You never hear anyone talking about scurvy any more unless they’re telling a bad pirate joke. Scurvy, usually associated with long sea journeys of centuries past, has gone by the way side because we now know that sufficient vitamin C can prevent it. But the history of its disappearance is a storied tale that has important lessons for public health today.
During the era of the great naval explorations, literally boatloads of sailors would die of scurvy during those long periods at sea. When Vasco de Gama sailed around the Cape of Good Hope in 1497, he lost 100 of his 167 sailors to scurvy. They knew they had scurvy by a sense of malaise and lethargy followed by spots on the skin, jaundice, losing teeth and eventually death. As the story goes, in 1601, the British Navy Captain James Lancaster ran a study between his ships that were sailing from England to India. The crew members on one of the four ships got lemon juice every day. I’m sure you know the ending of this story—40% of the crew members on the other three ships without the lemon juice died of scurvy, but none of the crew getting the lemon juice got scurvy.
Captain Lancaster had discovered a miracle! A simple intervention that can save lives. And what happened with this new found knowledge? Besides its early adoption by James Cook, one of history’s greatest explorers, unfortunately, it sat on a shelf for almost 150 years until a Navy physician, James Lind, did the experiment again– public health’s first randomized controlled trial. And yes, with the same result.
Did this irrefutable evidence then lead to the immediate adoption of lemon juice by all sailors of the high seas? Well, it took another 48 years until the British Navy finally decided to make citrus part of the diet on ships, and then another 70 years to be brought to merchant marine vessels and actually become part of the British preventive policy.
All said and done, it took 264 years to get lemons, limes and oranges to sailors. It is mind boggling to think about the lost time, health and lives simply because of the disconnect between evidence generation, knowledge sharing, and behavior adoption.
I would like to say that we have learned from the great British navy how not to introduce a new health intervention. But, unfortunately, health care is still notoriously slow to gain new knowledge and actually put it to use.
One example is Kangaroo Mother Care, when a mother wraps her baby to her chest, skin-to-skin, to provide warmth, love and breast milk. It’s a very simple method that has been proven time and again to save premature newborns, those born before 37 weeks of pregnancy. Holding a baby skin-to-skin promotes breastfeeding, reduces neonatal infection, and significantly improves the odds of survival. Recent estimates suggest that if we could scale up this behavior worldwide, the lives of 450,000 preterm infants would be saved each year.
The benefits of Kangaroo Mother Care have been recognized since it was first introduced in 1978. That was 34 yearsago, and doctors, nurses, midwives, frontline workers, and moms around the world still do not know about this lifesaving method. It’s only practiced with any consistency in a few countries (South Africa, Malawi, Brazil and Colombia). And there are no clear indicators to even measure the coverage and quality of care.
Why is this great intervention so underutilized? Some doctors prefer complicated technology, calling Kangaroo Mother Care inferior and not appropriate for hospitals. Some health administrators don’t even know it exists. Family members may not believe it works or are nervous to be holding such a tiny baby so closely. It is also a major commitment—most babies should be continuously held, making it difficult for the caregiver to carry on with other life activities.
But the evidence is clear: preterm babies have a better chance of survival if held skin-to-skin.
Which boat would you rather be on? If we go back to scurvy and Captain Lancaster’s experiment, I bet the crew members on the ship that got the lemon juice were really happy to be on that ship where their chance of survival was much higher than the others.
Shouldn’t a baby born too soon have that same chance to be on the right boat?
This blog was originally posted on Impatient Optimists, the blog of the Bill and Melinda Gates Foundation.
*Picture: Simon Tong