COMMENTATOR (COMM): Previously on Life...
DR MUSTAFA KHALIL: There is a specific health problem here: anaemia, growth and development problem, as many things.
DR IKLAS MUSTAPHA: Most of the pregnant women here, they are suffering from anaemia.
NEELAM ADHIKARI: Literacy of women, education, hygiene, availability of food; the whole situation is really socio-economic.
COMM: Basma is anaemic; she's one of over two billion people world-wide who suffer from this exhausting condition. She has no appetite, she's tired and she can't concentrate. There's not enough iron in her blood to allow it to carry enough oxygen to her body and her brain. Without treatment, the disorder will have long term effects on Basma's health and she could even die. Iron-deficiency anaemia is the most widespread nutritional disorder in the world. It's particularly severe in the Middle East and it affects the rich as well as the poor. It's often a hidden disease and young children and women of childbearing age suffer the most. Children can suffer irreversible mental and physical damage. Women with severe anaemia can die in childbirth and miscarry their unborn children.
DR IBRAHIM M ISMAIL: People live with anaemia but they can't work well; people live with anaemia but they can't think well. If you can't live well and if you can't think well, how can you make you a better life - you can't.
COMM: Basma is getting specialist treatment from Dr Ibrahim, a nutritional expert at a clinic in Cairo. Young children are especially vulnerable to iron deficiency and need a constant supply of iron to grow properly.
DR IBRAHIM M ISMAIL, Education & Communication Unit, Nutritional Institute, Egypt: Here we are facing many problems of anaemia. I find that she is very pale from the conjunctiva of her eye and her pallor of the lip, OK? And also in the nail. Her weight 18kg which is not suitable for her age which is five years and 11 months and also her height is 109 cm which is also not suitable for her age. This child is not growing well even physically or mentally and this will affect her in the school age - when the starting school age, next year, OK? She will get some educational problems if she is not well treated now.
COMM: Because of complex social and cultural issues, over 50% of the population of some countries in the Middle East suffer from iron-deficiency anaemia. It stunts the health of entire populations and slows down productivity. The economic consequences of a tired, weak and iron deficient workforce can run into billions of dollars.
DR ANNA VERSTER, Director, Health Protection & Promotion WHO/EMRO, Egypt: Now, when you translate this iron deficiency - this lack of productivity - into actual money terms there's a huge loss. You come up with amounts of up to four to eight dollars per capita per year. Now, times 60 million inhabitants, for instance, that's a huge amount of money and that's really to be taken very seriously. COMM: One of the most effective ways to combat iron deficiency anaemia is to add iron to staple foods everybody eats, a process known as iron fortification - here bread is the staple food. Western countries have been fortifying bread and cereals for the last 50 years but in the Middle East the idea's still quite new and the process has thrown up a number of problems. The idea is to add iron to flour so that everybody will get their recommended dose of iron when they eat their daily bread.
COMM: It was in Egypt the ancient land of the Pharaohs that legend says that bread making was invented many thousands of years ago. Loaves were often buried with the dead to provide them with sustenance on their journey to the afterlife. Ancient hieroglyphics from over 5,000 years ago show bread that was even then the staple food. Possessing a great number of loaves meant great wealth, bread was the currency of the kingdom - used to pay priests and pyramid builders. The Pharaoh was the lord of all wheat and flour. In present day Egypt, bread is in abundance everywhere. Eaten at least four times a day, there are said to be over 100 different types of bread here. The most common is Baladi bread. In Egypt, bread is known as aysh - the world aysh means life.
WOMAN (TRANSLATION): This bread means everything to us, everything! This bread is the best! That old man over there refuses to eat anything else.
COMM: Ramdam Fawzy is one of many thousands of bakers in Egypt. He inherited this bakery from his father, who inherited it from his father. Every day he bakes at least 5,000 loaves.
RAMDAM FAWZY (TRANSLATION): Of course, I am proud of what I do. I feed everyone - from politicians to poor people, it's a service that I provide to the whole community when I bake bread, insh'allah. COMM: Because bread is so important to Egyptians any government policy on fortifying bread flour with iron needs careful management. People are anxious at the thought of interfering with something so natural.
RAMDAM FAWZY (TRANSLATION): We shouldn't put anything into our flour, it will affect the bread - any small changes will affect our work. We shouldn't play around with things that God gave us, changing nature will give us a lot of problems.
