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It also contains sesame seeds that have beneficial minerals. GudNess bars are sold at many retail outlets and schools in 12 cities in 4 Indian states. According to Mehta, they sell , bars a week. The project also looks for ways to involve the community in iron nutrition education. Through a health scout program high school students spread awareness about anemia in their local communities.
Mehta said she loves learning from the community about problems that they have faced with anemia and knowing a simple solution like GudNess bars has changed them. Series allows Duke researchers to share their international works-in-progress. Share this story Share this story on facebook Share this story on twitter Share this story on reddit Share this story on linkedin Get this story's permalink Print this story. Shakira Warren. Additionally, there was the challenge of determining what phase the person presenting sickle cells was in, and this meant it was impossible to make any prognosis about the disease.
Diagnosis was hampered by these question marks surrounding the hematological presentation of the disease and by the variety of symptoms, which were not specific and could mimic other illnesses. In , Eldridge Campbell, a surgical resident at The Johns Hopkins Hospital, warned that physicians needed to be more aware of the clinical symptoms of sickle cell anemia, since many cases were misdiagnosed as appendicitis or some other illness responsible for abdominal pain Campbell, Furthermore, a good share of the diagnostic efforts by doctors in the southern United States focused on diseases then of greater concern to the region, while sickle cell anemia was relegated to a secondary plane in epidemiological terms.
It was not only the issue of technique that kept the disease invisible. In the United States, it was a common notion that blacks were "a naturally diseased people" Wailoo, , p. Interpretations of sickle cell anemia did not deviate from this, since they were underpinned by the same theoretical framework. Winsor and Burch used the varied clinical presentation of sickle cell anemia to reinforce the notion that black people supposedly had a propensity to disease:.
Like syphilis, sickle cell anemia may present many clinical syndromes. Some of these are easily recognizable, while others may imitate many disease states such as rheumatic fever, tuberculosis, Hodgkin's disease Like syphilis, the disease may be so subtle as not to enter the mind of the clinician. Because of the fact that sickle cell anemia is such a great imitator and because it may remain so subtle, it is necessary, again as in syphilis, to study the blood routinely for sickle cell anemia in all Negro patients. As in the case of routine serologic examinations for syphilis, this has resulted in the unexpected discovery of many patients with sickle cell anemia p.
The relation drawn between sickle cell anemia and syphilis reflects the belief not only that black people's bodies harbored disease but that their 'black blood' did so as well. In the case of sickle cell anemia, this link between the black race and the disease was even more significant because of the absence of a specific etiological agent, like the syphilis bacteria, and because of the presence of a blood alteration believed intrinsic to the organism.
A hereditary disease that occurred almost solely among blacks made for a more convincing argument than the incidence of any other kind of disease within this racial group Tapper, , p. We find this association between sickle cell anemia and people classified as black right from the outset of the process to characterize the disease 9 , and it was always mentioned in scientific papers.
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In the late s, according to Tapper , p. From that point forward, many studies adopted criteria for delimiting race, such as the analysis of physical features and research into family ancestors, all in an effort to identify a black heritage among carriers of such cells Castana, ; Archibald, ; Cooley, Lee, ; Rosenfeld, Pincus, ; Lawrence, ; Cook, Mack, ; Haden, Evans, ; Ogden, It is worth reiterating that this focus on the observation of sickle cells in whites was intended to tease out a hidden black ancestry.
Yet detecting sickle-shaped cells in whites did not shake the widespread belief that the disease was racially specific. To the contrary, the effort then shifted to calling into question the racial purity of the 'white' person presenting sickle cells. A fine example is found in a discussion by two physicians at New York's Brooklyn Jewish Hospital, Samuel Rosenfeld and Joseph Pincus , concerning the presence of sickle cells in the blood of three generations of a white family.
