In the Belly of Africa
Among the poverty-stricken, nutrition efforts are being
stepped up to combat disease.
Story and Photos by Allan Richter
In the bush north of the Ugandan capital Kampala, Ndiito Okumu proudly displayed the mud chicken coop he built. He pointed to its stick-and-twine door—a kind of sturdy vertical blind, really, to keep small predatory animals at bay. The coop, set between jackfruit and avocado trees on a sliver of land, was not entirely up to specifications, however. Visiting veterinarian James Matovu gently advised Okumu, 42, to create ventilation about three feet from the dirt floor so any gathering moisture could evaporate before it begins to harbor disease-carrying bacteria.
For Okumu, who two years ago was diagnosed as HIV positive, an epidemic on this continent, the 10 chickens that a charitable foundation gave him are just about as vital as the antiretroviral medication he receives at the Bishop Asili health clinic in nearby Luwero. The foundation, Just Like My Child, is Bishop Asili’s main benefactor and donates the animals—either a dozen or so chickens or a pair of pigs for each recipient to raise, sell and eat—to help the clinic’s patients fend for themselves.
In the past few years, the foundation has raised about $350,000 to help Bishop Asili build an obstetrical surgical suite, hire two doctors, install a generator, and buy sonogram equipment and incubators for its maternity ward. The clinic also received a donation of what foundation officials say is one of only three CD4-count machines in the country. The machines determine the strength of the immune system.
But it is the foundation and clinic’s efforts to raise the nutritional IQ of patients, coupled with the chicken and pigs program, and the funding of new schools in area villages, that are central to the chief goal of the clinic and its benefactors—making both the clinic and its patients self-sufficient.
“Just saving a life isn’t enough,” says Vivian Glyck, a former marketing executive who runs San Diego-based Just Like My Child, “so we developed the education and the microfinance initiatives and are working very hard to make this place sustainable.”
Children At Risk
Uganda is a study in contradictions. Sun-drenched, emerald fields of sugar cane, green beans and lush mango trees blanket the countryside. In Kampala and its outskirts, petrol fumes mix with the smell of charcoal and grilled meat as African rhythms and hip-hop beats blare from boom boxes.
Roadside marketplaces are filled with sweet pineapple, green plantains and cages of squawking chickens. Yet within a few hours drive of these scenes, half-naked children, many malnourished and with only one surviving parent, the other lost to AIDS, tend goats or play in front of huts made of mud, dung and straw. The sight of children walking with jerry cans atop their heads or on bicycles they push is a constant reminder of the scarcity of clean water.
Blindness, caused by a lack of vitamin A, is still found in Africa, as are diseases long gone from Western shores: rickets, from a calcium deficiency; scurvy, from a vitamin C shortfall; and pellagra, an affliction marked by skin lesions, weakness, insomnia and other symptoms, brought on when niacin is missing from diets.
At Bishop Asili, newborn children of anemic and malnourished mothers have weighed in at as little as 800 grams, or under 2 pounds, said Sister Teresa Akulu, a longtime midwife at the clinic. “There are so many babies with low birth weight,” she said as she folded wool blankets stored by the incubators. The equipment, used when birth weights are under 2 kilograms, or about 4½ pounds, have helped. “Many babies have survived through it,” says Sister Teresa.
A range of challenges stifle the population’s nutritional needs. Many people are too weak for the labor-intensive tasks involved with keeping cattle and goats, says Josephus Walulya, a veterinarian and farmer who helps train villagers who receive chickens or pigs under the Just Like My Child program. And smaller, more manageable livestock often die, Walulya adds, before they have a chance to reproduce or otherwise benefit the owners and their families.
Okumu, the man in the bush with the mud chicken coop, had kept chickens earlier but they all died. He was seeking guidance from Just Like My Child’s Ugandan experts on raising the birds that the foundation had just donated to him. On another visit with the charitable foundation in the bush, veterinarian Matovu was advising Mohammed Kiwuuwak, a single father who is HIV positive and who is supporting a 13-year-old girl and 11-year-old boy.
As the vet doled out medicine and advice on feeding pigs a pulp of fish and maize, Kiwuuwak’s male pig, shivering with fever, nestled itself under a blanket of cassava and yam leaves in its pen. Pigs play an important role in helping the villagers who receive them become self-sufficient; their urine is used as both a pesticide and fertilizer. Kiwuuwak and other villagers who receive the pigs place their pens close to their crops and build cement channels to funnel the urine toward the plants.
When they do grow more nourishing crops, such as vitamin C-laden green beans or protein-rich peanuts (called groundnuts in Uganda), villagers often sell rather than eat them. Drought may strike or plots of land are too small to provide enough of the crops through the year. Seeds are expensive and there are few farming advancements. “People here still use a hoe,” Walulya says. “The problems are so many.”
Hunger Versus Nutrition
In these impoverished communities, filling stomachs trumps nutritional value. “When a child is hungry the parent will buy bread instead of an egg so the child will feel more full,” says Walulya. As a result, poor villagers pursue convenience and cost savings over nutritional diversity—evidenced by the widespread reliance different regions of Uganda have on a single food.
