put the prevalence at 3.2 per 10,000, a vast improvement but still short of the mark.

"By and large we’ll reach the goal, with the exception of about four or five countries," says Dr Sheik Noordeen, senior adviser to the WHO action programme me for the elimination of leprosy.

The target will likely not be met in India, Brazil, Madagascar and in places where war has hampered elimination efforts, such as Mozambique, Afghanistan and Sudan.

"Having a goal of the elimination of leprosy as a public health problem has been very effective in that it mobilised the resources and mobilised the governments," says Terry Vasey, Director of the British Leprosy Relief Association (Lepra).

But he adds, "I think the goal was slightly unrealistic when you consider the size and the logistics of the problem."

By any measure, the progress in fighting leprosy has been remarkable. The number of cases in the endemic countries in 1985 was four million; now it’s down to 770,000.

Hampering progress, however, is the fact that the number of new cases identified each year is not dropping. An average of 600,000 new leprosy victims were identified every year in the 1990s and the trend shows no sign of changing.

The harder that health workers look, the more cases they find. In India — home to two-thirds of the world’s leprosy cases — close to one million volunteers were trained for a massive search campaign in 1997. It covered the country and found 450,000 previously unidentified leprosy cases.

All this makes the task of reducing leprosy’s prevalence a lot like mountain climbing:the last stretch before reaching the summit is the toughest part.

"The remaining task is quite formidable because we are getting into the most difficult parts," says Noordeen.

What has to happen next, says Noordeen, are more massive search campaigns like the one in India, and a big push to give communities the training, the resources and the drugs they need.

The success of the part decade has come as a result of a multiple-drug therapy (MDT) that costs only $36 and works wonders for curing leprosy. In addition, there has been huge financial backing for the fight against the disease, allowing MDT to be delivered to patients for free. Much of the funding has come from one source, the Tokyo-based Sasakawa Foundation, which has given over $100 million to WHO’s anti-leprosy efforts in the past decade.

Vasey, who is also the incoming president of the Federation of Anti-Leprosy Associations, is worried about what he calls WHO’s "triumphalist attitude" over the dropping prevalence rates. His concern is that it could backfire, prompting policy-makers and funders to believe that leprosy is no longer an issue.

If anti-leprosy work gets put on the back burner, there’s a fear that leprosy could stage the same kind of comeback as tuberculosis, which health workers once thought they had conquered.

"It wouldn’t take much for leprosy to creep back up to the numbers that were so horrific a few years ago," says Vasey.

He’s supported in this view by Dr Colin MdDougall, a retired British leprosy specialist. He believes there’s a short window of opportunity in the next few years to knock leprosy to the mat.

"If our efforts flag now, it’s just possible that the moment may pass and we’ll face a problem in the next century," says McDougall.

He says efforts "should be intensified and backed with appropriate funding".

Once leprosy reaches a low prevalence, the belief is that the infection will be transmitted much less frequently and the incidence of the disease will gradually diminish. But that will take a long time, partly because of leprosy’s long incubation period and the difficulty of searching for leprosy victims in the endemic countries.

If the goal of eliminating leprosy is met — whether or not it meets the year 2000 target — the world will consign to the history books a scourge that has afflicted humans since the beginning of recorded time.

Mike Crawley is a Canadian newsman. He has got a fellowship from the IDRC.

Mission to restore vision

By Taani Pande

MADURAI: His hands are severely crippled by arthritis and he can barely hold a pen. Yet his eyes sparkle with infectious optimism.

At 80, Govindappa Venkataswamy, one of India’s most renowned ophthalmologists and surgeons, is a man with a mission — to eradicate "needless blindness" from the world by the year 2010 by providing cost effective, quality-controlled treatment.

Decorated with a number of national and international awards — including the Padma Shree in 1973, the Helen Keller International Award in 1987 and the Time-Life Award of the International Agency for the Prevention of Blindness in 1980 — Venkataswamy is the founder of the Aravind Eye Hospital in the temple town of Madurai in Tamil Nadu.

The hospital, which was founded in 1976 with Venkataswamy’s lifetime’s savings about Rs 200,000, has today expanded from a 20-bed to a 1,200 bed facility, making it one of the largest eye hospitals in the world.

Known as "Dr. V" or "Chief" to his colleagues, he sits in his room, a computer by his side, on which he is "still learning" to access the Internet or send an e-mail.

"I think in these days of technological advancement, barriers of countries have been demolished," he says. "So I have set myself a target of eradicating needless blindness (blindness resulting from diseases like cataract, glaucoma or other eye infections, that can be cured) by 2010."

And how does he intend to achieve this? "Simple," the man replies with a smile — by merely replicating the Madurai Aravind model in other parts of the world. "Needless blindness can be prevented. And if it just takes simple surgery, why keep people blind?"

There are 12 million blind people in the country, according to the World Health Organisation (WHO), and doctors say that in 80 per cent of the cases, cataract, a disease caused by the clouding of the lens, is the cause of blindness.

According to government statistics, in 1997-98, over three million cataract operations were performed in the country but they are obviously not enough.

At Aravind, named after the Indian mystic-philosopher Aurobindo Ghosh, a staff of about 600, including 100 doctors and 252 nurses, cater to the needs of the over 2,000 patients a day.

Doctors operate continuously for almost four hours every morning, conducting 250 to 300 surgeries a day. In 1997, records reveal, 123,095 surgeries were conducted at the hospital.

