Foetal Alcohol Syndrome hits crisis proportions

The dry and dusty town of De Aar in South Africa's Northern Cape province is unremarkable in every way but one. It has the world's highest prevalence of Foetal Alcohol Syndrome (FAS), the group of physical and mental defects caused by alcohol consumption during pregnancy, according to the Foundation for Alcohol Related Research (FARR), an NGO that carried out a five-year survey of the community's newborns. More than one in 10 babies in De Aar aged up to 12 months suffered from a severe form of FAS. Just as worrying was the finding that up to 50 percent of children were in some way afflicted by FAS, which is characterised by brain damage, facial deformities and growth deficits. FARR founder Denis Viljoen maintained that the high prevalence of FAS in De Aar was intrinsically linked to the demise of the town's railway junction, one of the largest in the country. The community's economic existence was entirely dependant on the railway junction until South Africa's parastatal transport company, Transnet, decided to cut back on operations during the latter half of the last century, causing the unemployment rate to shoot up to 80 percent and creating a depressing environment in which alcohol abuse has become commonplace, said Viljoen. FARR, which was invited to conduct the survey by the provincial government, examines 100 babies a month in De Aar. "It is more difficult to diagnose the condition in babies than young children," he said. Heart, liver, and kidney defects also are common symptoms of the syndrome, as well as vision and hearing problems. Individuals with FAS have difficulties with learning, attention, memory and problem solving. To prevent the next generation of FAS babies, FARR is concentrating its efforts on mothers. "In conjunction with the survey, we provide an education programme for the mothers who take part to make them aware that there are dangers to their unborn children if they drink while pregnant," said Viljoen. FAS has been prevalent in South Africa for many decades, but the scale of the problem among marginalised communities in the Western and Northern Cape provinces has only came to light during the past 10 years as a result of the research carried out by FARR. De Aar might have the highest levels of recorded FAS in the world, but extreme socioeconomic inequalities, giving rise to an environment in which alcohol abuse thrives, are widespread in South Africa, where the national unemployment rate is an estimated 40 percent. A FARR survey carried out in the Soweto township of Johannesburg revealed that 25 in every 1,000 seven-year-olds tested had a severe form of the syndrome. By comparison, surveys in the USA indicate a prevalence rate of 1 or 2 per 1,000 births. According to Viljoen, at any given time 500,000 South Africans are suffering from Fetal Alcohol Spectrum Disorders (FASD), an umbrella term describing the range of symptoms that can be manifested by an individual whose mother drank alcohol during pregnancy, including the narrower group usually encountered under FAS. The disorder can also have larger implications for the society. People living with FASD have an "IQ [that] is low as a result of their stunted brains and, consequently, they can be easily influenced and led astray. Unfortunately, they are more likely to be shoving a knife into someone than paying their taxes," he added. FAS can be traced back to the illegal "dop" or tot system, in which white-owned vineyards paid their black and mixed race employees in part with low-grade wine as an alternative to cash. The "dop" system left a legacy of alcohol abuse and dependency. Workers employed in vineyards spent a substantial portion of their salaries on alcohol, according to surveys conducted by the Dopstop Association, an NGO combating the problem. "Shebeens" or informal bars found in every township in South Africa have replaced the "dop" system. "When coupled with poverty the shebeen system creates a similar environment, where alcohol abuse flourishes. We are discovering extremely high levels of FASD in many other places throughout South Africa - other towns and cities that are not linked to the wine-growing regions but struggle with high poverty levels and unemployment," Viljoen commented. At last count, Viljeon's research team recorded 99 illegal shebeens operating in De Aar, a town of 28,000 inhabitants, the majority of whom had migrated from the Western Cape to work for Transnet. Last Wednesday was a public holiday in South Africa, and consequently De Aar's drinking establishments were full for most of the day. Groups of men and women sat languidly outside the "shebeens" on every street, drinking potent homebrewed concoctions - made from yeast, sugar and bread - out of plastic containers. By late evening dozens of inebriated men and women were either walking unsteadily through township streets or lying in a drunken stupor after having collapsed. The following morning, when the research team went to collect the mothers who had agreed to have their babies examined, some women refused, saying they were still too drunk. Anna Marie Kok, 26, who had brought her baby girl to the research team's Joan Wertheim clinic in Sunrise township, said that while she did not consume alcohol, many pregnant women in her community did. "The problem is poverty - there is no work so they have nothing to do. People know about FASD but they drink anyway; they have so many other problems to deal with that they need to escape. When they drink the homebrew they say: 'We don't need to eat when we drink this'," she explained. Tackling FASD in South Africa will not be an easy task, Viljoen maintained, even though the disorder is completely preventable if the mother abstains from drinking while pregnant. "It will take at least 20 years to change the mindset that allows FASD to flourish," he noted, adding that lack of awareness was a major hurdle as it also prevented early diagnosis. According to Viljoen, while FARR has initiated programmes such as the establishment of a community-based 'safe house' in De Aar, providing treatment and education to address the problem, HIV/AIDS and other illnesses was forcing the syndrome down the government's list of priorities.