In her recent blog post, Caryl M. Stern , President and CEO, U.S. Fund for UNICEF, wrote to join us to help every child achieve the milestone of a fifth birthday. Once children reach age five, they are far more likely to survive to adulthood. A key element for children to reach their fifth birthday is receiving proper nutrition. Below we posted an interview with Michael Golden, who is one of the world’s leading experts on childhood nutrition.Q and A by Anthea Moore.
Nutrition expert Michael Golden speaks with a participant at the UNICEF-supported workshop training health workers to manage complications associated with severe acute malnutrition, in Nouakchott, Mauritania. © UNICEF Mauritania/2012
In the world of nutrition, Professor Michael Golden is something of a celebrity. He is famous for his work developing Formula 100 (F-100), which is the basis for therapeutic foods that treat malnutrition.
Recently, Mr. Golden was visiting Nouakchott, Mauritania, to train regional health staff in the management of malnutrition, and UNICEF took the opportunity to ask him some questions.
: How did you come to work on malnutrition?
: I started 40 years ago as a gastroenterologist in Northern Ireland. I realized that patients with coeliac and Crohn’s disease weren’t dying from their diagnosed diseases, but from malnutrition. So I went to London and then Jamaica to study malnutrition. I built on the work of my predecessors and then led a research team of 65 for 17 years, studying all aspects of malnutrition. We looked at biochemistry, clinical features, physiology, anthropometry, as well as psychosocial and developmental aspects. From this work, I developed Formula 100 and wrote the manual for the World Health Organization [WHO] on treating malnutrition.
: Why was F-100 so important for treating malnutrition?
: In developing F-100, we did all the technical things to produce a product that is simple to use. It looks simple, but there is a lot of science behind it. It took 17 years to design F-100 so that all a nurse has to do is open the packet and pour it into water.
: What challenges face Mauritanian health care workers in treating malnutrition?
Nutrition expert Michael Golden and regional health workers and doctors stand together after a training session in Nouakchott, Mauritania. © UNICEF Mauritania/2012
: The Mauritania health staff are functioning in a health system that needs development, more nurses and better coordination between health centers and hospitals. I was here in 2007, and the situation has improved. There are a lot of people with a grounding in malnutrition now. There is also a medical faculty and Mauritania is just about to open six nursing schools. But it would also help to establish dedicated district malnutrition officers, and to have hospital and health services combined and empowered to enforce cooperation.
: Why does malnutrition persist?
: No country is going to get rid of malnutrition until it has economic growth and social mobility. The possibility of social mobility is so important; it changes societies in a dramatic way. Where there is major malnutrition, there is a lack of social mobility. The malnourished come from the poorest sections of the society. Doctors come from the elite and the middle classes and often don’t understand how the poor live.
The poor have amazing skills at living on almost nothing, but they can’t afford to take the risk of believing you if you ask them to do something innovative. If I ask you to spend $50 on something that I say will help, you will try it, and maybe it will work. If it does not, your lifestyle will not change. The poor will not try it. They can’t afford to take the chance. If it does not work, their family will not eat for a month. Instead, they will wait until they see for themselves that it has worked for other people.
: What can we do to help end malnutrition?
Nutrition expert Michael Golden conducts a training session teaching regional health staff and doctors to manage complications of severe acute malnutrition in Nouakchott, Mauritania. © UNICEF Mauritania/2012
: What is needed now is to focus on health services research—how to deliver services effectively to poor people in places like Mauritania. We need to maximize the efficiency of small numbers of staff who are not always well trained. We need to have a system where doctors teach nurses and the nurses train aides. The senior staff must lift up the junior staff.
Diseases of poverty, like malnutrition, need medical sociologists and anthropologists—people who go into communities, live with the poor, understand them, and assist without imposing a Western model. And we need to think innovatively. Probably the most important invention for medicine in Africa is the mobile phone, which lets isolated patients and health workers get medical advice.
We need to think out of the box, live with and understand the people. This thinking will make the difference.
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