COMM: Dr. Farouk and his colleagues are working with the government and international agencies to encourage the fortification of bread flour with iron. But he knows that he has to take things one step at a time.
DR FAROUK M SHAHEEN, Director, Nutritional Institute, Egypt: Balady Bread, you can say, is a staple food in Egypt like rice in the Far East. But in Egypt it is very precious for - the bread is very precious, and sacred since ancient, ancient times. And we are keen that the fortification of the bread - the process will be thoroughly studied and done in a very cautious way. So that's why we decided that it must be - it has been decided that we have to, to do a pilot study in one of the governorates - not universal for the whole nation.
COMM: As part of the pilot study, Dr Ibrahim is working on helping people understand that the fortification of flour is safe and necessary.
DR IBRAHIM M ISMAIL: We are planning a social marketing campaign for the flour fortification project because people must know that we are getting in the-the bread what is - must be in the first [place]. You know, the whole flour contains iron but when we are milling it we exclude a lot of iron, so we need return it back - just return it back, OK? And this in a dose which is safe, in a dose which is not harmful, in a dose which is under control.
COMM: Dr Ibrahim takes his work out on the road to the eastern region, Al Fayoum, where a new project to fortify bread flour with iron is scheduled for the near future. Here, he works with local nutritional educators, like Afaf, who help him talk to people and discuss any concerns they might have.
COMM: Today they're visiting Sabah who's eight months pregnant; because of this she needs more iron than usual to feed her growing baby.
DR IBRAHIM M ISMAIL: ...and because of our marketing campaign - which is a very good idea that the nutritional educator comes to the mother at home. We use nutritional educators like Afaf, we will teach her - we teach nurses, we teach her supervisors so that they can visit the home - we cannot visit all homes. We just train them how to educate the people about fortification...
COMM: Home visits aren't just an opportunity to talk about flour fortification - they're also a good way to teach people about the importance of eating iron rich foods. A few kilometres from Sabah's house is the Al Fayoum flour mill, one of 500 mills in Egypt, it was the first to install a simple flour fortification system. For the last two years they've been adding iron to flour used to bake biscuits for school children. In a few months time they also plan to add iron to bread flour. The iron is added in the form of ferrous sulphate, in small doses. The process is carefully monitored at every stage. In this test, the darker colour means the flour now contains the recommended dosage of iron. Dr Ibrahim wants to help people like Basma and her mother understand why iron is so important to their diet and how their eating habits can affect their iron intake.
DR IBRAHIM M ISMAIL (TRANSLATION): There are many natural sources of iron given to us by God like spinach, parsley, cabbage - all of them which are rich in iron. The thing is that we need to be careful what we eat with what; we shouldn't drink tea with our meals and we need to eat our meals fresh.
DR IBRAHIM M ISMAIL: The problem is that we make foods which are rich in iron not rich in iron. Some of the problem with iron is absorption - iron is an element which has to be in a suitable circumstance to be absorbed: we must have some vitamin C - or fruits or vegetables which is containing vitamin C - to absorb iron well. Here in Egypt is that we are taking tea with lunch, not after lunch - no, with lunch - we are taking it with lunch! So the iron content of the food cannot be absorbed, so I take iron but I can't absorb it.
COMM: Basma is lucky. As well as eating an iron rich diet she is receiving iron supplements.
DR IBRAHIM M ISMAIL: OK, not more than one!
COMM: Her prognosis is good: with luck, she won't suffer any long-term damage. Across the Red Sea to the South East, Yemen is also launching a national flour fortification programme in the near future. In some areas of the country, up to 80% of the population suffers from iron-deficiency anaemia. Yemen: a country the size of France, but with a population of just 18 million. Yemen has only recently emerged from centuries of isolation and the ravages of civil war. As in Egypt bread is Yemen's staple food but here the challenges are different: fortifying flour is just one part of a need to address basic health issues compounded by extreme poverty, primitive infrastructures and inaccessible mountain ranges. Mountains cover over 60% of the country.
DR MAGDI BAYOUMI, Chief, Health & Nutrition Section, UNICEF, Yemen: We have to combat iron deficiency anaemia at different levels everywhere by all means. And what I mean by that, that we have to-to fortify flour; to control parasites and their advances; to control malaria - to combat and control malaria - to improve the obstetric care and the reproductive health care.
