Remembering the faces of childhood malnutrition

Courtesy photos

Two victims of childhood hunger, Nicaraguan kids Miguel and Van in 1968. Left: Miguel, shown in the arms of his older sister, suffered from a protein deficiency. Above: Van is pictured in the lap of Jan Cunningham, wife of an American then in medical school along with the author. Malnutrition had robbed him of the energy even to cry.

For me, hunger has very real faces. There are Miguel and Van, and a 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 on 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 hospital in Puerto Cabazas – operated as a mission of the Moravian church – had a different story to tell.

A girl I saw in a 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,” she said. “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 practices gynecology in Durango. Reach him at ©Richard Grossman MD, 2013

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