Mauritania

Q&A with Professor Michael Golden: Tackling malnutrition in Mauritania

UNICEF Image
© UNICEF Mauritania/2012
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.

By Anthea Moore

NOUAKCHOTT, Mauritania, 30 April 2012 – In the world of nutrition, Professor Michael Golden is something of a celebrity. Mr. Golden is famous for his work in developing Formula 100 (F-100), the basis for therapeutic foods that treat malnutrition.

Mr. Golden is visiting Nouakchott, Mauritania, to train regional health staff, paediatricians and medical doctors in the management of severe acute malnutrition and its medical complications. The UNICEF-supported workshop was attended by health workers from the Government, NGOs and UNICEF.

The training was critically important for Mauritania. The southern regions of the country are in the grip of a nutrition crisis, part of the vast food crisis affecting much of the Sahel region of Africa. Food insecurity currently affects some 700,000 people in Mauritania. More than 35,000 children have already been identified as suffering from global acute malnutrition, and more than 5,000 of these have severe acute malnutrition – a life-threatening condition. As many as 12,600 children could suffer severe acute malnutrition this year.

UNICEF.org: How did you come to work on malnutrition?

Michael Golden: 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.

UNICEF Image
© UNICEF Mauritania/2012
Nutrition expert Michael Golden and regional health workers and doctors stand together after a training session in Nouakchott, Mauritania.

UNICEF.org: Why was F-100 so important for treating malnutrition?

MG: 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.

UNICEF.org: What challenges face Mauritanian health care workers in treating malnutrition?

MG: The Mauritania health staff are functioning in a health system that needs development, more nurses and better coordination between health centres 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.

UNICEF.org: Why does malnutrition persist?

MG: 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.

UNICEF Image
© UNICEF Mauritania/2012
Nutrition expert Michael Golden conducts a training session teaching regional health staff and doctors to manage complications of severe acute malnutrition in Nouakchott, Mauritania.

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.

UNICEF.org: What can we do to help end malnutrition?

MG: 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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