COMM: Hospital is a luxury reserved for the few Yemenis who manage to make it into town. It can take days to travel to the nearest health centre. Once there, patients still have to pay something towards the cost of their treatment - a cost few of them can afford. Eight out of ten women are illiterate and only one in five receive any medical assistance in childbirth. With little access to family planning most families have at least seven children and women who suffer from iron deficiency anaemia are much more likely to die in childbirth. In this hospital in the Yemeni capital Sana'a, one out of every ten women who go into labour die because of complications from anaemia.
IDR MAHAN AMIN ABDUL WAHED, Specialist, Obstetrics & Gynaecology, Al Sabeen Hospital, Sana'a (TRANSLATION): I feel so sad and frustrated when I see how many women are dying - the cases that we are unable to save. There is a lack of awareness and education about family planning and also about general health and nutrition issues.
PROF A NASSER AL MUNIBARI Minister of Health & Population, Republic of Yemen: Health education in Yemen till the moment is still limping and the only issue is preparation our qualified people to overcome this problem and to give them suitable training where they can educate the population and the community.
COMM: Rachel Chandiru, a health specialist from Uganda, trains midwives in the western region of Yemen. One of Yemen's poorest areas, it also has a high malaria incidence which adds to the problems of iron-deficiency anaemia.
DR RACHEL C CHANDIRU, Vitamin A/Iron Project Director, Adventist Development and Relief Agency, Yemen: The problem we have here with anaemia is mostly abortion, stillbirth, and also death of mothers during delivery. COMM: As part of her daily work, Rachel sees the basic challenges that pregnant women and new mothers face. She teaches midwives to discuss primary health care and nutrition with their patients.
DR RACHEL C CHANDIRU: And all these midwives here, they do home visits and she's the one supervising. She says she will be delivering in the house and so I was asking her: who is going to help her during the time of delivery? She said she was going to a trained midwife.
COMM: Rachel accompanies the midwives on their home visits. Anisa is 16, she has two children - she gave birth to her second child two days ago.
DR RACHEL C CHANDIRU: The baby she delivered it, the mother, here - just in this place where we are - she delivered, the mother, on the floor!
COMM: Rachel emphasises the key role midwives can play in persuading women to take iron tablets during pregnancy. In Yemen ignorance combined with cultural misconceptions often exacerbates basic health problems.
DR RACHEL C CHANDIRU: I was asking her - as the midwife, she was the one taking care of her during antenatal - did she give her iron tablets? She said 'Yes'. That was the first things they told us when we started giving iron tablets: it will make our babies big and we shall have difficulties, difficulties in delivering - all these kinds of things. But we have to teach them, train them what iron tablets does for the baby and for the mother.
COMM: Sixteen-year-old Anisa is only a couple of years older than these girls in the same village. Many of them already suffer from iron deficiency anaemia.
DR RACHEL C CHANDIRU: Children don't have the right foods at the right time and the mothers need to be taught in fact what to feed their children with, yeah. So most of them are really small for their age.
DIRECTOR: Can you tell us what you saw in there?
DR RACHEL C CHANDIRU: She told me she has ten - nine children and that's her ninth, er tenth child. I asked her why she doesn't visit the midwife. She says she doesn't want to visit her. I asked her: why don't you visit the midwife because she's the next - nearest to you? She says she doesn't want to visit her. I said: why, because it's important for you to visit the antenatal clinic because if you have anaemia or anything like you have a swollen leg, the midwife would have detected it earlier because this is anaemia due to not taking iron tablets and not eating well.
COMM: Half the population of Yemen is under the age of 15; many of them suffer from easily curable childhood diseases. One in 11 children die before the age of five.
DR RACHEL C CHANDIRU: Of course when children have diseases of nutrition, or nutritional deficiency, they will not grow up well, they will not perform well in school or they'll not be active among their peer group or in their home to help their parents do some work. The eye, when you look at the eye it is so pale and she has this swelling. I think this is a sign of deficiency and you can see that the child is not happy. So this must one of the signs for nutritional deficiency. Here women are not allowed to go outside and as there's only one market a day here, it's the men who go outside to buy food. So it causes anaemia to women because market day's only once and then you have to get food and they don't have storage, good storage, so it's difficult to get fresh foods maybe which will last perhaps for one week. They talk about fortification and I think that would be the best, the best solution here where there is in fact no food for the community and they have no access to markets and they are very poor. I think that would be best thing.