In the east, potato-like cassava tubers dominate, offering variety only in the ways they are ground, sliced, mashed, grilled and otherwise prepared. Traveling eastward toward Kenya, it is common to see people laying out cassava pieces along the roadside to dry in the sun. Near the eastern town of Mbale, cassava mill workers are covered in the white powder of the plant’s ground flesh.
Cassava is hardy and resists drought. The dominant food in eastern Uganda, it is also highly popular throughout Africa, Asia and South America—a big reason many who grow, consume and study it are raising eyebrows over a new virus, brown streak, that has infected cassava crops around Lake Victoria and elsewhere in East Africa. Cassava is the world’s third-biggest source of calories, after rice and wheat. The new blight underscores the risks of over-reliance on one food.
If cassava is the primary food of choice in eastern Uganda, plantains—like cassava, potassium-rich and carb-heavy—are omnipresent in the area around Luwero and other central points. While unripe and still green, the fruits, which resemble large bananas and grow in bunches, are peeled, wrapped in their leaves, cooked and mashed while still in their leaves. The resulting pulp, which turns a Day-Glo yellow from its original white during cooking, is formed into a basketball-size starchy loaf called matoke and sliced. Nary a lunch or dinner plate is without it.
“If you go to the north, nutrition is so different,” observes Sister Ernestine Akulu, Bishop Asili’s general administrator. “In the north they eat a lot of cereals. They have a lot of grains, beans, millet. And they work the land a lot. The same in the southwest; they have varieties, they have beans, they get a lot of protein. Here, we are called the matoke region.”
A New Path
Until the Bishop Asili clinic can help ease its patients to more balanced diets, it supplies dietary supplements that it receives through donation. Sister Ernestine, petite and soft-spoken, oversees a model garden at Bishop Asili to teach the clinic’s patients about crop diversity and how to cultivate plants under different conditions. Corn stalks grow cramped in a 10’ x 10’ patch of dirt; in other small plots, beans and groundnuts grow. Mango, banana and papaya trees dot the property. “The idea,” she says, “is to show the patients that you don’t need huge, huge land.” In the villages surrounding Bishop Asili, as elsewhere in largely agrarian Uganda, plots of land are so small people bring their cattle and goats to graze along public roads.
Just Like My Child’s strategy for sustainability extends to the village schools it is building. The foundation hires promising locals who show responsibility, like Judith Akware, a teacher who bucked convention by waiting until she turned 30 to become a mother. The foundation hired Akware as headmistress of a new school it funded several miles from Bishop Asili.
“In Uganda most girls produce babies when they are 15, 16, 17. But for me when I looked at them, I said, ‘I will be different.’ So I studied and studied, and I finished my [primary schooling],” Akware said as she nursed her newborn, Enoch, with her school behind them. “After finishing, still I said, ‘No. I have to study.’ After studying, I will be producing. My fellow teachers asked me what I am doing. They thought it was abnormal. But I told them, no, I have my goal. After my studies, I need a good husband who will take care of me, who will love me instead of being a single mother. Most of them are single mothers. After they get pregnant, the men usually abandon them.”
Akware plans to have no more than two children. One of seven siblings whose father died young, she recalled that her mother fasted to feed the children. “When my dad passed away, my mother used to suffer very much,” she said. “I said, ‘No, I won’t be like that. I will have few children and love them, shelter them, give them food.’ My colleagues who I studied with at university said, ‘Wow, Judith, you have challenged us.’ They said, ‘You have planned.’ Most of them didn’t plan.”
Back at Bishop Asili, Sister Ernestine’s latest project to help make the clinic self-sufficient is raising rabbits whose meat she hopes to sell to hotels. And near the clinic’s gate, builders worked feverishly to finish a new staff cafeteria where doctors and midwives can buy tea and snacks, helping to fill the clinic’s coffers.
But she says it is the focus on a more balanced, vitamin-rich diet that will ultimately keep area residents healthy and clinic costs in check. “When they have good nutrition, they don’t fall sick,” Sister Ernestine said. “We have seen that children with malnutrition don’t thrive. They are dull. Their brains do not work. They are susceptible to diseases. And when they come, they take a long time in the hospital. You need to treat them in so many ways. Nutrition is a big, big preventative.”
Veterinarian James Matovu dispenses medicine for Mohammed Kiwuuwak's sick pigs.
Vivian Glyck, founder of the Just Like My Child Foundation,
photographs a boy pushing a jerry can of water atop his bicycle.
Ndiito Okumu displays the door he built for his chicken coop.
Government-sponsored signs with slogans aim to promote healthy living.
Judith Akware and her newborn son Enoch. Akware is headmistress
at the elementary school, behind her, built by Just Like My Child.
A man wheels plantains, a ubiquitous crop.
A roadside mango stand.
Bags of charcoal for sale.
Children with jerry cans of water they retrieved.
The makeshift bamboo divider in a classroom in the bush. One side of the room houses a
class of 55 students; the other, a class of 45, both taught simultaneously.
Just Like My Child works to alleviate such overcrowding by building new schools.