PoPulationand Public HealtH etHics

inadvertently inhaled and ingested the dust. In a period of months, hundreds
of children died; thousands more remain at risk for the chronic effects of
lead poisoning. Who should respond, nationally and globally, to such crises?
Case
In recent years, the public health surveillance system in northern Nigeria has
proven inadequate, with epidemics of measles, meningitis and cholera going
undetected through official channels. Aware of this situation, the Ingo was
conducting active measles and meningitis surveillance in the area when it
heard of many children dying in a remote village. Once the Ingo arrived onsite,
it was told by the local community health worker that he had informed
his superiors of the mysterious outbreak, but simply received more of the
same antimalarial drugs that were proving ineffective. A calculation of the
death rate qualified the situation as a humanitarian emergency. The Ingo
assembled a team to provide 24-hour medical care onsite and sought special
government permission to send blood samples to a lab in Europe for analysis.
It was these efforts that led to the diagnosis of a lead-poisoning epidemic.
At the village clinic, the Ingo took over management. Then, as a first for the
organization, it worked with two local field hospitals to establish a lead-poisoning
treatment program, providing free chelation treatment for the worst
affected: children five years of age and under and breast-feeding mothers. In
both the first village and another that was similarly affected, the Ingo provided
health education and organized transportation to hospital. Other international
organizations arrived to conduct community health surveys and implement
environmental remediation (cleaning and soil removal and replacement).
To date, more than 400 children have died, amounting to more than 40 per
cent of the children in one village alone, and there is an entire generation
of young village residents at risk of death or serious short- and long-term
irreversible health effects. It has been described as unprecedented and the
worst such lead-poisoning outbreak in modern human history. Yet, despite
the well-established role of lead contamination as the source of the epidemic,
illicit artisanal mining continues.
Ingos may inadvertently contribute to the continuation of this mining. By
providing free environmental remediation (and in many cases, paying the
Whose role is it to deal with societal determinants of health?
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