Nutritionists Fill Crucial Missionary Role

by Mary Alyce Holmes

When contemplating the rapid spread of Christianity and the demand for African leadership, a dilemma arises when we consider that such a high percentage of the population is children.

Various evangelical publications are predicting that Africa, with the exception of the northern desert region, will possibly be about half Christian by the year 2000. People are reported to be coming to Christ in large numbers, new converts needing shepherds. Much of the evangelism work in Africa is being carried on by nationals. With the growing number of nations becoming independent and self-governed, there is the growing need and demand for African leadership. Mission boards are asking for more missionaries trained in various professions.

When contemplating the rapid spread of Christianity and the demand for African leadership, a dilemma arises when we consider that such a high percentage of the population is children, often more than half. Disease takes its toll, but malnutrition takes a greater toll. Low span of life expectancy decreases potential for leadership development. Decreased mental achievement, irritability, and reduced physical stamina have long been associated with even marginal cases of poor nutrition which show no outward physical signs, again reducing potential for leadership. A diet moderately low in thiamin (vitamin B,) alone in only ten days has shaven humans to become irritable, depressed, unable to concentrate, and unable to take interest in work. Within three to seven weeks there is increased loss of appetite, fatigue, weight loss, constipation, muscle cramps and other pains. Thiamin has thus been called the "morale vitamin."

Slavery to the soil for mere subsistence by the masses also reduces potential for leadership. The challenge to missions is clear: an increase in professional nutritionists to teach nutrition on a people-to-people basis, within the local culture in areas where there is sufficient food, and an increase in both agriculturalists and nutritionists, probably also entomologists and civil engineers, in areas where food and/or water are insufficient.

Governments cannot penetrate the heart and teach the sanctity of life, but Christ can. "More people are hungry and malnourished in 1979 than five years ago, reports Maurice Williams, director of the United Nations World Food Council.

Maurice also says that religious organizations form a `major part’ of voluntary efforts to help the hungry, and that distribution of food is `better handled by church groups than by government’" (World Vision, August, 1979, p.19).

The same can logically be said for nutrition education as for relief work. Surely within Christ’s kingdom lies the spiritual soil for effective nutrition education, especially when dealing with traditional tribal customs whereby the men of a family are fed first, the women second (pregnant or not), and children last. By the third round, often little nutritious food is left; yet it is the children who are most vulnerable to malnutrition.

The most glaring nutritional problem in developing countries, including Africa, is protein-calorie malnutrition, technically labeled as kwashiorkor-marasmus, which is exhibited most tragically among children. In later stages the outward signs are obvious, but it is known that in the earlier stages, there are no obvious early warning physical symptoms, except for growth failure. Many children progress undetected to the serious consequences of kwashiorkor-matasmus. The total of all causes of death among children places an estimated mortality rate, up to age four, from ten to forty times that of affluent countries. It is significant to reiterate at this point, that often in Africa, the total population is over half children Dr. Michael C. Latham, Professor of International Nutrition, Cornell University, and formerly of Tanzania, states:

Malnutrition is perhaps the most important public health problem in the developing countries. Yet the ministries of health, and before them, the colonial medical departments, have tended to regard nutrition as of second-rate importance. If in any single year an infectious disease killed one quarter of the number of people that &washiokor or marasmus kills in an average year, there would be an outcry and a campaign of unprecedented urgency (Human Nutrition in Tropical Africa, p. 4).

Dr. Latham, who received an award from President Julius Nyerere of Tanzania for his work in contribution to the improvement of nutrition services in that country, also says in the same text:

. . in much of Africa, although the spread of western ideas has increased the desire for education and for material possessions and has led to vast improvements in many spheres including health, it has done little to reduce the extent of malnutrition and in some instances it has directly created new and serious nutritional problems. In East Africa, the problem is not so much a lack of food as a lack of knowledge about food. For this reason, nutrition education in its widest context should be the spearhead of the attack on malnutrition . . . the most important nutritional work in a community consists of the prevention rather than the cure of nutritional disease (p. 2).

