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Global Health
China is oldest civilization

Editor's note: Welcome to the Global Health page. The purpose of this feature is to raise awareness of global health issues with an academic spirit to help improve the quality of care provided to patients. E-mail

Historians consider China to be the world’s oldest continuous civilization. Although various dynasties rose and fell, a basic ruling system held the civilization in place from 221 BC to 1912.
It is thought that the Chinese were making silk by 3000 BC. Eventually the manufacture of silk and trade would give its name to the infamous Silk Road.
A court official named Tsai Lun is credited with the invention of paper in 105 AD. Other early Chinese inventions include the saddle (25 AD) wheelbarrow (200 AD), and paper money (618 AD). Later Chinese inventions include gun powder, the magnetic compass, the mechanical clock and the sternpost rudder.
Ice cream was invented in China around 2000 BC when the Chinese packed a soft milk and rice mixture in the snow as a treat.
Herbs, acupuncture and eating a balanced diet comprise traditional Chinese medicine. Acupuncture has been practiced in the country for more than 2,000 years.

Progress challenges modern health care

by Boshao Zhang
College of Graduate Studies
During the last half-century, a comprehensive health care system has been established throughout China. Today, most Chinese have access to doctors and hospitals whether they live in cities or rural areas. With highways and communication systems available to most people, patients can have access to advanced health facilities more easily and quicker than ever. As a result, the mortality rates for infectious diseases such as polio, measles, tuberculosis and maternal-child death rates are approaching levels seen in other developed countries.
This doesn’t mean that the health system isn’t facing great challenges. In the last three decades, China has achieved tremendous economic growth and people are proud that China has become “the factory of the world.” Still, the economic achievement comes with a heavy price—severe pollution of the environment. The incidence of diseases related to pollution is increasing dramatically. For example, cancer rates in Zhejiang province, one of the most developed provinces in China, are five times higher than they were 10 years ago.
In contrast to the economic growth, the public's awareness of health risks has not changed much. One very modern problem tied to China’s booming economy is the increase in obesity. Yet many people do not realize that being overweight is related to diseases such as stroke, hypertension and cardiovascular disease. Chinese people enjoy what modern technology can offer in the traditional ways—eating as much as their stomachs can hold, taking elevators whenever possible (due in part to the fact that many more people now live in skyscrapers) and watching TV whenever they have leisure time. Children are raised with a preference for high-fat fast foods and high-sugar beverages instead of more healthy traditional fare. Men drink and smoke for social life. These risk factors combined with workplace stress impact millions of people without their noticing.
Realizing these issues, the government has started to make a transition from pure economy-oriented development to more sustainable economic growth. The air quality in major cities such as Shanghai and Beijing has greatly improved during the last several years, but pollution is still a severe issue in other cities and towns whose economic growth outpaces their ability to cope with the problems that come with modern industrialization.

Tropical medicine film and discussion at 5:30 p.m. March 5 in Room 100, Basic Science Building.
MUSC Global Health presents a film on Karl M. Johnson, M.D., founding chief of the Centers for Disease Control’s Special Pathogens Unit and a past president of the American Society for Tropical Medicine and Hygiene. Dinner and a discussion about tropical medicine will follow.

St. Patrick’s Dinner and Dance, March 17.
Learn how to Irish Square and Line Dance and enjoy authentic Irish stew. All MUSC international family and friends invited to this free event.

Cypress Gardens Music Festival, March 28.
A celebration of Bluegrass, Country and Gospel music. Handicrafts, children’s activities and take a boat ride through the swamp.  The bus will leave from the Jonathan Lucas bus stop .

Café Polyglot—Culture and Language Exchange. The Citadel Modern Language Council and MUSC International Programs will host an afternoon at Café Polyglot. This is a new opportunity to have casual conversation and hone in your speaking and listening skills.
For information on these and international events, visit

Clinician’s corner
A 45-year-old woman complained of a growing mass in the neck more than 20 years, and she felt short of breath for a couple of months, but no fever, pain and other obvious symptoms. She mentioned that many people in her country have the same problem. An enlarged mass (thyroid gland) could be palpated and the mass moved when she swallowed. The diagnosis of “goiter” was given to her. The most likely cause responsible for her disease is:
A: Thyroiditis                         B: Thyroid cancer
C: Hashimoto’s thyroiditis      D: Graves’ disease
E: Iodine deficiency

The correct answer is E.
The most common cause for goiter is iodine deficiency. Iodine is necessary for the synthesis of the thyroid hormones thyroxine  (T4) and triiodothyronine (T3). In endemic goiter, iodine deficiency leaves the thyroid gland unable to produce its hormones because the hormones are made out of iodine. It causes the thyroid gland to grow in size by increasing cell division.
The patients with large goiter accompanied by pressure symptoms may have dyspnea, which requires surgical treatment. The most important iodine deficient areas in the world include the Himalayas, the Andes and the western of China.
Based on a recent evaluation, iodine deficiency currently represents a significant public health problem for 1,575 million people in 110 countries. More than 600 million are affected by goiter, 20 million are believed to be significantly mentally handicapped as a result of iodine deficiency which is therefore the most prevalent preventable cause of impaired intellectual develop-ment in the world today.
Iodized salt has been used as the simplest and most effective way of providing extra iodine in the diet. Many countries long ago introduced iodized salt which resulted not only in a dramatic reduction in the prevalence of goiter but also progressive disappearance of endemic Cretinism. Iodination of irrigation water also has been successfully used in China.

Friday, Feb. 27, 2009

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