Although they in principle agreed that sickle cells could be found in 'white blood,' we see them retreating at the end of their argument:. Because of the tendency to deny such descendancy by those who are free of all Negro features, no history will be obtained of such racial origin in affected individuals, thereby increasing the number of apparently pure white cases of sickle cell anemia p. The use of sickle cells as racial markers belonged to a period when other blood characteristics were also used to identify and compare human races. At the time, blood groups were accepted as inherited characters, believed to be distributed across races at different rates Schneider, In , William Warrick Cardoso, pediatrician at Provident Hospital in Chicago, published a study that sought to verify the relation between sickle-shape erythrocytes and a specific blood group Cardoso, , p.
So research into sickle cells was not limited to clinical studies. The possibility of using these as racial markers reshaped the history of the disease, as evident in anthropological research exploring a number of questions, such as the differences between blacks in Africa and the United States Tapper, , p. In the next section, we will see how scientific research conducted in Africa first sought to establish whether sickle cells were specific to the black race.
Once this correlation had been established, investigations turned to elucidating the differences between rates of sickle cell anemia among African and U. The racial specificity of sickle cells in Africa.
In the wave of genetic and anthropological studies based especially on blood group rates, research was done on the rate of sickle cells in tribal groups in different regions of Africa, as a way of better understanding ancestry Singer, ; Hiernaux, The idea that the disease had originated in Africa was not embraced straightaway.
For Foy and collaborators , for example, the racial specificity of sickle cells remained in question, although by that time more than fifteen statistical surveys had been conducted among African populations, revealing a high incidence of sickle cells. The earliest research in Africa was aimed first at confirming or refuting the hypothesis that sickle cells, along with the disease deriving from them, were inherent to members of the black race.
This specificity was accepted subsequent to statistical studies 11 , and research moved to investigate differences in the presentation of sickle cell anemia between African and U. In , physician Alan B. Raper , p. That same year, a Philadelphia physician by the name of John H. Hodges , p.
In a editorial, the British Medical Journal also raised the hypothesis that interbreeding with whites had boosted the rate of this type of anemia in the United States Editorial, , p. Prior to this African research, in an article published in the U. They posited that lighter-skinned people presented a higher rate of incidence while those with dark skin presented the lowest rates p. From these conclusions came the conjecture that even though sickle cells were hereditary, the condition could also be brought on by miscegenation with 'white blood.
Findings from studies done in Africa were used in the United States in the effort to establish differences between African and U.
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For Tapper , p. It was believed that by identifying racial differences in susceptibility to diseases, these differences would be less perceptible than those already pinpointed by traditional anthropology, and sickle cell anemia was one of its focal points. It was thought that this new methodology would enhance both racial classification and the determination of ancestral background. The interpretation that more Africans displayed the sickle cell trait and that more U. During the first decades of the twentieth century in the United States, sickle cell anemia fit into the following interpretative framework: it was specific to the black race; it was detected through observation of sickle cells in the blood and associated with a varied gamut of symptoms; and it manifested in two phases: active and latent.
Moreover, it is worth emphasizing the belief that miscegenation influenced the epidemiology of the disease by increasing the cases of sickle cell anemia in the active phase. Although in Brazil it was also thought that blacks were more prone to certain pathologies, there were marked differences between the views of U. Blood, race, and sickle cells in Brazil, Although Castro offered no statistical data on his findings, he presented the results of systematic analyses of eighty black children that were part of his search for sickle cells, thereby qualifying his paper as one of the first studies on the incidence of sickle cell anemia in Brazil.
In , Arcanjo Penna de Azevedo, a pathologist at the Oswaldo Cruz Institute, published a brief exposition on the autopsy of one of Castro's patients; two years later, he released another histological study of a sickle cell carrier Azevedo, , In and , two medical interns belonging to the same team as Serra de Castro published papers on hereditary anemias, which included reference to cases of sickle cell anemia Azevedo, ; Santos, We believe there was little knowledge of sickle cell anemia among Brazilian physicians, save for some pediatricians and hematologists, with this lack of information extending to its very existence as a disease.
Sickle cell anemia was difficult to diagnose because of its non-specific clinical symptoms and doctors' unfamiliarity with the necessary hematological exam, known as the Emmel test. Scholars in our country thus have an excellent opportunity to help refine understanding of this morbid state, thereby enhancing the merits of Brazilian medical science while also contributing to alleviating a malady found in a large share of the world's population.
