Monday, January 30, 2012

Let's get real about Africa's burden of malnutrition

In the past, I have received criticism for my work linking malnutrition to underdevelopment and social dysfunctionality. My critics have suggested that, by identifying problems in African society and highlighting the "stigmata of malnutrition," I am giving racists ammunition for their claims that Africans are genetically inferior to other races.

I beg to disagree with my critics. First, race is not a biological category. It is a socially constructed category. I have no essentialist arguments to make about Africans. What I do talk about is nutrition, which can be changed willfully by people who have choices. The point of my intervention is to raise awareness of the kind that will increase the number of nutritional choices available to most people.

No reasonable man or woman would dare to claim that the nutritional needs of most of Africa's children were being met. Conditions such as kwashiorkor, pellagra, rickets and others are commonplace in our communities. Any African who has lived in a community where having one meal a day is a luxury knows that children do not thrive under those circumstances. They do not thrive physically: Their bodies are stunted, and they succumb easily to diseases and parasites. The children do not thrive emotionally either: Hunger does not breed joy, nor is competition for limited resources in the home conducive to cooperation between family members. Families quickly become dysfunctional. They do not thrive intellectually: How can they, when their bodies are ailing and their brains do not receive the nutrients necessary for the growth, development, and optimal function of the brain? Furthermore, they may also be vulnerable to mental disease as teenagers and adults. Remember that mental disease is like any other form of disease: It thrives where there is chronic malnutrition, stress and trauma.

These are the challenges that the majority of Africans (who are poor) must wrestle with as they raise their children. Their children, in turn, grow into adults who are physically and psychologically marked by the deprivations they suffered. They may be small in stature, prone to falling ill, may have failed to reach their full intellectual capacity, and may experience undiagnosed depression and other forms of mental disease. All these factors can be attributed, not to their race, but to chronic lifelong malnutrition and the other difficulties they have endured. Anybody who takes the time to study the experiences of populations the world over that have historically been subjected to similar deprivations will notice similar problems.

Boer residents of British concentration camps in Southern Africa in the early 20th century endured such deprivations. Furthermore, prisoners in the Russian Gulag experienced similar forms of deprivation, as did Jewish people and other European minorities in Nazi-occupied Europe. The Kikuyu families who were put into concentration camps by the British during the so-called Mau Mau Emergency experienced similar deprivation. Those occupants of the Sahel and the Sahara who have lost their livelihoods to drought, and have had to seek refuge at relief centers decade after decade have experienced the same. A quick internet search will reveal that Asia and the Americas have similar stories to tell.

Whether chronic malnutrition results from poverty, natural catastrophes, wars or political repression and marginalization, it deprives entire communities of their potential. Thus, observations about diminished intellectual capacity and physical stamina, and vulnerability to physical and mental illness in such communities are a testament to the long reach of malnutrition. They are not essentialist claims about "the nature of a race."

If the nutritional needs of most of Africa's children were somehow to be met, then there would be no reason for us to be having this conversation. Africa would be a self-sufficient continent, confident in her dealings with itself and the rest of humanity. But we all know that that is not Africa's present reality. A country like Kenya can afford to pay its parliamentarians world class salaries, but the average person in the village or in the urban slums often struggles to get one square meal on to the table daily. The cycles of famine and drought, which have come to define Eastern Africa, are destined to continue, punctuated by emergency cabinet meetings to deliberate the hunger crises.

Educated Africans must take a step beyond their comfort zone. Instead of spending most of their energy trying to deny the deep-seated problems that plague our societies, they should look at the bigger picture. The underdevelopment burden due to malnutrition across sub-Saharan Africa is real. By not accepting that there is a problem, Africa's educated elites become part of the problem; they stand in the path of advocacy for better nutritional health. Once we accept that there is a problem, policy makers can be pressured to diversify agricultural production on the continent. Africa's educated elites need to shed the disdain they hold for the majority of their own people and, instead, start using their skills to offer transformative advocacy and support.

Thursday, January 26, 2012

An open letter to the African woman

Dear sisters,

I'm writing this letter because I have lost several nieces to childbirth in the recent past. This problem has been on the rise in my community, despite the fact that modern knowledge and medicine should have minimized it. The same is true for child malnutrition, which is rising, even as our adoption of modern nutritional and medical practices intensifies.

On September 20th, 2010, Ida Odinga, the wife of Kenya's Prime Minster devoted attention to the issue at the United Nations. Cited here is a Daily Nation article on the meeting: Malnutrition destroys young bodies and minds, harms education and work performance and ultimately damages communities. Nowhere is this more apparent than in Africa. We know the solutions to prevent this cycle, and it is urgent that we, as women and as leaders, set our goals in action.

 The article goes on to state that, “About 60 per cent of the world’s chronically hungry people are women. While undernutrition is a critical human development issue across the globe, it is especially prevalent in Africa, where one in four people suffer from malnutrition and 40 per cent are stunted.”

That these observations are being discussed at such forums is encouraging. However, we must try to understand this issue as a communal problem. Our friends from other continents and regions can only help us effectively if we make the effort to understand the problem ourselves and to develop homegrown solutions for it.  

My dear sisters, I am addressing you because women are often viewed as the custodians of a people’s culture. Empowered women help to build a thriving culture. In turn, a thriving culture helps to create empowered women.

Those of you lucky enough to be reading this have a moral obligation to empower yourselves, as do I. Then the choices we make, which will serve as examples to the majority, will be rooted in knowledge. The first step in empowering ourselves is to read about the subject of malnutrition. We should not assume, as we often do, that we know everything. I am a doctor, but it took me many years to learn what I know about malnutrition.

Heed these words as the fate of future generations may depend on what you know.

Yours respectfully,
Nelly M’mboga.

