Toxic Lunch: Questions Concerning Nutrition Aid Programs in Developing Countries
Twenty three children died of poisoning in the Indian state of Bihar on Tuesday after eating a free midday meal at school. The children fell sick almost immediately, which means they ate a large amount of a highly toxic substance. Sure enough, an organophosphate chemical was found in their bodies upon autopsy. Organophosphates are commonly used in insecticides and solvents, and are highly toxic.
A similar case occurred in Iraq in 1971, when people used grain treated with the pesticide methyl mercury, which was meant to be used as seed grain, not food. The grain was dyed red as a warning, but the people that used it actually liked the pink bread it made, and it was popular in the markets. People suffered from numbness of the skin, lack of coordination and loss of vision. The death toll was 650.
There is no doubt that NEED is a central issue in these tragedies: in India, 4 of 10 children are severely malnourished and over half suffer from some level of malnutrition. School lunch programs were launched in India in 2001 to combat malnutrition and encourage families to keep their children in school. In Bihar alone, 20 million children are enrolled in the program (which is administered by the state). However, CORRUPTION is an impediment to progress, and the funds intended to buy food are often redirected. Many state-run schools in rural India lack hygiene, infrastructure and running water, and often must buy the lowest quality grains and vegetables due to insufficient funding.
A lack of KNOWLEDGE contributes in all of these cases. Such mistakes are common in regions that are poor and illiterate. Officials speculate that in the Bihar case, cooking oil was either stored in a container that previously held pesticides, the oil was accidentally mixed with pesticide, or pesticide was used as oil. However it occurred, the cooks didn’t know the container held pesticides because they couldn’t read (or perhaps the label was removed), and when they complained of the strange odor when cooking the food, the principal told them to ignore it. Would a different standard for marking containers have made a difference?
To my toxicologist coworkers, I asked why the skull and crossbones symbol wasn’t on the container. The response was thought provoking: “Officially adopted symbols are only obvious to the educated. To the uneducated, symbols could well appear to be a logo or branding symbol.” Indeed, some of the methyl mercury grain involved in the 1971 incidence in Iraq was marked with Skull and Crossbones and it didn't help; the local residents didn’t know what it meant. Also, the warning labels on the bags were not in their language. Don’t think that the U.S. is immune; on Thursday the front page of the NPR website had an article about how most pesticide health/safety/usage labels are only in English, despite 80% of farm workers in the US not speaking the language. So, technically this stuff could happen here too.
What can we do to avoid this type of tragedy in the future? How can aid programs circumvent local corruption to address the need? What labeling standards would be understood universally? Although I am genuinely surprised that the skull and crossbones didn’t work, the current Hazard Communication Standard Pictogram for “Health Hazard” is even worse; it looks to me like the substance will make you a superhero (see image).
Pictogram credit to Occupational Safety and Health Administration web page (https://www.osha.gov/Publications/HazComm_QuickCard_Pictogram.html)
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