By NICHOLAS D. KRISTOFTEGUCIGALPA, Honduras
It’s not ambrosia, and it’s not even pepperoni pizza. Hint: It’s far cheaper. A year’s supply costs less than the cheapest hamburger.
Give up? Here’s another hint: It’s lifesaving for children and for women who may become pregnant. If you know of a woman who may become pregnant, make sure she gets this miracle substance.
A final hint: It was a lack of this substance that led to a tragedy that I encountered the other day at a hospital here in the Honduran capital. Three babies lay in cots next to one another with birth defects of the brain and spinal cord.
In the first cot was Rosa Álvarez, 18 days old and recovering from surgery to repair a hole in her spine. She also suffers from a brain deformity.
In the next cot was Ángel Flores, soft tissue protruding from his back.
Closest to the door was José Tercera. His mother unwrapped a bandage on his head, and I saw a golf-ball-size chunk of his brain spilling out a hole in his forehead.
The doctors believe the reason for these deformities, called neural tube defects, was that their mothers did not have enough micronutrients, particularly folic acid, while pregnant. These micronutrients are the miracle substance I’m talking about, and there’s scarcely a form of foreign aid more cost-effective than getting them into the food supply.
“It’s unnecessary to have these kinds of problems,” Dr. Ali Flores, a pediatrician and expert on these defects, said as he looked over the three babies.
If a pregnant woman does not have enough folic acid (also known as vitamin B9) in her body at the very beginning of her pregnancy, then her fetus may suffer these neural tube defects. That’s why doctors give folic acid to women who plan to become pregnant.
Equally important is another micronutrient, iodine. The worst consequence of iodine deficiency isn’t goiters, but malformation of fetuses’ brains, so they have 10 to 15 points permanently shaved off their I.Q.’s.
Then there’s zinc, which reduces child deaths from diarrhea and infections. There’s iron, lack of which causes widespread anemia. And there’s vitamin A: some 670,000 children die each year because they don’t get enough vitamin A, and lack of the vitamin remains the world’s leading cause of childhood blindness.
“In the early stages of life, the die is cast,” said David Dodson, the founder of Project Healthy Children, an aid group that fights micronutrient deficiencies in Honduras and other poor countries. “If a child is not getting the right micronutrients, the effect is permanent.”
Nine years ago, Mr. Dodson was simply an American businessman running a 300-employee waste company that he had founded. Then he happened to visit Honduras and, in a hospital, encountered a mother whose newborn baby had a hole in the skull. He learned that negligible amounts of folic acid would prevent such heartbreaking defects — and his life was transformed.
“I had never seen anything in my life that could have so much impact for so little money and be sustainable,” Mr. Dodson said. He and his wife, Stephanie, sold their company and used some of the proceeds to start Project Healthy Children.
The most cost-effective way to distribute micronutrients isn’t to hand them out. Mary Flores, a former Honduran first lady who is active in nutrition, notes that impoverished women can be hard to reach, and even if they are given folic acid pills they sometimes won’t take them for fear that they actually are birth control pills. So micronutrients instead are often added to such common foods as salt, sugar, flour or cooking oil.
Adding iodine, iron, vitamin A, zinc and various B-complex vitamins including folic acid to a range of foods costs about 30 cents per person reached per year. Groups focusing on micronutrients also include Helen Keller International and Vitamin Angels.
In the United States, the Food and Drug Administration has required that flour be fortified with folic acid since 1998. Even in America, with better diets, medical care and widespread fortification, not all women get enough micronutrients, but the problem is far worse in poor countries.
Mr. Dodson notes that it is much cheaper to prevent birth defects than to treat them.
“It’s not a sexy world health issue, but it’s about the nuts and bolts of putting together a healthy population,” Mr. Dodson said. “Putting small amounts of iron, iodine and folic acid in the food supply hasn’t drawn attention the way it does when you treat someone who is sick or in a refugee camp. Until recently, this has been off everybody’s radar screen.”
As the United States reorganizes its chaotic aid program, it might try promoting what just may be the world’s most luscious food: micronutrients.
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