Monday, January 16, 2012

Contemporary Africa's implication in its own underdevelopment

In early April of 2010, I was hosted at a Public Library for the presentation of my book, A Healthy You: Tame Africa's Child Malnutrition. I was quite surprised at the interest the contents generated: I had assumed the book would primarily interest Africans, but the audience was predominantly American. To cut a long story short,the presentation went well, and gave me fresh food for thought.

One issue that came to the fore during the question and answer session was the poor utilization of quality protein maize (QPM) in the place of ordinary maize to tame childhood malnutrition on the continent. Other developing continents seemed to have made greater use of this resource than Africa. One participant in the audience hinted that the African establishment seemed to enjoy "victimhood." The person speculated that they preferred to exploit the sympathy that poverty, disease, the orphan burden, and violence attracted than to do the hard work that was necessary to undo institutional dependency on foreign aid.

Globally, research on QPM has been ongoing for many years. On the African continent, it is only in Ghana that  community studies have been documented. These studies have shown that Ghanaian children with Kwashiorkor fed on QPM recover. I have thoughtfully compared these with my own casual observations that Western Kenyan children, fed predominantly on a white hybrid maize staple diet continue to suffer from Kwashiorkor. The high infant mortality rate in Wetern Kenya is a crying shame, yet any possible solutions must come down to political will. When political will catches up with the reality on the ground the problem will receive the attention it deserves. The officials concerned with addressing malnutrition nationally then will be well advised to break down the national statistics for disease burden, poverty rates, and child mortality into regional figures. It will be important to identify the communities most afflicted and to apply the most intense programs within them.

Several reasons have been cited for the minimal undertaking of QPM research efforts on the African continent. One of these reasons is that many nations do not have the technical capacity to support such research. However, if Ghana can do it, why can't other African countries do it? Keep in mind that much of the hard scientific work that would facilitate such research has already been done. It seems more likely that the absence of such research efforts is attributable to the absence of coherent national development goals in many African nations. Such goals are rendered impossible because of the degree to which resources are commandeered for ethnic interests rather than national interests.

Leaders focus more on meeting the superficial needs of "their people" so that the tribal voting blocs on which they are dependent can get them back into office during the next political cycle. There really isn't much time or energy left to look into the more profound needs of their communities in the long-term, or to even think about other communities nationally. What this means is that ordinary Africans who want to see Africa change for the better have to learn to do the dirty work themselves, often without government support.

The African culture of poor leadership is bred in our homes. We must start taking responsibility for this culture: If there is something you can do to change Africa for the better, do it now, starting in your home. Don't just complain about "Africa's poor leadership." Leadership should start with you, dear reader. If you can't make the necessary sacrifice, why should you expect that somebody else will? Leadership arises from the people.

Monday, January 9, 2012

How Africa's maize turned white: a review

A while back, I read James McCann's book Maize and Grace: Africa's Encounter with a New World Crop, 1500-2000. Beautiful book! Any of you out there who can should grab a copy.

My favourite chapter in the book is "How Africa's maize turned white". It opens with the dramatic events that have characterized and shaped modern Africa, starting in South Africa i.e. mining, industrialisation, European settlement and male migrant labour. Maize is at the heart of all these events. However, whereas maize serves as the native South Africans' staple diet (in mealies and beer), for South Africa's commercial farmers, maize is a traded commodity used globally in industry and as cattle feed (and allied feeds).

According to McCann, native African maize (originally imported from South America during the Columbian era) expressed itself in very different ways on small peasant farms, displaying many colours. Up to the beginning of the 19th century, farmers could choose seed from their previous crop; they also had a variety of coloured maize varieties to choose from (e.g. Blue Flint, which they had by then christened "Blue Zulu"), but the arrival of hybrid maize changed all this. This was preceded by the discovery of diamonds at Kimberley in 1867, which led to an influx of migrant workers and capital, opening up the area for commerce and an increased demand for food. In the late 19th century White American Maize, which birthed the hybrid varieties that would revolutionize maize farming in both Southern and Eastern Africa, was imported. These new (hybrid) varieties were, in addition, high-yielding and utilized commercial fertilizer, making maize farming attractive to large commercial farmers.

While most of the world's maize crop is yellow, Africa produces mostly white maize. Chemically and genetically the 2 varieties are similar, although the yellow maize has a nutritional edge over the white maize because it contains the "carotene oil pigments responsible for the colour of yellow maize". Carotene is a precursor of Vitamin A. Most Africans prefer the white maize and refuse any other colour. In fact, when given a choice, they will pay more dearly for the white variety. This sharply contrasts with earlier Africans who selected "coloured maize ranging from crimson to blue to colourful mosaics of red, blue, yellow and orange." So how did this transformation occur?

This transformation is linked to the commercialization of maize that naturally followed increased demands for the crop. Maize became an exportable commodity which, for the purposes of the British starch and distillery industries, had to be homogeneously white. The South African crop could therefore compete on the international market, and get premium prices as a white homogeneous crop. In Southern Rhodesia, in an effort to force farmers to grow this homogeneous white crop, the cultivation of coloured varieties was outlawed. The flour mills also preferred the hybrid white maize because it was easier to mill, having a softer grain than the other varieties. One author mentioned in the book hints at another reason, divorced from the above two: "The real cause is the tendency of the native to imitate the white man, and that as the white man in Southern Africa eats only white mealie meal, the native thinks he ought to do so too". Contrary to this assertion, however, white South Africans had long identified maize as a "kaffir food".

McCann ends the chapter by reflecting on the political and economic forces inscribed by hybrid maize onto Southern Africa at the end of the 20th century: White farmers prospered while black farmers declined. Medical records from the 1920s and 1930s show that in colonial Basutoland "the incidence of pellagra and kwashiorkor increased in direct proportion to the rising percentage of maize in the diet".