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Molekylärantropologisk Forskning Om Konzo Ad Modum Hans Rosling

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Molekylärantropologisk Forskning Om Konzo Ad Modum Hans Rosling Om forskning Molekylärantropologisk forskning om konzo ad modum Hans Rosling Thorkild Tylleskär Thorkild Tylleskär, professor och barnläkare, Centre for International Health, Universitetet i Bergen, Bergen, Norge. E-post: [email protected] Hans Rosling hade en lysande forskarkarriär under 1980 och 1990-talen innan sin karriär som edutainer. Under tiden som läkare i Nacala i norra Moçambique stod han plötsligt mitt i en epidemi av en okänd typ av spastisk förlamning, numera kallad konzo. Detta blev startpunkten för en lång rad fält- studier i flera afrikanska länder. Utmärkande för hans forskning var en extremt tvärvetenskaplig ansats som han kallade molekylärantropologi och där han tog i bruk allt från antropologi via medicin och kemi till jordbruks forskning. Omkring konzo och kassava handledde han ett dussintal doktorander inom klinisk medicin, klinisk kemi, nutrition och agronomi. Han ordnade en tvär- vetenskaplig kurs om kassava, kassavaodling och kassavatoxicitet i Uppsala 1990 och ett internationellt tvärvetenskapligt symposium i samma ämnen i Nigeria 1994. Hans Rosling had a bright research career in the 1980s and 1990s before his career as edutainer. During his time a district medical officer in Nacala in northern Mozambique, he was confronted with outbreak of unknown type of spastic paraparesis, nowadays called konzo. This was the starting point for a series of field studies in several African countries. His research was characterized by an extreme interdisciplinary approach, which he called molecular anthropology where he involved disciplines from anthropology via medicine and chemistry to agricultural research. In the field of konzo and cassava, he supervised a dozen PhD-candidates in clinical medicine, clinical chemistry, nutrition and agronomy. He organised an important international inter disciplinary symposium on cassava, cassava cultivation and cassava toxicity in Nigeria in 1994. Vårt första möte Hans Rosling (figur 1) och hanpratade om den epidemi av förlamade barn Jag träffade Hans Rosling första som han hade hamnat i i slutet på sin gången på hösten 1985. Jag gick arbets period i Nacala i norra Moçam­ kirurg terminen på läkar utbildningen bique. Jag hade just kommit tillbaka i Uppsala och mitt i den terminen till läkar utbildningen efter två års hade vi en enveckas kurs i ”Katastrof­ bortavaro, ett års studier i afrikansk medicin”. Fredag morgon i den lingvistik vid Sorbonne i Paris och veckan hade vi en föreläsning om ett års fältstudier i norra Bandundu­ ”katastrofer i u­land”. Den hölls av provinsen i dåvarande Zaire, nuvaran­ Socialmedicinsk tidskrift 6/2017 707 Om forskning Figur 1. Hans Rosling vid sitt skrivbord på International Child Health (ICH) i den gamla barn­ kliniken, ingång 15 på Akademiska sjukhuset nån gång i slutet på 1980­talet. Huset är numera rivet. Foto: Thorkild Tylleskär 708 Socialmedicinsk tidskrift 6/2017 Om forskning de Demokratiska Republiken Kongo fall beredde kassavan: de grävde upp (DR Kongo). Bandunduprovinsen hela plantan, delade rötterna på läng­ ligger strax öster om huvudstaden den och lade dem att torka på mar­ Kinshasa och min nyblivna fru Karin ken i ett par månader. För mig lät och jag hade bott ett läsår i en liten det lite som: ”Så gör man i Afrika”. Jag by med 500 invånare som heter Ikoko, räckte upp handen och avbröt Hans inte långt från staden Kutu vid Mai­ och förklarade att jag bott i Zaire Ndombe­sjön. Vi var där för att lära och ätit kassava dagligen och att där oss lokalspråket kisakata. Planen var gjorde man på ett helt annat sätt: man att vi senare skulle jobba i området började med att lägga rötterna i blöt som missionsläkare. Samtidigt skrev till de blivit mjuka och att man gjorde jag på min masteruppsats i afrikansk en deg av den blöta massan som man lingvistik där jag på samma gång ville virade in i blad och därefter kokade beskriva det fonetiska ljudsystemet i till degen blivit halvgenomskinlig. kisakata. Den var då klar att avnjutas. Nu var vi tillbaka i Uppsala och I pausen inleddes det fortsatta sam­ läkarutbildningen. Jag var otroligt talet med Hans ivriga fråga: ” Va d g ö r fascinerad av Hans framställning du i sommar?” Han hade nämligen läst av epidemin av den då okända en kort notis i WHOs veckomagasin förlamningssjukdomen som man i Weekly Epidemiological Records om ett Moçambique kallade ”Mantakassa”. lokalt utbrott av spastisk paralys som Med sofistikerade kartor på overhead hade observerats i området omkring med flera olika overheadblad som Masi­Manimba, i Bandundu provinsen han lade uppepå varandra fick vi vara (figur 2). Han ville genast skicka mig med på detektivuppdraget som han tillbaka för att se efter om det var sam­ hade hamnat mitt i. Från den första ma sjukdom som han hade sett. Dess­ instinktiva tanken att det var smitt­ utom menade Hans att jag kunde ha samt över till tanken att det hängde goda chanser att få ett så kallat Minor ihop med den svåra torkan som drab­ Field