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Lessons from the History of Medicine
Lessons from the History of Medicine

In the years immediately following the Second World War, the World Health Organization and UNICEF (the United Nations Children’s Fund) trained their resources on addressing malnutrition in countries around the world. And yet, while efforts have continued, international groups combating malnutrition still face a global burden of poor nutritional health associated with the deaths of nearly three million children under the age of five every year.

Kwashiorkor is one type of severe acute malnutrition that affects the health of millions. Associated with a diet deficient in protein, its symptoms include the accumulation of fluid in tissue that gives malnourished children a swollen appearance, a form of dermatosis in which skin peels away, and the loss of pigmentation in hair. Before treatments were developed in the early 1950s, forty to ninety percent of afflicted children died from this particular form of malnutrition.

Beginning in the 1930s and through the 1960s, the efforts of scientists and physicians to identify the causes of, treat, and prevent kwashiorkor produced many programs, some of which were great successes while others turned out to be horrific failures. Scientists searching for what caused symptoms used ethically questionable methods to conduct their research. Miracle treatments like protein-rich dried milk that restored health when administered in hospitals resulted in the deaths of untold children after they were removed from the clinical setting. As a result, public trust in treatment centers and biomedical science waned, resulting in even more negative outcomes. But this failure ultimately prompted a different approach, one that engaged with the community, creating a culturally informed intervention focused on nutrition education and empowering women in the promotion of nutritional health.

According to Dr. Jennifer Tappan, a professor of history at Portland State University, the events of those years left a lingering residue in the memories of the communities who are to this day on the front lines of the battle against malnutrition. For the international aid organizations and global health programs whose mission it is to treat and reduce instances of kwashiorkor, that residue accompanies them into the cities and villages where they work. An understanding of that complex history and its impact on communities is essential to the design of future campaigns if they are going to reduce the prevalence of kwashiorkor and minimize morbidity from conditions associated with malnutrition.

Dr. Tappan is an Africanist historian whose work focuses on the history of medicine, public health, and historical epidemiology in Sub-Saharan Africa. She conducts much of her research in Uganda, peering back into the turbulent decades following the Second World War and the end of colonialism where she studies the relationships between the people of Uganda and the scientists, physicians, and aid organizations that worked on kwashiorkor. Her investigations weave critical analysis of historical records and existing scholarship with personal histories recounted by the medical professionals and community members who experienced Uganda’s emergence as an international center for nutritional science in the three decades following the Second World War.

Next summer, the Ohio University Press will publish Dr. Tappan’s first book: The Riddle of Malnutrition: The Long Arc of Biomedical and Public Health Interventions in Uganda. Examining over a half-century of efforts to address kwashiorkor, the book focuses on what led to the development in the 1960s of a community-based intervention that has succeeded in improving public health for decades now. The program, locally known as Mwanamugimu, is an intervention that enlists Ugandan women and emphasizes the preparation of Ugandan cuisine made from nutritious foods found in local markets and household gardens. According to Dr. Tappan, the program empowers women and men in the community to manage the nutritional health of their families. For generations now, these women and men have passed on what they learned, making the intervention an integral part of the daily and cultural lives of the community. It is a remarkable example of a sustainable public health initiative, a program that could be sustained even in the midst of waning donor interest and investment following decades of political violence and unrest. 

“The history of medicine and public health is a field of inquiry that helps us chart past efforts to contend with contemporary disease challenges,” Dr. Tappan said. “When you examine historical epidemiology you often find teachable moments, hints as to how past generations made forward leaps, and you can observe the actions that led to unintended consequences. But the history of medicine isn’t necessarily emphasized in public health training. Consequently, many aid organizations and public health practitioners create programs that are not able to take into account what’s been done before and how the community received those efforts. Historians can bridge that knowledge gap and help those working in public health integrate an understanding of the past into their current efforts. And that can have a profound impact on global health programming going forward. It can help us save lives.”