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Sunday, March 15, 2009

Song for an Unsung (2.28.09)

Prominent accolades exist from Nobel prizes, book prizes, Time's top ten lists of influential people, badges, honors, knightships, to colored hearts. And, we know that it is the countless men and women on the ground level that move the world forward in obscurity. However, one man took the world on a global stage yet is rarely ever mentioned; he should not just be on any "Top 10" list, but surely on the "Top 5" lists. It is because of him that upwards of 25 million people are alive today and while his name surely must be gilded in public health institutions, I have not met a single medical student who knows what he has done. His name is James Grant. His true-to-self global story is one of persistence, coherence, and perspiration.

James Grant was the head of the UNICEF from 1980 to when he passed away in 1995 and stewarded the "child survival revolution." Grant was profiled in David Bornstein's "How to Change the World," which centers around Bill Drayton's 'Ashoka' organization; despite the poor titling choice, the book is truly a Magna Carta on social entrepreneurship. During the 1980s when the world marched forward while, in the rearview mirror, 14 million children died every year from the most basic conditions of diarrhea, TB, malnutrition, and completely preventable/curable diseases; that's 40,000 children every day! It took Grant to finally exclaim that this was unacceptable and create a stand that would last a generation. On a side note, it is important to point out that 3 million people die needlessly each year from TB, while mainstream news screens place surprisingly disproportionate attention to flesh eating bacteria and laughing disease.

At the time in the early 1980s, the call was not for breakthrough science. We already had everything we needed. Grant emphasized that our shortfall was simply a lack of vision, stating that "morality must march with capacity." We needed simple solutions on a grand scale. For example, oral rehydration therapy (ORT), a simple mixture of glucose, salt, and water, was revealed in the late 1970s to be a lifesaver for diarrhea, which killed 5 million children yearly at the time, the majority of them easily preventable. Moreover, premixed ORT packets for mixing with water could be prepared for 10 cents each.

Grant's strategy, was both elegant and targeted, heeding the moniker "GOBI"

G: growth/weight monitoring
O: ORT
B: Breastfeeding
I: Immunization for TB, polio, diphtheria, tetanus, whooping cough, and measles.

"FFF" was added later for food supplements, family planning, and female education. Resulting from the campaign, most importantly, was the dramatic change in the world state of immunization from a level of 20% to 80%, Grant's effective rate of "universal child immunization." By the early 1990s, 4 million deaths were prevented yearly through ORT, 3 million children were prevented from being crippled through polio vaccination, not to mention countless saved from measles. Further, Grant championed the use of iodized salt to prevent iodine deficiency; at the time, 43 million people were estimated to have had brain damage from lack of iodine. Propelled by campaign, the proportion of the world using iodized salt increased from 20% to 70% in the 1990s. Grant would never be seen without a packet of ORT salts and a pocket iodine salt test.

Grant took three approaches to reach his global feats:

1) He stood up to the existing system, not only to the status quo of apathy, but to a World Health Organization that disagreed with his selective ideas in favor of more system structural improvement, guiding the entire establishment in a new direction

2) He implemented a dynamic network of both collaboration with world leaders, health organizations, religious heads, etc, and competition amongst country groups to immunize more children

3) He stuck to his message, hammering it relentlessly, speaking unabashedly to statesmen about their own priorities, as well as diarrhea. Bornstein also insightfully highlights that if you wanted your core purpose to shine through "you had to overcome your own inhibition of repeating yourself."

Grant's efforts were a marriage of brute force with innovative management and cooperation to steer simple measures to the both the global doorstep and the village doorstep.

By doing so, he went far beyond the definition of selfless, and, in fact, such cliché descriptives of tireless and selfless simply fall short of encapsulating Grant and his contribution. On a practical level, he demonstrated that "pipe dreams" and next to impossible goals can be amassed to the entire globe with the right coaxing. Thomas Friedman has emphasized that we are at a point where our dreams must exceed our memories. Grant epitomized this point. He knew that it was not the memory of thousands of years and hundreds of millions of lives lost to epidemics of smallpox that led to the disease's eradication in 1980. Nor could the fond memories of rising living and health standards in the U.S. and Europe be of use to tens of millions of dying children. His dreams outsized these memories.

Grant was a man of total self awareness with a complete lack of self importance and his contributions are seemingly impossible to size up. Apart from stoking my cynicism about the vanity and true ignorance of the bubble we live in, on a positive note, Grant's story made me reconsider the traditional calibers of humanity and "humanness" we so often use.