Traditionally, Africans have included dark green leaves in their diet. These contribute more protein and far more vitamin value than light greens. Dark greens are important in a culture where every ounce of protein counts. This is true in many inland areas. Unfortunately, foreigners, including missionaries, have been named as those who have tried to encourage people to change from the dark greens such as amaranth, pumpkin, and sesame, to lettuce and cabbage! Unfortunately, the foreigners were working against themselves and the people without realizing it.

There is a rather obscure biblical passage related to protein nutrition in Ezekiel 4:9 which seems of little significance to the theologian, but which has significant meaning for the nutritionist. God gave Ezekiel a rather unusual recipe for bread for his demonstration of coming famine: "Take thou also unto rhea wheat and barley and beans and lentils and millet and fetches, and put them in one vessel, and make rhea bread thereof." Some commentaries say Ezekiel lived on loathsome bread. The bread itself was not loathsome. It was the fuel he was directed to use for baking it which was loathsome.

It is an interesting sidelight to note that he would have to bake bread preferably every day or at least every other day to prevent mold formation, since without refrigeration, in warm temperatures, bread without preservatives easily molds within two days. He did not have calcium propionate to add as a mold inhibitor as we do today. He probably also had no effective means for keeping his ground flours from becoming "buggy," making it necessary to prepare it frequently in small amounts. (Hand preparation of grain, along with the necessity of walking several miles for water, becomes extremely time consuming in much of rural Africa and from the standpoint of time alone contributes to nutritional problems). Add to this Ezekiel’s task of gathering manure for fuel.

Assuming that Ezekiel baked the bread himself, as the passage seems to indicate, he spent considerable time in breadmaking and would not be dying continuously or even necessarily most of the day on his side, as some commentaries would indicate. The bread mixture, although scientists did not know it until this century, is an interesting combination of legumes and grains which provides high quality protein equal to meat and animal products such as milk, eggs, and cheese. In other words, it supplied Ezekiel all the essential amino acids of complete protein. The grain foods of course, would be wheat, barley, and millet. The legumes would be beans and lentils. The fitches, aromatic seeds sometimes identified with cumin, which is similar to caraway seeds, would provide a flavoring herb for the bread.

In 1907 Osborne and Mendel began research on protein metabolism in rats at the Connecticut Agricultural Experiment Station. It was not until the 1940’s and early 1950’s that certain amino acids (the building blocks of protein) were discovered to be essential to the diet of man, through the work of Rose at the Illinois Station. From his studies and those of Ruth Leverton at the Nebraska Station, dietary needs for man were worked out. Many studies were involved in simply analyzing the amino acid composition of an endless variety of foods. Thus, only since World War II, nutrition scientists have discovered that a major problem in many developing countries is protein malnutrition, coupled usually with a lack of total calories for body needs.

It was discovered that all individual animal proteins provided all the essential amino acids for normal human metabolism, but that individual plant proteins did not. However, by combining certain types of plants at the same meal, specifically grains and legumes, all the essential amino acids would be provided. It was this precise combination that God gave to Ezekiel.

It seems clear from this that God was quite interested in Ezekiel’s physical welfare during his strenuous and unusual assignment. Even though he was on a famine type diet of bread and water, the bread was a high protein type. This concern of God for the body brings to mind the cup of water in Matthew 10:42 and the body as the temple of the Holy Spirit in I Corinthians 3:16, 17 and I Corinthians 6:19. However, the Ezekiel passage singles out the technical discipline of nutrition, an infant science with a mammoth world-wide challenge.

High sugar consumption in the United States has been a concern of nutritionists for a number of years. By 1973, the average consumption of sugar was about one-half cup per person per day. Probably the two chief contributors to this consumption were candy with an annual expenditure of about two billion dollars, and soft drinks, representing an annual national consumer expenditure of over five billion dollars.