Although there was little awareness of the existence of the disease, the physicians working on it were in contact with each other and often exchanged research material. Doctors found that their main motivation for studying sickle cell anemia came from working with outpatients, where they encountered clinical cases of the disease. Hematologists, for their part, were concerned with studying blood disorders, while other scientists were concerned with the relations between race and disease, keeping in step with a widespread interest in Brazil.
The latter group was comprised mainly of those devoted to statistical studies of the incidence of the disorder in Brazil. In the s, such surveys often appeared in articles and theses on sickle cell anemia. The incidence of the syndrome was evaluated based on the racial classification of those studied. In this racial classification, the descendents of blacks could therefore display grades of black ancestry, as manifested in their skin tone. He found: a no cases among the thirty xantodermos , and 0. He disagreed with Huck about the notion that the sickle-shape characteristic of red blood cells was transmitted in accordance with Mendel's laws, through a dominant character.
Out of all 1, people analyzed in the two studies, 1, were leucodermos , with a meniscocitemia rate of 0. He also continued to contrast his results with those of Diggs, Ahmann, and Bibb , asserting that people with more mixed blood displayed a lower proportion of sickle cells. He obtained the following percentages in his second study: faiodermos , 1. Miscegenation proved an issue to be addressed in Brazilian studies of sickle cell anemia in the s. The suggestion that sickle cell anemia was on the decline in Brazil because of miscegenation is in line with the ideology of branqueamento 'whitening' , a notion dating to the nineteenth century that posited that the biological interbreeding of whites and blacks would lead to a predominantly white society Skidmore, ; Santos, In the case of sickle cell anemia, mixing with whites could actually help eliminate a disease.
The lengthy medical thesis by Frimm contains 11 chapters on such topics as clinical and hematological symptoms of the disease, forms of prevention, and racial distribution. Sickle cells were detected in eight patients from Santa Casa and in three girls from the orphanage.
With a view to studying the relation between the active and latent phases of the disease, Frimm chose both sick and healthy people for his groups. Besides looking for sickle cells, Frimm ascertained the blood types of the Indians at the Nonoai Post. In his medical thesis, Frimm , p.
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Using this method, Frimm concluded that "the Brazilian population had 1,, people with Drepanocytemia and, of these, 52, had Drepanocytic Anemia , that is, the disease itself" p. The suggestion that miscegenation was leading to a decline in sickle cell anemia in Brazil shows how something deemed detrimental to the population in the early twentieth century had been transformed into a possible aid in eliminating a pathology.
The bulk of research on the rate of sickle cells across different racial groups grew out of outpatient work at big city hospitals. As a hematologist with the Medical and Surgical Pediatric Clinics at the Belo Horizonte Faculty of Medicine Faculdade de Medicina de Belo Horizonte , Oswino Penna Sobrinho was also involved in the research on the incidence of sickle cells conducted by pediatrician Berardo Nunan Filho as part of the latter's qualifying thesis for the chair in Pediatrics at the faculty.
Tests indicated sickle cells were present in 21 of "black and mestizo" children, three of thirty mothers, and none of thirty white children p. Amato investigated sicklemia see Table 1 in blacks and mestizos, of which were hospitalized; they found a 4. Araujo, , p. The children were racially divided as follows: melanodermos blacks , whose incidence of sickle cells was 0. The number of studies attempting to establish incidence rates among those with the disease and those presenting sickle cells in their blood were fewer in number.
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The purpose was to elucidate active forms of the disease, whose incidence was still unclear in Brazil, according to these doctors. However, the article confined itself to analyzing the relation between race and "disease by sickle cells" understood to be the presence of such cells regardless of symptoms. The number of people with sickle cells totaled 6. As with statistical research, the purported racial specificity of sickle-shaped red blood cells comes up often in other studies consisting basically of descriptions of clinical cases.
Some publications call this specificity into question, such as an article by Arcanjo Penna de Azevedo , who did not regard sickle cell anemia as an "innate feature of [the black] race" p.
Although he included an "ethnological exam" as part of his clinical analyses, Capriglione underscored the ideas of Italian physician L.