Rickets Education and Prevention
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"When we set up a clinic in a Tibetan village, the people
come in droves to see the doctors. We ask to see the children
first, and watch the lines of mothers, fathers, and grandparents
gather expectantly. We weigh and measure the kids, and then
we feel their bones and look at their heads. Some have extended,
or bossed, foreheads that protrude beyond normal roundness.
Knots on their ribs and distended bellies are also common. These
bone deformities are often subtle. The percentage of children
with significant signs of rickets is overwhelming. We touch
hundreds of the children each day of a village clinic, hoping
that whatever we can give will grant them the chance for a healthier
life ." |
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—Field intern, 2000 |
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Problem: Studies conducted by the Terma Foundation have
found that 67% of Tibetan children clinically appear to suffer
from rickets, which causes deformities of the skeletal system.
Rickets is caused by vitamin D and calcium deficiencies that
weaken the immune system, causing children to be vulnerable
to severe childhood diseases including pneumonia and tuberculosis.
Rickets can cause pelvic deformities in young girls, which can
predispose them to later difficulty during childbirth. |
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What Terma has done to address the problem: Because the
body exposed to sunlight naturally produces vitamin D, we have
launched a "chugkpa" campaign. Traditionally, chugkpas,
the highly supervised sunbathing of infants, were practiced
daily, but have fallen by the way in recent decades, due to
more limited time of the infants' caretakers. Encouraging the
reemergence of this practice may present an elegant, no-tech,
no-cost solution to vitamin D deficiency. Vitamin D is not found
in foods on the Tibetan Plateau, and the only other recourse
would be vitamin D pill supplements. |
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Our rickets program compares the outcome of
400 children less than three years old who either receive vitamin
D or heath education regarding sunbathing. Intervention began
in agricultural and nomadic villages in 1998. Protocol with
the program included questionnaires regarding the child's heath
and current sun exposure of mother and child, a 24-hour dietary
recall, anthropometric measurement (height, weight, arm/head/chest
circumference) and a clinical exam of the child. Peripheral
blood samples are also obtained as well as x-rays of hands,
wrists, and chest. Acute clinical care is provided for those
with TB and pneumonia as identified on their x-rays. |
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Each month, a Tibetan Terma staff
member visits each village to monitor the progress of the program,
distribute another month's supplements, and continue the rickets
education to village families.
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