COMM: The Red Sea flour mill in Yemen is the third biggest flour mill in the world.
EL SIR EISSA, Technical Manager, Red Sea Flour Mills Co. Ltd: But I think that people will accept it because, since they know the benefit of this for the health of the people and especially the mothers and the children. I think that they will accept it willingly.
COMM: Fortifying flour for bread means people across Yemen, from mountain village to bustling town, can now receive a daily dose of iron as part of their diet. According to World Health Organization studies it costs just US$2 per person, per lifetime to tackle the problem of iron deficiency anaemia. Flour fortification is one way of ensuring that with every meal they eat, every piece of bread they consume, people will now get the iron they need to create a nation of physically and mentally healthy people.
DR ANNA VERSTER: Flour fortification is such a great opportunity and I feel that if you have this bread - people eat bread, they say this is the 'bread of life', it is 'life itself' and I think that life should be healthy and life should be prosperous. So if we can add iron and make sure that this bread enhances the iron status of the individual person and therefore improves the economy of the country, I think we have done a great job.
DR MAGDI BAYOUMI, Chief, Health & Nutrition Section, UNICEF, Yemen: Just yesterday the Prime Minister of the Republic of Yemen and the Minister of Health has issued a decree, a law to fortify all flours, consuming flours, in Yemen - and the challenge now is how to enforce this law.
DR IBRAHIM M ISMAIL, Education & Communication Unit, Nutritional Institute, Egypt: Bread is a sacred food to the whole Egyptian population in Egypt. We eat bread in breakfast, we eat bread in lunch and we eat bread in dinner. But I was lucky because I have a mother, she was electric! She give me all foods which I now find was very rich in iron and was very healthy food. Anaemia is a very dangerous disease: it affect our health, it affect our future, it affect our children. We have to combat iron deficiency anaemia; we have to prevent iron deficiency anaemia. We have to be more healthy, not anaemic.
END
DR MUSTAFA KHALIL: There is a specific health problem here: anaemia, growth and development problem, as many things.
DR IKLAS MUSTAPHA: Most of the pregnant women here, they are suffering from anaemia.
NEELAM ADHIKARI: Literacy of women, education, hygiene, availability of food; the whole situation is really socio-economic.
COMM: Basma is anaemic; she's one of over two billion people world-wide who suffer from this exhausting condition. She has no appetite, she's tired and she can't concentrate. There's not enough iron in her blood to allow it to carry enough oxygen to her body and her brain. Without treatment, the disorder will have long term effects on Basma's health and she could even die. Iron-deficiency anaemia is the most widespread nutritional disorder in the world. It's particularly severe in the Middle East and it affects the rich as well as the poor. It's often a hidden disease and young children and women of childbearing age suffer the most. Children can suffer irreversible mental and physical damage. Women with severe anaemia can die in childbirth and miscarry their unborn children.
DR IBRAHIM M ISMAIL: People live with anaemia but they can't work well; people live with anaemia but they can't think well. If you can't live well and if you can't think well, how can you make you a better life - you can't.
COMM: Basma is getting specialist treatment from Dr Ibrahim, a nutritional expert at a clinic in Cairo. Young children are especially vulnerable to iron deficiency and need a constant supply of iron to grow properly.
DR IBRAHIM M ISMAIL, Education & Communication Unit, Nutritional Institute, Egypt: Here we are facing many problems of anaemia. I find that she is very pale from the conjunctiva of her eye and her pallor of the lip, OK? And also in the nail. Her weight 18kg which is not suitable for her age which is five years and 11 months and also her height is 109 cm which is also not suitable for her age. This child is not growing well even physically or mentally and this will affect her in the school age - when the starting school age, next year, OK? She will get some educational problems if she is not well treated now.
COMM: Because of complex social and cultural issues, over 50% of the population of some countries in the Middle East suffer from iron-deficiency anaemia. It stunts the health of entire populations and slows down productivity. The economic consequences of a tired, weak and iron deficient workforce can run into billions of dollars.
