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COLUMN ONE : Politics of an Epidemic : The mystery outbreak in Cuba turned out to be a nerve disease caused by malnutrition. Some blame inaction by the image-conscious regime, and question ethics of the U.S. trade embargo.

November 20, 1995|TERENCE MONMANEY | TIMES MEDICAL WRITER

It was the largest epidemic of its kind in history.

From November, 1991, through the summer of 1993, the bizarre neurological disorder struck more than 50,000 people in Cuba, frightening and mystifying the bereft island nation.

Most victims became partially blind, perceived colors as gray or viewed the world as if through grease-covered glasses. Many also suffered nerve damage in their legs and feet, which caused intense pain, a wobbly gait or numbness so profound they had to deliberate over each robotlike step.

In the four years since the epidemic began, dozens of scientists from around the world have visited Cuba, looking into possible causes from leaking pesticides to exotic viruses to germ warfare by the CIA.

This month, the official U.S.-Cuba government research team released its long-awaited study. The conclusion is as pertinent to U.S. policy as it is damaging to Cuba's pride: Tens of thousands of Cubans were not getting quite enough to eat.

The study, published in the New England Journal of Medicine, documents that with the 1991 collapse of the Soviet Union, Cuba's prime benefactor, many Cubans started skipping meals or squeaking by on a bland diet consisting primarily of beans and unfortified rice. Thus deprived of vitamins and other nutrients necessary for nerve function, many developed the disorder, called nutritional neuropathy. It was disabling but not deadly, in the twilight between passing hunger and outright starvation.

The massive epidemic ended abruptly, months after the Cuban government handed out vitamin pills. But cases of nutritional neuropathy still occur now and then, according to the Pan American Health Organization. A balanced diet eludes a great many people, and the only thing preventing the return of la neuropatia epidemica , some medical researchers say, is that free vitamin pill Cubans are urged to swallow daily.

Although it was the most spectacular epidemic of nutritional neuropathy ever, it was not the first. A strikingly similar disorder broke out among prisoners of war during World War II in Asia and the Middle East, and also in Cuba at least once. That was at the turn of the century, during the Spanish-American War, when the U.S. Navy blockaded the already distressed island.

Every epidemic tells a story about the time and place where it occurred. The story of the Cuban epidemic is about dangerous scarcity and hardship on a vast, largely unacknowledged scale; about a Cuban government that is responsive enough to hand out vitamins but disingenuous enough to deny publicly that its people were malnourished, and about a U.S. government whose policies, some medical researchers charge, have added to the suffering.

Beyond that, it's about a powerful conflict between public health, with its tradition of scientific dispassion, and politics, that most zealously self-interested pursuit. Indeed, some researchers view the epidemic not primarily as a medical problem but as a social problem with medical consequences.

Dr. Gustavo Roman is a Colombian-born neurologist who participated in the U.S.-Cuban study while working for the U.S. National Institutes of Health. "In the final analysis," he said, "the outbreak of neuropathy in Cuba may represent the first epidemic of neurological disease whose cause is primarily political."

Shortages Common

The epidemic grew out of what President Fidel Castro called "the special period," a time of strict government food and fuel rationing that followed the Soviet Union's collapse.

Energy blackouts prevailed. Gasoline vanished. At bus stops, long lines of people wilted in the heat. Central Havana streets, virtually empty of private cars, were jammed with people on Chinese bicycles that had improbable English names like Forever.

The food shortages were the most agonizing. Pork disappeared, although not from the tourist hotels or the black market. The individual bread ration was a quarter of a loaf per day. The egg ration amounted to 1 1/2 eggs per week.

A highly educated Havana woman who worked for the United Nations said in the fall of 1993 that between all the bicycling and skimping, she lost 30 pounds. She loved coffee with milk so much that her friends called her cafe con leche. But she couldn't remember the last time she had coffee or milk.

If it seems obvious in retrospect that chronic malnutrition brought on the neuropathy epidemic, there was no such clarity when people rather suddenly lost the full use of their eyes in the far-west city of Pinar del Rio in November, 1991.

The initial cases were lean men in their 60s who smoked cigars and had no trouble consuming the bottle of rum that was the weekly government ration. Local doctors, after interviewing the men and checking their eyes, diagnosed the disorder as "tobacco-alcohol amblyopia." It afflicts Skid Row alcoholics, whose bodies are so wrecked that the scant nutrients they take in are hardly absorbed, while tobacco poisons are rendered more toxic to their nervous system.

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