Prevent Childhood Malnutrition

Miguel small

Van small

Give a man a fish, and you feed him for a day; show him how to catch fish, and you feed him for a lifetime.


            For me, hunger has very real faces. There are Miguel and Van, and the woman whose name I have forgotten.

In 1968, while in medical school, I spent a summer in Nicaragua on the Caribbean coast. Fortunately I had a camera with me and brought back some photos that I still use for teaching.

Miguel was fussy and had a big belly and reddish hair. In this picture he is being held by his older sister. A Nicaraguan medical student and I tried to figure out what was wrong with him. Our mentor, Ned Wallace knew immediately that Miguel had kwashiorkor, a type of malnutrition caused by lack of protein.

We admitted Miguel to the hospital and fed him a high protein combination of bananas, rice and powdered milk. I expect that he is now a healthy 46-year-old man.

Van was not so lucky. He was quiet—too quiet for a boy of almost a year old. Only his big eyes moved to follow people around him. My picture shows him sitting on Jan Cunningham’s lap before her husband, fellow medical student Brian, started an IV. The next day Van died despite the best efforts at the little mission hospital.

We traveled by dugout canoes to small towns that had never had medical care. The people there seemed pretty healthy. They lived in a fertile land with lots of rain and sparse population. I remember one man telling me that he had just come back from his “plantation”. An image of a Southern mansion with white pillars jumped into my mind! Reality was that this was just a small area that he had cut out of the savannah where he planted his crops. My recollection is that, despite parasites and the usual childhood complaints, the kids outside of the city seemed well nourished.

Our home base, the Moravian hospital in Puerto Cabazas, had a different story to tell. A girl I saw in clinic one morning complained of stomachaches. She was a slender, comely and self-possessed 10 year old. I examined her skinny abdomen and found nothing wrong except for lots of gurgling sounds.

“What did you eat for breakfast?” I asked.

“Just some coffee. My father didn’t have anything else in the house.”

Whereas in the villages the food came from trees and plants a short walk away, in Puerto Cabezas the economy relied on córdobas (the Nicaraguan currency). People grew food and fished for money, not to eat. Sometimes they ran out of money—and food.

Our time in Nicaragua was 45 years ago. Malnutrition there has dropped dramatically in the last 20 years, but there are other areas in the world, especially in Africa, where it has risen alarmingly.

No child should be hungry, let alone starve to death. Yet worldwide 17,000 kids die every day from lack of adequate nutrition. This is a complex problem without easy answers. I appreciate the First Baptist Church of Bayfield focusing our attention on this issue. Moreover, I will write more soon, including about the woman whose death 30 years ago still haunts me.

© Richard Grossman MD, 2013

By Richard

I am a retired obstetrician-gynecologist who has been fortunate to live and work in the wonderful community of Durango, Colorado for 40 years.

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