DR ANNA VERSTER, Director, Health Protection & Promotion WHO/EMRO, Egypt: Now, when you translate this iron deficiency - this lack of productivity - into actual money terms there's a huge loss. You come up with amounts of up to four to eight dollars per capita per year. Now, times 60 million inhabitants, for instance, that's a huge amount of money and that's really to be taken very seriously. COMM: One of the most effective ways to combat iron deficiency anaemia is to add iron to staple foods everybody eats, a process known as iron fortification - here bread is the staple food. Western countries have been fortifying bread and cereals for the last 50 years but in the Middle East the idea's still quite new and the process has thrown up a number of problems. The idea is to add iron to flour so that everybody will get their recommended dose of iron when they eat their daily bread.
COMM: It was in Egypt the ancient land of the Pharaohs that legend says that bread making was invented many thousands of years ago. Loaves were often buried with the dead to provide them with sustenance on their journey to the afterlife. Ancient hieroglyphics from over 5,000 years ago show bread that was even then the staple food. Possessing a great number of loaves meant great wealth, bread was the currency of the kingdom - used to pay priests and pyramid builders. The Pharaoh was the lord of all wheat and flour. In present day Egypt, bread is in abundance everywhere. Eaten at least four times a day, there are said to be over 100 different types of bread here. The most common is Baladi bread. In Egypt, bread is known as aysh - the world aysh means life.
WOMAN (TRANSLATION): This bread means everything to us, everything! This bread is the best! That old man over there refuses to eat anything else.
COMM: Ramdam Fawzy is one of many thousands of bakers in Egypt. He inherited this bakery from his father, who inherited it from his father. Every day he bakes at least 5,000 loaves.
RAMDAM FAWZY (TRANSLATION): Of course, I am proud of what I do. I feed everyone - from politicians to poor people, it's a service that I provide to the whole community when I bake bread, insh'allah. COMM: Because bread is so important to Egyptians any government policy on fortifying bread flour with iron needs careful management. People are anxious at the thought of interfering with something so natural.
RAMDAM FAWZY (TRANSLATION): We shouldn't put anything into our flour, it will affect the bread - any small changes will affect our work. We shouldn't play around with things that God gave us, changing nature will give us a lot of problems.
COMM: Dr. Farouk and his colleagues are working with the government and international agencies to encourage the fortification of bread flour with iron. But he knows that he has to take things one step at a time.
DR FAROUK M SHAHEEN, Director, Nutritional Institute, Egypt: Balady Bread, you can say, is a staple food in Egypt like rice in the Far East. But in Egypt it is very precious for - the bread is very precious, and sacred since ancient, ancient times. And we are keen that the fortification of the bread - the process will be thoroughly studied and done in a very cautious way. So that's why we decided that it must be - it has been decided that we have to, to do a pilot study in one of the governorates - not universal for the whole nation.
COMM: As part of the pilot study, Dr Ibrahim is working on helping people understand that the fortification of flour is safe and necessary.
DR IBRAHIM M ISMAIL: We are planning a social marketing campaign for the flour fortification project because people must know that we are getting in the-the bread what is - must be in the first [place]. You know, the whole flour contains iron but when we are milling it we exclude a lot of iron, so we need return it back - just return it back, OK? And this in a dose which is safe, in a dose which is not harmful, in a dose which is under control.
COMM: Dr Ibrahim takes his work out on the road to the eastern region, Al Fayoum, where a new project to fortify bread flour with iron is scheduled for the near future. Here, he works with local nutritional educators, like Afaf, who help him talk to people and discuss any concerns they might have.
COMM: Today they're visiting Sabah who's eight months pregnant; because of this she needs more iron than usual to feed her growing baby.
DR IBRAHIM M ISMAIL: ...and because of our marketing campaign - which is a very good idea that the nutritional educator comes to the mother at home. We use nutritional educators like Afaf, we will teach her - we teach nurses, we teach her supervisors so that they can visit the home - we cannot visit all homes. We just train them how to educate the people about fortification...
