INTERNATIONAL MAIL POUCH Malaria and Opium Control in Iran GLANCE at two major health develop¬ suffering attacks of malaria during the growing A ments in Iran, achieved in little more than season. For example, along the Caspian Sea a decade, illustrates the dramatic contributions in the north adequate rainfall should have made health workers have made to the well-being of the land particularly productive. But through¬ a people. out history malaria had caused it to be known Iran is one of the many countries with as the "poisonous region." shortages of transportation, communication, DDT spraying commenced in 1947 with the industry, equipment, trained personnel, and ad¬ first demonstration programs supported by the ministrative organization to overcome in its Near East Foundation and the United Nations. coordinated development. In addition, until They showed that the transmission of malaria 1950, malaria and opium addiction prevented a could be controlled rapidly by the in¬ of its spraying large proportion population from func¬ secticide on the walls where Anopheles mosqui¬ tioning effectively. toes, engorged with malarious blood, rested. In 1950 the Iranian Seven Year Plan Or¬ Malaria ganization began a national program of Despite the lack of national statistics, one malaria control. The U.S. Technical Coopera¬ could see that large numbers of workers were tion Administration (now the U.S. Operations A malaria control team from the Iranian Ministry of Health crosses a footbridge near the Caspian Sea. The U.S. International Cooperation Administration supplied sprayers and DDT for such teams. 352 Public Health Reports Fields of opium poppies, once conspicuous near every village in central and southern Iran, had disappeared by 1956. Strictly enforced laws forbid cultivation of the plant. Mission, International Cooperation Adminis¬ paign workers are concentrating on eliminating tration) contributed insecticide, technical the residual reservoir so that the disease can be guidance, and administrative support. The eradicated in Iran. The work is now supported World Health Organization supplied ma- predominantly by income from Iranian oil and lariologists, entomologists, and technical grants is being administered entirely by Iranians. to further scientific guidance. Despite difficul¬ ties brought on by the oil crisis and the political Opium pressures of the once strong Tudeh (Commu¬ To the casual observer, the most obvious in¬ nist) Party, the antimalaria work continued to dication of the of opium in Iran The has been in importance expand. campaign described was the large amount of precious agricultural detail (E. E. Palmquist and F. F. Aldridge: land devoted to the opium poppy. Of course, in 69: Malaria control Iran. Pub. Health Rep. not all of this easily transportable product was 976-981, October 1954). used in Iran, but it is safe to assume that only The progress against malaria can be gauged. a small fraction was turned to legitimate medi¬ In the Caspian area the spleen indexes of vil¬ cal uses. from 95 to an irre¬ lage children have dropped The number of addicts was not known, but 2 clinic there ducible percent. Formerly, every it was apparent that the narcotic was in fairly saw hundreds of cases each year; now only common use. While it is true that the sur¬ sporadic cases are confirmed. roundings appear less harsh under the influence Throughout much of the plateau which com¬ of opium, the loss of vitality and strength, prises most of the country, malariometric in¬ diminished sense of responsibility, the general dexes have fallen dramatically. Malaria still inertia, and the expense generally overshadow exists in Iran, especially in the southern part any benefits conceivable to users. They become of the Iranian plateau. But antimalaria cam¬ dulled and wasted. Vol. 75, No. 4, April 1960 353 By 1956, the opium poppy, previously grown number of users has been reduced by at least near every village in central and southern Iran, two-thirds. Villagers, dulled for decades, have had disappeared. Effective legislation forbid¬ given up opium and turned to the production of ding its cultivation had been hammered crops and flocks badly needed to support the through. With the firm support of the Shah development of the nation. The effect of Iran's and some exemplary penalties, the law has been achievement on the international traffic in illicit strictly enforced. drugs alone deserves worldwide interest, assist¬ Iran has accomplished a great deal through ance, and cooperation. its own efforts to combat addiction. The pub¬ lic health education division of the Public Other Changes Health Cooperative Organization (a former administrative pooling of Iranian and United International teamwork has led to other States funds, equipment, supplies, and techni¬ achievements in Iran. To mention a few.the cians) contributed to widespread education and newly emphasized concept of preventing publicity through talks, posters, and other disease has resulted in 12 million vaccinations; information media. Medical, narcotics, and typhus outbreaks have been cut short by DDT laboratory advisers from ICA and WHO dusting; women are experiencing a challenging worked with Iran's limited treatment facilities liberation as nursing becomes a respected and to ease the turmoil which follows suppression of useful profession; a widespread health educa¬ the availability and use of the drug. Drugs to tion program is reaching the people; basic pub¬ be used temporarily during withdrawal were lic health laboratory methods are being supplied. An ICA hospital administration con¬ adopted; the largest city in the world without sultant helped to expand and reorganize hos¬ a sanitary water distribution system now has pital facilities to care for those severely affected one; and rural sanitation workers are being by withdrawal. trained to work on the environmental factors Enforcement officers for antinarcotics work important to the villagers' health. were trained in a school started with the help of In these achievements no one worked alone, ICA, and scientists, under UN grants, were everyone worked together toward similar goals. trained abroad in laboratory techniques for de¬ Iranians worked with the Near East Founda¬ tecting usage. Contact with neighboring coun¬ tion, ICA, WHO, UNICEF, Rockefeller tries on the narcotics problem has been fostered Foundation, and others inside and outside the by the UN and the CENTO Pact. Agricultural country. Together they formed a team which advisers of ICA and the Food and Agriculture caused a country to change for the better. Organization helped to supply new crops to fill the gap created by suppression of cultivation .Franz W. Rosa, M.D., M.P.H., now in Lahore and marketing of the product. with the U.S. Operations Mission to Pakistan, was The cost of opium has increased to 40 times its formerly public health physician with the U.S. 1956 price, out of reach of most users, and the Operations Mission to Iran. 354 Public Health Reports.