World Health Organization (WHO) – The Pull Of The Land

In the 1950’s and early 60’s we (the boys in the camp) enjoyed an occasional treat: DDT spraying. On such days, we’d mischievously run behind the company pick-up as it pulled a powerful pump throughout the camp, spraying clouds of DDT, enveloping us as we ran and zigzagged behind it like crazy banshees following some loud piped piper billowing thick clouds of sweet smelling mist which protected the camps from outbreaks of malaria.

There’s something about clouds. When flying to and from the U.S. on annual leave, I’d always hope we’d fly into clouds. I would wonder how it would be to jump off the airplane, into the clouds. Clouds! Beautiful, soft, memorable clouds. Whether fog just above the ground, or mist rolling off the river, or high, cumulus clouds above, clouds pointed to the heavens, to freedom, to action, to beauty, to adventure, to … being a boy. And the white foamy mist the sprayer poured forth was close enough to real clouds!

Our parents did not like us getting anywhere near the stuff, but, like moths drawn to light, we simply refused to resist the temptation and once we heard the unique sound of the pump and saw the clouds coming down the road, we ran to it and followed it like athletes running a marathon; only these El Pao athletes screamed, waved their arms like butterflies, or held them straight out from their sides like airplanes and breathed the stuff deeply into our lungs. We competed to see who could get the closest to the pump. The driver would stick his head out and yell at us to keep away from the truck and pump, not because of the insecticide, but for fear he’d run us over. We’d laugh and he, well, he eventually had to laugh right back at us. But he would still shake his fist!

I don’t recall how often the DDT was sprayed: twice a year? Twice a month? But I do well remember how much fun it was and my bewilderment when I learned that DDT was banned worldwide because of concerns. It was hard for a boy to figure out what could be more of a concern than death by malaria and I do remember adults expressing worries about that.

Without getting into the controversies, which, incredibly, are still “hot” despite so many years of world-wide prohibition, for our purposes we’ll just point out some facts which help illuminate the history and one of the great successes of Venezuela.

The country had the highest number of human malaria cases in Latin America before 1936. During 1891-1920, malaria was endemic to over 600,000 squared kilometers of Venezuela; deaths from malaria substantially reduced the population during that period. No pathogen, including the influenza virus that caused the 1918 pandemic, caused more deaths than malaria during 1905-1945.

Venezuela’s efforts to eradicate this scourge sparked the world’s interest in global eradication. She developed an efficient control program, but, undeniably, it was the introduction of DDT in 1945 which did the lion’s share. I recall visiting my family in San Félix on the banks of the Orinoco and, every night at bedtime, my aunt or my cousins would manually pump insecticide in all rooms, shutting the doors as they finished. This reflects the extent of the malaria eradication campaign. All homes knew what to do and what processes to take.

“Success of DDT spraying was startling. Malaria disappeared after 3-5 years without additional measures beyond occasional quinacrine use in areas….” (Source: National Institutes of Health). Before DDT use, most municipalities in affected areas … had mortality rates of 20 – 50 / 1000 persons. This rather rapidly precipitated to near zero after the introduction of DDT.

It wasn’t all insecticide, of course. Looking back, I am still startled at the cleanliness in the humblest homes in the country; how all things were picked up right away and spills were mopped up immediately. Etc. Visitors wrote that the poorest Venezuelan homes were greater examples of cleanliness and neatness than many northern European dwellings at the time.

Venezuelan doctors, including the influential Arnoldo Gabaldón, insisted on eradication, and actively opposed the World Health Organization’s (WHO) approach of “control”. “In 1968, a WHO report found that ‘the concept of malaria eradication adopted by the national [Venezuelan] authorities’ has … and is … at variance with the [experts].”

But even before Gabaldón, other Venezuelan doctors were leading the way to eradication. In 1894, Dr. Santos Anibal Dominici (1869-1954) identified the malaria parasite in patients in Caracas. But he was more inclined to involvement in politics and upon return from exile in 1936, he named Dr. Enrique Tejera (1889-1980) to lead malaria efforts. However, Dr. Tejera resigned in disgust because global efforts did not address whether malaria could be eradicated or merely controlled.

His dissatisfaction presaged issues highlighted decades later by Dr. Gabaldón which eventually resulted in a split between Gabaldón and WHO, which is a story that continues to be repeated in many disciplines: “developing” countries resent it when fully developed ones seek to tell them what’s good for them, even when it comes to life or death matters, such as the eradication of malaria.

Sadly, “once a beacon of malaria eradication”, Venezuela is again being buffeted by the disease.

But those controversies were the farthest things from the minds of boys running after the clouds.