COMM: Home visits aren't just an opportunity to talk about flour fortification - they're also a good way to teach people about the importance of eating iron rich foods. A few kilometres from Sabah's house is the Al Fayoum flour mill, one of 500 mills in Egypt, it was the first to install a simple flour fortification system. For the last two years they've been adding iron to flour used to bake biscuits for school children. In a few months time they also plan to add iron to bread flour. The iron is added in the form of ferrous sulphate, in small doses. The process is carefully monitored at every stage. In this test, the darker colour means the flour now contains the recommended dosage of iron. Dr Ibrahim wants to help people like Basma and her mother understand why iron is so important to their diet and how their eating habits can affect their iron intake.
DR IBRAHIM M ISMAIL (TRANSLATION): There are many natural sources of iron given to us by God like spinach, parsley, cabbage - all of them which are rich in iron. The thing is that we need to be careful what we eat with what; we shouldn't drink tea with our meals and we need to eat our meals fresh.
DR IBRAHIM M ISMAIL: The problem is that we make foods which are rich in iron not rich in iron. Some of the problem with iron is absorption - iron is an element which has to be in a suitable circumstance to be absorbed: we must have some vitamin C - or fruits or vegetables which is containing vitamin C - to absorb iron well. Here in Egypt is that we are taking tea with lunch, not after lunch - no, with lunch - we are taking it with lunch! So the iron content of the food cannot be absorbed, so I take iron but I can't absorb it.
COMM: Basma is lucky. As well as eating an iron rich diet she is receiving iron supplements.
DR IBRAHIM M ISMAIL: OK, not more than one!
COMM: Her prognosis is good: with luck, she won't suffer any long-term damage. Across the Red Sea to the South East, Yemen is also launching a national flour fortification programme in the near future. In some areas of the country, up to 80% of the population suffers from iron-deficiency anaemia. Yemen: a country the size of France, but with a population of just 18 million. Yemen has only recently emerged from centuries of isolation and the ravages of civil war. As in Egypt bread is Yemen's staple food but here the challenges are different: fortifying flour is just one part of a need to address basic health issues compounded by extreme poverty, primitive infrastructures and inaccessible mountain ranges. Mountains cover over 60% of the country.
DR MAGDI BAYOUMI, Chief, Health & Nutrition Section, UNICEF, Yemen: We have to combat iron deficiency anaemia at different levels everywhere by all means. And what I mean by that, that we have to-to fortify flour; to control parasites and their advances; to control malaria - to combat and control malaria - to improve the obstetric care and the reproductive health care.
COMM: Hospital is a luxury reserved for the few Yemenis who manage to make it into town. It can take days to travel to the nearest health centre. Once there, patients still have to pay something towards the cost of their treatment - a cost few of them can afford. Eight out of ten women are illiterate and only one in five receive any medical assistance in childbirth. With little access to family planning most families have at least seven children and women who suffer from iron deficiency anaemia are much more likely to die in childbirth. In this hospital in the Yemeni capital Sana'a, one out of every ten women who go into labour die because of complications from anaemia.
IDR MAHAN AMIN ABDUL WAHED, Specialist, Obstetrics & Gynaecology, Al Sabeen Hospital, Sana'a (TRANSLATION): I feel so sad and frustrated when I see how many women are dying - the cases that we are unable to save. There is a lack of awareness and education about family planning and also about general health and nutrition issues.
PROF A NASSER AL MUNIBARI Minister of Health & Population, Republic of Yemen: Health education in Yemen till the moment is still limping and the only issue is preparation our qualified people to overcome this problem and to give them suitable training where they can educate the population and the community.
COMM: Rachel Chandiru, a health specialist from Uganda, trains midwives in the western region of Yemen. One of Yemen's poorest areas, it also has a high malaria incidence which adds to the problems of iron-deficiency anaemia.
DR RACHEL C CHANDIRU, Vitamin A/Iron Project Director, Adventist Development and Relief Agency, Yemen: The problem we have here with anaemia is mostly abortion, stillbirth, and also death of mothers during delivery. COMM: As part of her daily work, Rachel sees the basic challenges that pregnant women and new mothers face. She teaches midwives to discuss primary health care and nutrition with their patients.
DR RACHEL C CHANDIRU: And all these midwives here, they do home visits and she's the one supervising. She says she will be delivering in the house and so I was asking her: who is going to help her during the time of delivery? She said she was going to a trained midwife.
COMM: Rachel accompanies the midwives on their home visits. Anisa is 16, she has two children - she gave birth to her second child two days ago.