Transplant this U. S. trend to Africa, where consumption of soft drinks is increasing, with its grave problems in food and nutrition, and the matter becomes extremely serious. Infants have a natural affinity for sweets. For this reason, nutritionists recommend that mothers introduce their babies to vegetables before fruits, helping to "educate" the taste buds away from the natural tendency. For many years, it has been a common sight in the Southeastern part of the United States to see sick-looking babies sucking on bottles filled with Pepsi or Coke, catering to the "sweet tooth" even before weaning! After all, what a nice way to keep the baby quiet.

Bottle feeding has gained at least a toehold already in various parts of Africa through advertising. Yet, according to Dr. Latham, "to the top ten percent of Africans, this change to bottle feeding is not a tragedy. To the other 90 percent of Africans, the bottle feeding of an infant under 6 months of age is very close to signing the death certificate of the child" (Human Nutrition in Tropical Africa, p.18).

There are various reasons for his statement, one being the practical fact that bottle formula feeding is unsafe and unsuccessful without running water, refrigeration, and a cooking stove, which most Africans still do not have. It would be no more surprising to see African mothers turn to soft drinks for infant feeding than to see poor United States mothers do it; yet the toll nutritionally would be far more devastating.

A missionary in South Africa described particular malnutrition problems at her mission station. Everyone fell asleep in church every Sunday, regardless of who preached or how short the sermon was. This was a situation facing Ardeth Johnson, missionary nurse in KwaZulu, South Africa, as reported in TEAM Horizons, July/August, 1979. ‘ She thought, "We’re never going to have a church standing on its feet unless something can be done. How can these people learn spiritual truths if they can’t stay awake?"

As she investigated the situation, she found that the people did not eat before church and that their total consumption of food was inadequate, particularly in protein and vitamins, to meet body needs. Yet she found harvested peanuts, beans, fruit, chickens, eggs, and fish. The people simply were not eating them, or were not eating enough of them. In spite of opposition and complaints toward her initial recommendations, she continued with basic nutrition lessons at outpatient clinics and churches. She ultimately taught Africans to teach others in basic nutrition and preventive health care. Using the illustration of the house built upon the sand and the house built upon the rock from the Sermon on the Mount, she was able to make both spiritual and nutritional applications which were well received. Ultimately, she lectured to a group of 400 doctors, nurses, and matrons at a university hospital. Calls came from other hospitals and the Bantu radio station in Durban broadcast her lessons.

In regard to the results of her excellent work, some of Ardeth’s own words are significant. "We’re overworked . . , patients are coming for treatment at an earlier stage than usual . . . you have an overload of clinic patients …. But in the end, we will profit, if we can just held out."

This KwaZulu story illustrates both need and response to attempts to meet need. However, overwork by workers cannot continue forever. It is as unfair to expect doctors and nurses to be professional nutritionists as it is to effect doctors to be nurses, nurses to be doctors, or nutritionists to be either. Each field is a special technical discipline with its particular role, even though overlap exists. It is impossible to be constantly up-to-date in even one of these fields. Nutrition education in the United States historically has been carried out primarily by home economists trained in food preparation, food technology, nutrition, educational methods and techniques, and demonstration techniques. It has been done mostly through the public schools, universities and colleges, and the Cooperative Extension Service, which has a methodology well suited to missionary work.

Home economists are particularly trained to apply nutrition at the practical level in teaching-knowing how to appeal to the taste buds. Adeptness in knowing how to use food is a key factor, as illustrated by the fact that at least one African country which grows soybeans actually exports them because no one has yet shown the people a palatable, practical way to incorporate them into their diet! Nutritionists might also be attracted from among dieticians and public health nutritionists, although they seem to be in great demand even in this country.

In the developing countries, nutrition research has been carried out on food habits, needs, and nutrient content of available foods. The task ahead is to help literate and illiterate peoples to apply this knowledge to everyday life. There was a time when some mission boards did not hire doctors and nurses, but the time arrived when the need was evident. That time has arrived for nutritionists, if Africa is to develop the leadership demanded, if the African church is to "stay awake," stand, and walk, that "his truth" may go "marching on."

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