Should we be force feeding African children?

I haven’t been very inspired to write for the past month or so, as there has been a lot of drama and negativity amongst the volunteers here that I don’t really want to go into. I had a couple of really nice visits to some national parks, saw dancing lemurs and the world’s smallest chameleon, and now I’m in Ambovombe, an incredibly poor town in the far south of Madagascar.  I had to get here by way of Fort Dauphin, which I expected to be relatively large given that it’s got the only airport in the region, but instead I found a ghost town with what looked like long-abandoned buildings. Given the general deterioration of the situation here in Madagascar, partly because that’s the way it always is and partly because of the “transitional government” (the DJ president who gained power via coup d’etat 3 years ago), there has also been increasing violence in the region. Just last week a band of thieves attacked and murdered people outside of Ambovombe in order to steal their zebu (cows), and it’s not safe to walk outside the main streets during the day or anywhere after dark, which unfortunately starts at 6pm.

But even more striking is the poverty I’ve found in Ambovombe. The region is dry and windswept, the landscape covered in cactus. The town itself is the capital of the region, with about 40,000 people living in it, although it mainly comprises one long, dusty street with some smaller streets off to the side. The big problem here, which has been a problem for decades, is that there is no water. They have dug some wells but they have to go incredibly deep to find water and they keep drying up. They cart in water from these wells via zebu-drawn cart, and people have to buy it, and it’s expensive. As a result of this there has been widespread famine, and various well-known NGOs (you can guess who they are) have been here at various times or continuously through the last several decades trying to help. As one long-term volunteer put it to me, “I think the best answer for the food and water problems here is for everyone to just move somewhere else.”

One large NGO is handing out PlumpyNut, a nut-based protein and vitamin concoction that is designed for severely malnourished children, and various other groups are giving out rice, cassava and other staple foods. Unfortunately what has happened is that anything given to moms for their malnourished kids – including food and hygiene products like soap – is instead sold on the street to buy cassava for the fathers, with only leftovers going to the kids. Despite being educated that malnutrition leads to disease and death in children, the mothers feel compelled, for reasons I don’t entirely understand, to put the fathers first, even if it means their children suffer. Various explanations have been offered to me by locals, for example that people here are short-sighted and unable to see beyond the right now that their child is currently alive, or that elders are held in esteem while children are considered little more than a nuisance, or even that husbands beat their wives if they are not fed first, but I am having trouble wrapping my head around the fact that the maternal instinct does not outweigh all of those cultural factors. And in truth, though I have come here to try to figure out how the NGO I’m working with can contribute to the fight against malnutrition, it is difficult for me to see how I can convince mothers to care about their own children’s welfare if they don’t do so already.

The solution I’ve arrived at is something akin to “directly observed therapy” like we use for TB patients, wherein we would give the kids PlumpyNut but they would have to eat it in front of us rather than take it home where it could be sold instead. Maybe a few better-nourished kids would be enough eventually to break the cycle and show people it doesn’t have to be this way. However, this solution is extremely labor intensive, and moreover it starkly emphasizes the fact that we are forcing something on these people that they do not want. Even if the thing we are forcing is nutrition for children, it starts to walk a line where you begin to question who has the right to tell other people what to do, and why I, as a white person, think I have the right to tell an African mother how to raise her children.

I just finished reading The Bottom Billion, by Paul Collier, a book you should read if you haven’t already. Madagascar is solidly among those bottom billion, which are a group of about 60 countries that, while you may think of them as part of the “developing world,” in reality are not developing at all, but for various reasons are just stagnant. The author tells a story about how the former president of Madagascar, unhappy at having lost an election, decided to blockade a port that was the main source of growth and jobs for his country, in hopes of blackmailing his way back into the presidency. After 8 months and the loss of more than 250,000 jobs, he finally gave up, but by then the foreign companies who had been using the port had been scared off. Collier quotes one company’s manager as saying “If it’s like that, then count us out. We’ll stick to Asia.”

This president’s short-sightedness and selfishness are pretty typical of what I’m seeing here on a day to day basis. These people seem determined to work against their own best interests no matter how hard anyone tries to show them another way is possible. At some point you start to wonder if it would be better to go to a country where they are interested in learning, collaborating and bettering themselves, and to come back to Madagascar when they’ve developed enough to want that, too. One of the major arguments made in The Bottom Billion is that aid to these countries is most effective when timed with movements within a country, such as just after a major conflict, when the people are looking to make changes and improvements. But of course, it’s not so easy to turn your back on a country with such obvious need while you are waiting for them to revolt.

So what’s the answer? Do we force feed the kids and hope that eventually they see the positive effects of good nutrition and want to continue it on their own? Do we throw in the towel and go somewhere where our efforts are appreciated and welcomed in hopes that with cooperation from local people we can make a bigger difference? Do we keep on walking the middle ground, making ourselves feel better by handing out PlumpyNut to malnourished children and ignoring the fact that it’s not actually reaching the children at all? I don’t feel right about the last option, although this is what the major NGOs are doing and it certainly avoids any moral dilemmas about forcing our views onto unwilling people. Of the first two, I don’t know that there is a “right” answer, but I look forward to hearing your comments and opinions.