The Hetzel Family's Friendship with China

By MA TAI

Basil & Anne Hetzel accompanied by author at the IDD endemic area of West China.

At the National Re-Advocacy Meeting to Eliminate IDD (Iodine Deficiency Disorders) held in October 2000 at Beijing's Great Hall of the People, Dr. Basil Hetzel, Chairman of the International Council for Control of Iodine Deficiency Disorders, and a major contributor to IDD control in China, spoke of the strong bond between his family and the Chinese people, and how it started with his father, Dr Kenneth Hetzel. The course of this longstanding relationship is related by Ma Tai, former Chairman of the IDD Advisory Group of the Chinese Ministry of Health.

Dr. Kenneth Hetzel: Initiator of the Chinese Bond

Born in Australia, Dr. Kenneth Hetzel worked as a professor of medicine at Adelaide University. In 1945 he was appointed traveling professor of medicine for the then United Nations Relief and Rehabilitation Association (UNRRA), which during the post second-world-war period gave help to countries throughout the world. He went to Chongqing, capital of China during the war, and then moved from one big city to another in Nationalist controlled China. On arriving in Shanghai he had the privilege of meeting Soong Ching Ling (Mme. Sun Yat-sen), the distinguished and respected figure who eventually became Honorary Chairperson of the People's Republic of China.

In 1946, Dr. Hetzel had the unforgettable experience of visiting the Communist enclave in Yan'an. In this loess area, with its caravan routes rather than roads, the people lived in caves carved out of hillsides, open at the front, whose windows were paper covered wooden grills. Such caves housed the Communist headquarter. As a UN officer Dr. Hetzel was invited to visit the Communist Army, and personally witnessed how doctors were trained for the armed forces. He was very much impressed by their meritorious conduct, which contrasted strikingly with that of Chiang Kai-shek's soldiers. On leaving, he was presented with a crudely made medal from the Chinese Communist Army. It was a token of gratitudes that represented 25 million people in areas under communist control. In the years that ensued, Dr. Hetzel followed closely the fortunes of the Chinese people, and was delighted when they finally achieved liberation.

In 1978, at the advanced age of 78, Dr. Hetzel revisited China, as a tourist. He was impressed by the immense progress the Chinese people had made in the intervening years. He died in 1981, and in 1982, while I was in Adelaide, his son Dr. Basil Hetzel, took me to meet his mother, Mme Kenneth-Elinor Hetzel. Knowing that I had come from China, she o fetched the UNRRA uniform her husband had worn during his time there, and asked her son to put it on for me. She was immensely proud of her husband's work all those years ago.

Dr. Basil Hetzel: Striving for IDD Control in China and the World

Born in 1922, Dr. Basil Hetzel first studied at the Adelaide University School of Medicine. After taking postgraduate studies in New York and London, in 1964 he became Professor of Medicine at the University of Adelaide. It was then that he began to study the effects of iodine deficiency in Papua New Guinea, with special reference to the use of iodized oil. Through controlled trials he and his team members found that endemic cretinism could be prevented by an injection of iodized oil before pregnancy. After his appointment as Director of the CSIRO Human Nutrition Institute his team studied the pathogenesis of cretinism in sheep and monkeys. They were able to demonstrate that iodine deficiency causes a severe reduction in maternal and fetal thyroid secretions, resulting in brain damage.

On October 1 1981, Dr. Basil Hetzel visited China as a member of a scientific delegation from the Australian Academy of Science. On arrival in Beijing, he received a telegram from the distinguished Chinese scientist, Professor Zhu Xianyi, president and professor of medicine at Tianjin Medical College. Prof. Zhu was the great pioneer of iodine deficiency control in China. His initial program, with iodized salt, had begun in 1961, but was forced to a halt during the "cultural revolution" (1966-1976). He was acquainted with Dr. Hetzel's work in Papua New Guinea as well as his studies in Australia on the effect of iodine deficiency on the early development of the fetal brain in sheep and monkeys. On meeting, the two professors sorely regretted not having got together earlier, as they had both come to similar conclusions from their separate observations. That evening, Basil Hetzel stayed up all night drawing up a proposal to the Australian Government that they support joint collaborative research by Prof. Zhu's team in Tianjin and his team in Adelaide.

Basil Hetzel examining the epidemiological data in Endemic Disease Control Institute of Shandong Province.

In August 1982, with the financial support of AusAID obtained through Basil Hetzel, six Chinese scientists attended the Second Congress of the Asia-Oceania Thyroid Association in Tokyo. There Prof. Zhu detailed the achievements of scientific research on iodine deficiency in China to the other world thyroid specialists in attendance. Dr. Basil Hetzel thus successfully introduced Chinese thyroidologists to international medical circles. After the Tokyo meeting, Prof. Zhu invited Basil Hetzel to China to observe the effects of iodine deficiency in certain areas. He went to Hotan, Xinjiang Uygur Autonomous Region, where he examined the child of an impoverished family that was afflicted with cretinism, and Chengde, Hebei Province, where he visited the village in which Dr. Zhu's team had initiated their study of prevention through iodized salt. In a typical family of four sons he observed that the three elder brothers were cretins while the youngest brother, born after the iodization program had begun, was perfectly healthy.

