Distribution and Use of Co-Fortified Salt

Background

Medical Missionaries intends to eliminate a disease that affects many residents of Thomassique and the surrounding areas, Lymphatic Filariasis (LF), also known as Elephantiasis. At the same time, Medical Missionaries will address the leading preventable cause of impaired cognitive brain development in children, the lack of sufficient iodine in their diet. Both of these health problems are prevalent in the Thomassique region. As a matter of fact, the largest number of surgeries performed by visiting teams of surgeons and nurses at St. Joseph’s clinic each year are for hydroceles, a problem related to LF.

The Program

Medical Missionaries is partnering with the University of Notre Dame Haiti Program to distribute co-fortified salt in Thomassique. The University of Notre Dame, working with the Haitian Ministry of Health and Population and the U.S. Centers for Disease Control, fortifies salt with DEC (diethylcarbamazine) and iodine without changing the taste or other characteristics of salt. Salt fortified with DEC is an effective way to interrupt the transmission of LF, while salt fortified with iodine promotes brain development in children. The co-fortified salt addresses these diseases in tandem.

Lymphatic Filariasis is a parasitic disease that causes disfiguring conditions of the legs and genitalia and often becomes debilitating. Iodine deficiency limits the development of the brains of children and, in some cases of both children and adults, causes goiter, cretinism, and other serious health problems.

In the fortification process, the Notre Dame Haiti Program puts the salt through an intense purification process and then fortifies it with DEC to interrupt transmission of LF, and with iodine, which is essential for proper brain development. Quality controls during the manufacture process assure that the correct dosages of the fortificants are added to the salt.

Medical Missionaries purchases salt from the Notre Dame manufacturing plant in Port au Prince and, in conjunction with local salt distributors in Thomassique, sells the salt to all the residents in the town of Thomassique and in four of its outlying villages. The salt is sold for approximately the same price that non-fortified salt is currently sold for.

Medical Missionaries has also embarked on an education and promotion program to (a) explain to the residents the importance of using fortified salt, and (b) teach them how to use it correctly. The latter is needed because residents often wash their salt before using it. Washing the co-fortified salt would rob it of its fortificants and defeat the purpose of the program.

Arrangements With The Salt Distributors

In the beginning of this program, Medical Missionaries purchased the salt in Port au Prince and subsidized the transportation of the salt to Thomassique. Medical Missionaries then sold the salt to the salt distributors for the city at the same price or less than they were paying to acquire non-fortified salt. (The distributors saved the transportation costs.) The distributors then sold the salt to the residents of Thomassique and the village for the same price they were paying for non-fortified salt. Over time, as the distributors became committed to selling the co-fortified salt, they adjusted the prices slightly so that they now pay the transportation costs and Medical Missionaries no longer has to subsidize those costs. The program is now self-sustaining.

The Promotion And Education Program

Introduction of this new product required promotion and education of the residents of Thomassique. Residents who go to church heard messages about the value of co-fortified salt after church services. They were taught the benefits of using co-fortified salt. Local politicians were recruited to reinforce the messages of the promotion campaign. Posters and flyers were distributed throughout the area. (They were visual posters since many in the region do not read.)

Looking Ahead

Medical Missionaries staff and volunteers continue to carefully monitor the success of this program. It appears that the program is working smoothly and will continue well into the future. It is our hope that concrete results of this program will begin to be seen about 2015 in the reduced incidence of LF and delayed brain development among the people of Thomassique.