Surgery and Healing in the Developing World - Dartmouth-Hitchcock

Nutrition and Development in Africa
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micronutrients, through vertical programs in rural areas such as Nyasa Province in
the same country where most of these hypertension consequences are still rare. Promotion
of, for example, iodized salt, is clearly intended as a means of combating
iodine deficiency, but it may not be seen (perhaps because it is too obvious) that it is
first of all a social marketing—of salt. In a population that has been chronically
short of both, we should monitor not only the laudable reduction in goiter and
cretinism as the benefits we seek, but also the changes in rates of blood pressure
abnormalities and perhaps the start of other evidence of urbanization patterns of
morbidity, reflected from the century earlier warning from Maputo Province and
the onset of possibly preventable epidemics associated with development. Untoward
consequences of medical relief and rehabilitation programs should be looked
for and honestly reported, even while the laudatory objectives are so easily and rapidly
reported. 6
No one should be advocating a retro-dedevelopment, much less celebrating the
health advantages of destitution from the privations attending famine, war, overpopulation
pressures or economic oppression. “Development”, however is usually
assumed quite comprehensively (unfortunately, by many economic advisors,) summed
as the iteration of the measurable data of consumption. Consumption of increasing
numbers of resources in health care might be viewed as a positive marker of development
(particularly by those who receive the benefit of these services—and lest it be
forgotten, these nearly always include the professional providers), but the need for
such services should fit on the debit scale in such a meta-analysis of nutritional
development, for which focus the authors are to be congratulated.
Is it the role of healthcare personnel and health educators to point out such
tradeoffs that should be mitigated in any development program? Some clearly think
not 7-9 and that such “collateral damage” should be relegated, at best, to other specialists.
But, it seems, at least in Southern Africa, that the very health care personnel
who should be the foot soldiers of this preventive program, who are the most embedded
in the culture, 10 are those most severely afflicted by these “diseases of development.”
A campaign in the Republic of South Africa to send public health nurses
through the schools to warn against the problems of obesity and in case finding for
diabetes and hypertension had to be called off, when every single one of the experienced
public health nurses (thus, employed professionals) who pitched up to be sent
out on the campaign was, herself, morbidly obese! 11 Many of the surprised health
personnel did not understand why the preventive program would be contradicted
by its very emissaries. It was explained that obesity, far from a stigma, was part of the
desiderata of development, like a big house or a motorcar, a mark of achievement, a
presumptively apparent negative serology in the context of the dreaded “Slim,” and
evidence particularly for a woman, implying a man who cared for her, or at least a
disposable income, invested in her overconsumption and underexertion.
Such cultural blind spots may have been prevalent in prior decades of First World
overachievers, who were really only certifiable as excelling type-A executive class
after their coronary bypasses. First world hospitals boasted about the superior
high-technology care invested in such individual cases of preventable disease. These
may be first and emerging Third World res ipsa loquitor cases of health professionals
in transition, dazzled by the immediate economic and technologic numbers, turning
blind eyes over the downside of development and the untoward consequences of
“advances” in nutritional development and health care.
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