In China, iodine deficiency was generally termed Endemic Goiter, and this obviously improper use of the term had concerned both Basil and me for years. It was difficult to get policy makers to shift their attention from the swollen neck to the much more serious defect in the central nervous system that iodine deficiency caused. Eventually, in 1983, Basil Hetzel devised the more appropriate term Iodine Deficiency Disorders, now used worldwide. This encompasses all the effects of iodine deficiency, including brain damage, at population level

In 1982, China was still at the initial stage of its reform and opening, and there was hesitance about establishing contact with the outside world. Negotiations for a collaboration project were, therefore, difficult. There was one man to look to for support, Dr. George Haitem, better known to the Chinese people as Dr. Ma Hai-de. Hatem was honorary advisor to the Ministry of Health in China. He was known for his successful treatment of venereal disease, and later for his unremitting efforts to combat leprosy. He had known Basil's father in Yan'an, and was ready to lend a helping hand within negotiations. In the two years that ensued, Basil visited many other Chinese iodine deficient areas where the project could be put in place.

It was on the train to Jiamusi, Heilongjiang Province that Basil came upon with the idea that, as iodine deficiency was a global problem, it was vital to set up an international organization for its control throughout the world. Aware of the gravity of the IDD situation in China, and knowing that it needed more than just China's efforts to control it, I expressed my immediate one hundred percent support.

A formal Preparatory Committee was set up in New Delhi in 1985. In 1986, the International Council for Control of Iodine Deficiency Disorders (ICCIDD) formally came into being in Kathmandu, Nepal with the support of the WHO and UNICEF. Comprising scientists and health officers from 82 countries, it was quickly accepted by the WHO as a related organization. Basil Hetzel was its Executive Director and I was elected one of its seven Executive Committee members. Prof. Zhu was, unfortunately, unable to witness the moment, having passed away two years before in 1984.

As Basil was busy initiating the work of ICCIDD, the functioning of the China-Australia Collaboration Program supported by AIDAB (later AusAID) was, on his recommendation, put into the hands of Dr. Creswell Eastman and Dr. Glen Maberly from Westmead Hospital in Sydney, while Basil remained its Senior Advisor. AIDAB contributed 2.8 million Australian dollars towards establishing four reference laboratories and trained more than 30 technical staff. The up-to-date iodization and monitoring techniques then began to be introduced in China.

Basil kept traveling from one place to another all over the world, campaigning about the dire consequences of IDD. He explained how it causes a generalized lowering of the intelligence level of whole populations, severely inhibiting the social-economical-cultural development of developing countries. He pointed out that if large-scale action were to be taken to combat IDD, governments would need to be involved and that the most effective channel would be under the leadership of the UN. He attended the WHO World Health Assembly almost every year, never missing an opportunity to appeal to government representatives. Finally, in 1990 a resolution calling for virtual elimination of IDD throughout the world by 2000 was passed at the World Health Assembly. It was included in the Declaration of the World Summit for Children held in New York later that year. Since then, IDD control has been taken up by the governments of over 100 countries.

Basil continued to visit China once or twice a year. In 1989, a consultation meeting was held in Tianjin between the ICCIDD and the Chinese Ministry of Health about the National Control Program in China. More than 200 experts from China and abroad attended, including Dr. Chen Minzhang, the then Chinese Minister of Health. After thorough discussion, a 10-year-control plan came into being. Two significant problems were taken into consideration: one was the setting up of a supra-ministerial leading group to enhance coordination between such departments as health and salt; the other the initiation of the Disabled Person's Federation, Family Planning Commission and the Women's Federation into the work of IDD Control.

Several years later in 1993, as a result of unremitting, arduous efforts by himself and others, the "National Advocacy Meeting to Eliminate IDD by the Year 2000 in China" was held in Beijing. During the meeting, the vice premier Zhu Rongji, gave his support to the project. Related governmental as well as non-governmental organizations were eager to join the work of IDD control, and related UN organizations agreed to give their support. Since then, IDD control in China, through increased consumption of iodized salt, has proceeded steadily.

Robert and Rupert: Continuing the Family Friendship with China

Basil Hetzel discussing works with his collaborators during Inaugural Meeting of ICCIDD, 1986 in Kathmandu.

Dr. Robert Hetzel is the second son of Basil Hetzel. He received his medical education in Melbourne, Australia and in recent years has worked in the Australian Red Cross. The Blood Transfusion Service of the Australian Red-Cross works on the collection and supply of blood and its preparations inside Australia, and also helps other countries to develop blood banks. In accordance with a government agreement, the service helped China to promote blood transfusions. It also held training courses in China and gave support to trained Chinese staff in Australia. The Tianjin Blood Center played an important role in these developments, and has maintained academic exchanges with the Australian Red Cross Blood Transfusion Service.

In June, 2001, Dr. Robert Hetzel came to Tianjin as the National Director of the Service for a discussion with the Tianjin Blood Center regarding further cooperation in the field of research and exchange of personnel. In November of that year, he went to Shanghai to attend the Asia-Pacific Regional Meeting of the International Society of Blood Transfusion.

Rupert is the eldest son of Robert. He is studying the Chinese language in Australia, now quite a common phenomenon among young Australians, as China rapidly gains economic prosperity and political prestige. Rupert looks forward to making his personal contribution to cultural exchanges between China and Australia.

MA TAI is former Chairman of IDD Advisory Group of the Chinese Ministry of Health.