Let them eat cake

I had some blood (quite a surprising amount, I thought) taken yesterday, and was reminded of many of the malnourished children I saw in various hospitals and clinics in the eastern Congo. As I've noted before, many of these kids have other (mostly related) health problems (including bad, bad burns), but I never saw a child cry except when a doctor tried to put a line into a vein. That's mostly psychological, I think (though it does smart a bit), but the real problem is that these kids' veins are incredibly hard to locate (I guess because of dehydration?). Which can mean multiple jabs, not easy when the kid is screaming and squirming ...

Not to diminish the seriousness of eating disorders, but I had to laugh the other day when I Googled 'malnutrition' and followed a link to a New York Times page on the subject that emphasized eating disorders as a primary cause. Perhaps among teenage girls living on Park Avenue and in Orange County, but not elsewhere. Malnutrition is estimated to directly cause 300,000 deaths worldwide each year among children five years and younger (and is a secondary cause of death for hundreds of thousands more). In 2001, it was a contributing or direct cause of death of 54 percent of children in developing countries. And the World Health Organization estimates that although by 2015 the prevalence of malnutrition will have decreased to 17.6 percent globally, it will nonetheless affect 113.4 million children below the age of five.

What's striking in the Congo (especially to me, with a medical knowledge base almost entirely accumulated by watching episodes of "House, M.D.") is the relative good health of the mothers bringing in malnourished children. That's because infants and young children are most vulnerable to the effects of malnutrition. The question that occurs to everyone who visits the Congo is why there is malnutrition at all. The country is so spectacularly fertile that more than a few people told me that a discarded beer can would quickly grow into a beer can tree. The problem is war. When people are afraid for their lives, they can't and don't cultivate the land. They hide in the bush, and eat what they can, when they can. The effects of these disruptions are usually not felt immediately, but the following season, or year, when crops that should have been cultivated are not available to be harvested. Other problems result when mothers stop breastfeeding too early (sometimes only two to three months after the child is born), give children food and drink that causes gastroenteritis, and rely solely on (nutrition-free) manioc flour rather than corn flour (distributed by aid groups, but often sold).

The ongoing fighting in the eastern Congo means that many children are treated for malnutrition and released, only to return some months later, when their health deteriorates again. The fundamental problems preventing parents from feeding their children have nothing at all to do with agriculture or the land.

Believe it or not, the child in the top photograph is three years old, and weighs seven kilograms.