This is a story of how a professor applied cultural intelligence to a major health issue and abolished Iodine Deficiency Disorders (IDD) throughout the developing world.
In a working environment where were under increasing pressure to demonstrate ROI, and theres so much focus on the what, its the leaders with vision who see that when it comes to cultural intelligence, what actually matters is the how.
Every so often, you come across an example that so clearly illustrates this point. On this particular occasion, I happened to be listening to ABC Radio with Richard Fidler interviewing Professor Creswell Eastman, who has done some incredible work in abolishing Iodine Deficiency Disorders (IDD) throughout the developing world. Professor Eastman was explaining the alarming consequences of a lack of iodine in the diet without it, the thyroid cannot function properly and growth and development are compromised. Children born to mothers deficient in iodine can suffer a range of defects including cognitive impairment, deafness and speech problems.
Eastman and his team have done some incredible work over the past decades, including getting the Chinese government to realise the magnitude of this problem. As a direct result of this, the addition of iodine to salt was made mandatory a huge achievement. However, when the team visited some more remote villages in Tibet, they discovered many people suffering severe deformity through iodine deficiency. Committed to helping Tibet, Professor Eastman needed to apply his cultural intelligence of Tibet to come up with a solution. Whilst Chinese law now stated that all salt for human consumption had to be iodised, the Tibetans, whod been collecting salt from the high lakes for hundreds of years, werent about stop to take notice of this. Furthermore, the Tibetan people didnt use money they bartered the salted water they collected for grain. There was simply no concept of selling in their culture, so little point in having iodised salt for sale. Eastman had the insight to understand that a one size fits all approach here simply wasnt going to get results – and the stakes were just about as high as they could be. Focused on protecting the most vulnerable; children and pregnant women, Eastman came up with a new solution; iodising oil and making it into a capsule that would offer long term protection. With the Tibetans living a very nomadic lifestyle, there was the challenge of getting to these people to administer the capsules. Eastman had bare-foot doctors go into the most remote villages, giving every woman and child an iodised capsule. He also engaged the monks, helping them understand the importance of this vital trace element, knowing that for Tibetans, whatever the monks have to say is highly important.
The result? It worked! The treatment, coupled with education programs delivered a 90% success rate. Furthermore, a survey has shown no new incidences of cretinism induced by iodine deficiency in children under the age of 5 in Tibet since 2000. It is estimated that approximately 600,000 people have been prevented from suffering brain damage in Tibet and the World Health Organisation rates this as one of the greatest achievements in modern health. The changes have meant that children can now attend school and get educated.
Applying a cultural lens to this sustainable solution shows that focusing on the how rather than the what is a pretty powerful formula. As in the case of Professor Eastman; the solution itself was simple (iodise salt) but providing the solution was the real challenge. In rising to that challenge, he has made a truly remarkable achievement.
Professor Creswell Eastman is a Clinical Professor of Medicine at the University of Sydney Medical School, and Principal of the Sydney Thyroid Clinic at the Westmead Specialist Centre.