What a difference 25 years -- and Iodized Salt -- can make!

In a lodge in Manang, a woman adjusts her headscarf as she laughs at the sight of her grandson feeding from his mother’s breast. The curious one-year-old can’t resist a quick break from his feed to see what’s going on around him in the room.

Only then do I notice his grandmother has a swelling around her neck, a goitre. I am surprised—not to see it, but to realise this is the first I’ve seen in five days of trekking. Things have changed dramatically from when I was here 25 years ago. ....

In this district in 1982, there is a strong chance that a young mother, like the one at the lodge, would have had a goitre, and her child would have been born with cretinism. Back then, while making a film about iodine deficiency for UNICEF, I took hundreds of photographs of people of all ages with goitres, some the size of footballs or large grapefruit. They were not hard to find. In one village, 80 percent of the population had goitres and 20 percent of all newborn children suffered from cretinism.

Today the term ‘cretin’ is considered passé, yet back in the early 1980s the medical profession had to redefine the word because of the high incidence of the illness throughout the Himalayas. At that time I followed a medical team through Manang, under the leadership of Dr Purushotam Thapa, which gave iodine oil injections to young women to provide five years of protection. The situation has now improved dramatically. Iodine Deficiency Disorders (IDD) no longer appear near the top of Nepal’s list of major health problems.

Historically, iodine deficiency has been a problem in most of the world’s major mountainous areas, where people lived far from the sea and so did not have access to naturally occurring iodine or sea salt in their diet. In the Alps, the Rockies and the Andes, it was common at the beginning of the 20th century to find people with goitres. In the Himalayas, the scale of the problem was not fully understood until the 1980s. Many remote communities had been devastated.

Children born to mothers with iodine deficiency suffered problems ranging from mild mental and physical stunting to more severe mental deficiency, deaf mutism, dwarfism and hypothyroidism.

Just 150 micrograms of iodine per day in an adult’s diet is enough to prevent these conditions, but 25 years ago few in Nepal knew this. Many blamed the water supply and responded with offerings to the gods. Children with severe cases were often tethered at home to avoid embarrassing the family.