All this has been made possible by Venkataswamy’s vision, his colleagues claim, which is influenced by a curious mix of people, from Shri Aurobindo and Mahatma Gandhi to Ronald McDonald — Aurobindo and Gandhi for their dedicated service to the poor, McDonald for maintaining quality-control standards while retaining an assembly-line technique.

"The aim is to provide a hi-tech, low-cost service to all people, while maintaining the same quality standards," Venkataswamy says.

Born in 1918 in a farmer’s family, Venkataswamy, who saw three of his cousins die from lack of proper healthcare during their pregnancies, wanted to be a gynaecologist.

Crippled by arthritis at an early age, he realised that gynaecology was simply out of the question. "So I decided to become an ophthalmologist. Even that was very difficult because my arthritis was so severe that I could hardly stand," he says.

But gradually, I learned to move, stand for hours at the operating table and hold a scalpel and use a suture," he told India Abroad News Service. He stopped operating four years ago.

The procedure to restore sight to a cataract patient is fairly simple — the doctor cuts the eye, removes the clouded lens and replaces it with another — all in less than 15 minutes.

Each operating theatre in the five-storeyed hospital building has three tables with a doctor moving from one to the other after completing each operation. "It is an assembly-line technique because, while the doctor is operating on the second patient, the first is removed to the recovery room and another brought in. So we are operating continuously for about four hours," points out G. Natchiar, Venkataswamy’s sister, who heads the neuro-ophthalmology clinic at the hospital.

At least 60 per cent of the patients are treated free. In the free wing, patients pay Rs 500 — the cost of a lens and a suture — and get free food and accommodation, with about 30 people in a room sleeping on cane mats. "Paying patients" are charged Rs 3,000.

The hospital has nine speciality clinics that treat diseases like glaucoma, eye infections and retinal disorders. It also has fellowship programmes with the St. Vincent’s Hospital in New York, Massachusetts General Hospital in Boston, University of Illinois’ Eye and Ear Infirmary in Chicago and the Johns Hopkins Hospital.

"Our visit here has helped us enhance our surgical skills. We wouldn’t have ever got to perform as many operations in the USA", said Diane Song, a visiting student here from the University of Illinois, adding that they performed at least four surgeries a day at Aravind, whereas in the USA they might have been able to perform only 90 during their three-year residency.

"The sheer number of people who come here is amazing. And the facilities are pretty good. We also get to see a variety of diseases that we may never have got to see otherwise," added Roy Lou of the Great Baltimore Medical Centre.

It is this training that is crucial to Venkataswamy’s dream to eradicate needless blindness from the world. "We cannot open an Aravind everywhere, but what we can do is replicate the Aravind model," he says.

The writer, who works for IANS, had recently visited the Madurai hospital.

Gold in plants

NEW Zealand scientists have harvested a crop of gold digging plants, Reuter reports.

The researchers used a technique called phytoextraction to encourage plants to take up gold from the soil into their roots and to above-ground shoots. After the shoots are dried and burned, the gold can be removed from the burned ash.

"This technique might be used as a form of biological mining (phytomining) for gold," Robert Brooks, from the Massey University in New Zealand, said.

Brooks and his colleagues treated soil with ammonium thiocyanate, a chemical use in mining operations to make gold soluble, and turned Brassica juncea plants into modern-day gold diggers.

Brassica juncea are a type of plant known as hyperaccumulataors. Under controlled conditions, these plants can be used to extract dangerous metals and radioactive wastes from soil and water.

Scientists are already using phytoextraction to clean up polluted or radioactive soil and water. But Brooks and his team said it is the first time it has been used to remove gold from soil.

"We believe this is the first evidence of significant gold uptake by any plant. Apart from the economic ramifications, this technology opens up the way for phytoextraction of other noble metals," said Brooks.

Telemedicine

The arena of medicine now embraces technology as telemedicine makes its way into healthcare. Gradually, the barriers of distance between patients and healthcare providers are being overcome as communication takes over the entire globe by storm. One particular feature, that of mobile telephony, has started making its contribution to this field.

In many developed countries, telemedicine is a well-accepted branch of medicine, and interaction between the patient and the doctor is not limited to symptomatic consultation, but rather to a variety of consultations, including ECG, X-ray and so on. In India, telemedicine is still in a nascent stage. According to a communication addressed to Health Tribune by Spice Telecom, Punjab, has taken a pioneering step "to help lead the people of Punjab towards better health". Having established a direct link through their network to five experienced and well-qualified medical counsellors, what the subscribers have to do is to dial 557 to get connected to one of the healthcare experts.

A wide variety of health-related issues and questions can be discussed with these counsellors. Diet for healthy living, premarriage and pre-pregnancy schedules, accidental poisoning, minor illnesses, emotional breakdowns, etc, are some of the areas that this service, named "Healthline", helps address.

In addition, advice on issues related to the growth and development of children as well as disorders and malfunctions in this area can be sought.

Healthline is not a substitute for the traditional doctor-patient relationship (Healthline experts do not prescribe any medicines); it supplements that system by helping to overcome barriers of time, distance and accessibility. This instant access to professional medical advice is available from 12 noon to 8 p.m. (Monday to Saturday). It is important that callers are aware that anonymity of both the callers and the counsellor is adhered to, and confidentiality of the cases is respected. This has been done to ensure that problems are freely discussed.

Readers are advised to make their own enquiries and assessments. The idea sounds good but the use of all such information has to be made judiciously after consulting knowledgeable people—particularly the family physician. — H.T.