Study stipendium. Dessa stipen­ bat området det senaste halvåret. Att dier administrerades på International människorna hade börjat äta någon Child Health på universitet där Hans giftig växt som de skulle hitta fram arbetade. Stipendierna var avsedda för till. Till tystnaden omkring vad män­ studenter som ville göra ett fältarbete niskorna åt när det nästan inte fanns i ett låginkomstland. något att äta. Till misstanken att det var en av de odlade grödorna som var Blod och urin giftig: kassavan (också kallad maniok). Med sig hem från Moçambique hade Kassava var ansedd som ”fattigmans­ Hans blod­ och urinprover från både mat” och hade lite dåligt rykte bland sjuka och kontrollpersoner men han lokalbefolkningen. Så folk var inte så visste inte hur eller var de skulle ivriga att berätta om de åt kassava eller analyseras. I sina ytterst noggranna inte. samtal med en stor mängd männ­ Så berättade Hans hur de i vanliga Socialmedicinsk tidskrift 6/2017 709 Om forskning iskor under utbrottet i Moçambique hade han ändå styrkts i misstanken om att folk blev förgiftade av maten de åt. Han lyckades förstå att under den lång variga torkan hade man änd­ rat beredningen av kassavan, kan­ ske på ett sätt som utsatte dem för en risk. Kassavan är en flerårig växt med stärkelse rika rötter som bara blir större om man låter plantan stå. Den tål också torka väldigt bra, bladen faller av och busken ser död ut men när den får vatten igen skjuter den ny fart. I denna svåra torkperiod så grävde man inte upp kassavan, man hoppades på att regnet snart skulle komma. När så till slut hungern blev Figur 2. Faksimil av Weekly Epidemiological för stor grävde man upp några plantor Records 1982;57:213-4 som hade gett Hans tanken att samma okända sjukdom som han för att få mat. Men den långa tork­ hade stött på i norra Moçambique också före­ tiden man brukade ha hoppade man kom i Zaire. nu över. Man försökte på olika sätt få den i ätligt skick över dagen. Hans Cyanid insåg att en sådan ”snabbearbetning” kunde höja giftinnehållet i kassavan Cyanidjonen består av kol och kväve ordentligt. I böckerna stod det att (CN-). I gasform föreligger cyaniden kassavan innehöll cyanogena gluko­ som vätecyanid, (HCN) även kall­ sider, dvs cyanidalstrande ämnen, lad blåsyra. I naturen finns cyaniden i främst linamarin. Hans behövde få ytter ligare en form, organiskt bunden i tag i en cyanid expert. växter som i amygdalin i bittermandel Efter lite letande hittade Hans eller i linamarin i kassava. Kroppen fram till Bo Sörbo som var profes­ har ett tvåstegsförsvar mot cyanid. sor vid avdelningen för klinisk kemi Hos en människa som vid en brand vid universitets sjukhuset i Linköping. andas in cyanidhaltig rök så binds Sörbos forskningsintresse var krop­ cyaniden inledningsvis till methemo­ pens svavelmetabolism som till stora globinet i de röda blodkropparna och delar var okänd när Sörbo i början på fastnar där. Methemo globin utgör 50­talet kristalliserade och beskrev cirka 1% av det totala hemo globinet. enzymet rhodanes (tiosulfat svavel­ Det går på sekunder. När methemo­ transferas) som avgiftar cyanid i globinet är mättat med cyanid och kroppen. om ytterligare cyanid tillförs kommer denna obundna cyanid kunna binda in till livsviktiga enzymsystem. Den direkta giftverkan av cyanid är att den 710 Socialmedicinsk tidskrift 6/2017 Tabell 1. De doktorsavhandlingar om kassava och kassavatoxicitet som Hans Rosling skrivit eller handlett. Namn År Universitet Titel Handledare ISBN Nätreferens Hans Rosling 1985 Uppsala Cassava, cyanide, and epidemic spastic Y Hofvander, 91 54 1798 1 http://uu.diva­portal. universitet paraparesis: a study in Mozambique on B Sörbo org/smash/record. dietary cyanide exposure jsf?pid=diva2:294462 Per Lundquist 1992 Linköpings Determination of cyanide and thiocya­ B Sörbo, 91 7870 647 5 http://liu.diva­portal. universitet nate in humans H Rosling org/smash/record. jsf?pid=diva2:246232 Thorkild 1994 Uppsala The causation of konzo: studies on a H Rosling, 91 554 3207 7 http://www.diva­portal.org/ Tylleskär universitet paralytic disease in Africa LÅ Persson smash/get/diva2:294863/ FULLTEXT01.pdf AJA Essers 1995 Wageningen, Removal of cyanogens from cassava AGJ Voragen, 90 5485 378 6 http://uu.diva­portal. Nederländerna roots. Studies on domestic sun­drying H Rosling org/smash/record. and solid­substrate fermentation in jsf?pid=diva2:295022 rural Africa Nicolas Mlingi 1995 Uppsala Cassava processing and dietary cyanide H Rosling, 91 554 3603 X https://bora.uib.no/hand­ universitet exposure in Tanzania Per Lundquist le/1956/6764 William 1995 Universitetet i Neurological disorders in Tanzania. H Rosling, 82 7815 000 1 http://uu.diva­portal.org/ Howlett Bergen, Norge Studies on HIV­I, Guillain­Barré syn­ B Bjorvatn, smash/record.jsf?searchId=nu drome and konzo J Aarli ll&pid=diva2:295140 Jean­Pierre 1997 Uppsala Dietary exposure to cyanogens from H Rosling, 91 554 3979 9 http://uu.diva­portal.org/ Banea­Mayambu universitet cassava: a challenge for prevention in T Tylleskär smash/get/diva2:165973/ Zaire FULLTEXT01.pdf Stefan Peterson 2000 Uppsala Controlling iodine deficiency disorders.
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