The striking image of the half-naked pot bellied African child that adorns the cover of Jennifer Tappan’s new book is one that carries with it a multitude of uncomfortable associations. Images such as this one became particularly common within western mass media from the 1980s, eliciting outpourings of public sympathy and raising awareness of the dire situations in which many human populations lived. These pictures unwittingly deepened existing associations of a generic Africa in crisis, filled with equally generalised ‘Africans’ desperately in need of Western public health intervention. The complex role colonialism had played in the creation of these cases of childhood malnutrition – displayed via these characteristic images of naked, swollen children – was rarely discussed: until new criticisms of the role of western medical colonialism came to centre stage from the late 1990s and early 2000s.
The Riddle of Malnutrition unravels this complicated and little-known history of nutritional health, focusing the site of its enquiry on Uganda, the country where much early research into malnutrition was conducted. Uganda was home to Africa’s first nutrition rehabilitation program, Mwanamugimu, at Mulago Hospital – a fact that has hitherto been overlooked outside the country. Tappan’s story is of one of the unintentional extension of a problem. Malnutrition was little understood, not least because initial biomedical investigations wrongly considered it more as a disease, requiring hospital-based therapies, than a condition that could be remedied through longer-term food programmes. It took the research conducted via Mwanamugimu to tackle the problem effectively, especially that of its most fatal form – kwashiorkor. The Mwanamugimu programme confronted malnutrition through developing a programme that gave agency to local people, particularly women, and was culturally sensitive to an African worldview. The programme’s success is even more amazing when it is presented against the unremitting backdrop of violence and upheaval perpetrated by Amin and Obote.
This is a fascinating story. Tappan uses a range of archival sources, both official and personal, and she also makes extensive use of oral history. The result is an interesting if somewhat predictable, critique, taking us through the rise and fall of biomedical interventions to a more optimistic (although far from perfect) standpoint from which to consider ways to tackle malnutrition in modern Africa. Throughout the book, the broader Ugandan political context is well considered, as are the varying responses to malnutrition as experienced by Ugandans differently over time. As a social and cultural historian, however, I craved more detail on this more personal angle. Particularly, I wished to know more about the environments and preconditions that caused the first colonial doctors to look down the wrong avenues. Similarly, although the book felt very close to the changing landscape of the science of malnutrition, I never felt I was inside the heads of those who championed different theories. Although Ugandan understandings of the condition are given space, I was left still wondering what it was like to be a Ugandan mother looking at medical options for her malnourished child. The overall impression, for me at least, was that this was a very efficient, welcomingly politically potent, but oddly detached book; especially given Tappan’s evident affection for the people she interviewed.
The central message is clear, so clear in fact that it dangerously teeters on the edge of repetitive overstatement. Throughout this study Tappan is passionate about the relevance of this history to modern-day policy makers. As she points out, the problem is urgent today, with an estimated ten million children globally identified yearly as suffering from the condition. Contemporary reactions to malnutrition today, argues Tappan, still unwittingly carry with them lingering remnants of its faulty historical conceptualisation.
In the United States, this book has made a modest splash and deserves to have done so. It is conscientiously researched and is earnest and deeply considered in its laudable aim to function beyond being purely a history book for scholars to discuss, remote from the on-the-ground reality, in their privileged ivory towers. Furthermore, this has obviously been a labour of love for a country and a people that are close to Tappan’s heart. Its central findings will influence those working in less developed economies to show, if nothing else, that biomedicine is not the one-stop fix it is all too often optimistically assumed to be. This is a solemn and worthy book, I really wanted to love it, and was left perplexed as to why it ultimately left me a bit cold. For me, at least, this was not a page-turner and was a touch repetitive, but I can simultaneously appreciate the meticulous underlying research that makes this an important scholarly addition to our understanding of public health interventions in Africa.