DR RACHEL C CHANDIRU: The baby she delivered it, the mother, here - just in this place where we are - she delivered, the mother, on the floor!
COMM: Rachel emphasises the key role midwives can play in persuading women to take iron tablets during pregnancy. In Yemen ignorance combined with cultural misconceptions often exacerbates basic health problems.
DR RACHEL C CHANDIRU: I was asking her - as the midwife, she was the one taking care of her during antenatal - did she give her iron tablets? She said 'Yes'. That was the first things they told us when we started giving iron tablets: it will make our babies big and we shall have difficulties, difficulties in delivering - all these kinds of things. But we have to teach them, train them what iron tablets does for the baby and for the mother.
COMM: Sixteen-year-old Anisa is only a couple of years older than these girls in the same village. Many of them already suffer from iron deficiency anaemia.
DR RACHEL C CHANDIRU: Children don't have the right foods at the right time and the mothers need to be taught in fact what to feed their children with, yeah. So most of them are really small for their age.
DIRECTOR: Can you tell us what you saw in there?
DR RACHEL C CHANDIRU: She told me she has ten - nine children and that's her ninth, er tenth child. I asked her why she doesn't visit the midwife. She says she doesn't want to visit her. I asked her: why don't you visit the midwife because she's the next - nearest to you? She says she doesn't want to visit her. I said: why, because it's important for you to visit the antenatal clinic because if you have anaemia or anything like you have a swollen leg, the midwife would have detected it earlier because this is anaemia due to not taking iron tablets and not eating well.
COMM: Half the population of Yemen is under the age of 15; many of them suffer from easily curable childhood diseases. One in 11 children die before the age of five.
DR RACHEL C CHANDIRU: Of course when children have diseases of nutrition, or nutritional deficiency, they will not grow up well, they will not perform well in school or they'll not be active among their peer group or in their home to help their parents do some work. The eye, when you look at the eye it is so pale and she has this swelling. I think this is a sign of deficiency and you can see that the child is not happy. So this must one of the signs for nutritional deficiency. Here women are not allowed to go outside and as there's only one market a day here, it's the men who go outside to buy food. So it causes anaemia to women because market day's only once and then you have to get food and they don't have storage, good storage, so it's difficult to get fresh foods maybe which will last perhaps for one week. They talk about fortification and I think that would be the best, the best solution here where there is in fact no food for the community and they have no access to markets and they are very poor. I think that would be best thing.
COMM: The Red Sea flour mill in Yemen is the third biggest flour mill in the world.
EL SIR EISSA, Technical Manager, Red Sea Flour Mills Co. Ltd: But I think that people will accept it because, since they know the benefit of this for the health of the people and especially the mothers and the children. I think that they will accept it willingly.
COMM: Fortifying flour for bread means people across Yemen, from mountain village to bustling town, can now receive a daily dose of iron as part of their diet. According to World Health Organization studies it costs just US$2 per person, per lifetime to tackle the problem of iron deficiency anaemia. Flour fortification is one way of ensuring that with every meal they eat, every piece of bread they consume, people will now get the iron they need to create a nation of physically and mentally healthy people.
DR ANNA VERSTER: Flour fortification is such a great opportunity and I feel that if you have this bread - people eat bread, they say this is the 'bread of life', it is 'life itself' and I think that life should be healthy and life should be prosperous. So if we can add iron and make sure that this bread enhances the iron status of the individual person and therefore improves the economy of the country, I think we have done a great job.
DR MAGDI BAYOUMI, Chief, Health & Nutrition Section, UNICEF, Yemen: Just yesterday the Prime Minister of the Republic of Yemen and the Minister of Health has issued a decree, a law to fortify all flours, consuming flours, in Yemen - and the challenge now is how to enforce this law.
DR IBRAHIM M ISMAIL, Education & Communication Unit, Nutritional Institute, Egypt: Bread is a sacred food to the whole Egyptian population in Egypt. We eat bread in breakfast, we eat bread in lunch and we eat bread in dinner. But I was lucky because I have a mother, she was electric! She give me all foods which I now find was very rich in iron and was very healthy food. Anaemia is a very dangerous disease: it affect our health, it affect our future, it affect our children. We have to combat iron deficiency anaemia; we have to prevent iron deficiency anaemia. We have to be more healthy, not anaemic.
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