Wednesday, July 6, 2011

Nigerian nutrition.

Food has probably been the most challenging aspect of living in Nigeria. It is not a matter of taste – I find the dishes to be plenty flavorful (albeit spicy) – it is a gross imbalance of nutrition.

The typical diet in Nigeria (by caloric intake) is probably something like 50% starch, 30% oil fat, 10% meat, 10% vegetables. Not sure if you’ve ever experienced this kind of diet, but for your sake I hope you don’t. It seriously messes your stomach up. There is palm oil in EVERYTHING they cook; even ramen noodles will be drenched in it.

A classic dish is boiled yam with a palm oil/vegetable sauce. That’s it. Or, fried yam or potatoes with a sauce of palm oil and some tomato paste. Sounds like a nice filling meal, right? Eat that for two weeks straight and you really begin to crave meat and vegetables.

The other interns have stepped up to take nutrition into their own hands. We now order larger quantities of vegetables and fruits at the start of the week (Sunday). They last until about Wednesday, after which spoilage becomes a serious problem. Most of the time, we cook them as an auxiliary dish to whatever our chef has prepared for dinner.

Julia (the doctor) and Sarah (the landscape architect) have been particularly amazing about cooking for the group. They are the most nutritionally conscious and capable in the kitchen. There have been attempts to transfer knowledge about proper meal portions to our chef, Mercy, but change has been slow; vegetable-filled, nutrient-rich meals remain under the sole purview of our kind intern cooks.

These efforts have improved the situation dramatically. Energy levels are generally higher and people have stopped whimpering every time another meal is served. Virtually all the spice has been cut; some of the folks have sensitive stomachs and were dealing with diarrhea on a daily basis. Apart from the bout of food poisoning a couple weeks back, our intestinal health has regained much strength.

Still, we lack protein, especially those of us doing the Insanity workout every day. The workout guide suggests 250g of daily protein intake to keep apace with the extreme demands from the workout. I would guess that we get 100g tops, more likely 50g, per day. (Addition of rice+beans twice a week for lunch was a big step in the right direction.) This deficiency is not a huge deal, as I will survive without a massive protein intake, but it’s immensely frustrating because it wastes a lot of the effort from my workouts. Without protein, the body breaks down muscle – essentially reversing the work I am doing.

A few of us, most notably Eric and I, have been more proactive about securing protein sources. I now augment my diet with a steady supply of peanut butter, yogurt (spelled “Yoghurt”), semolina noodles, and Tummy-Tummy (i.e. ramen). The first two sources, however, are less than ideal; both are heavy in fat and sweetened with sugar. The ramen is, well, ramen, and comes with refined palm oil, so there you go. Also, remember that I mentioned that Mercy adds oil to the ramen? Yeah: refined palm oil ramen noodles with a fresh coating of palm oil. Delicious. And by delicious, I mean more likely to cause cardiac arrest than a McDonald’s meal.

Still, it’s better than nothing, so I deal. We are planning to grind our own peanuts to make a natural peanut butter sans sugar, but that will be for everyone to share (read: not a steady and abundant supply). Oatmeal has also become a favorite post-workout meal, though we have incidentally run out early for this week. The last two days have been particularly low energy, but hopefully I will see a comeback soon.

I also missed the last two days of Insanity, which is personally disappointing. Finding a new time for Insanity is part of the problem. They now turn the power off 4-7pm each day. I normally would do it at 6pm, an hour before our 7pm dinner, but it’s even harder to do Insanity without a fan to provide some ventilation.

Personal challenges aside, the nutrition profile of a typical Nigerian meal informs the health problems faced by locals. We have seen numerous cases of malnutrition in the neighboring villages. Children walk around with bellies bloated from ascites. This condition came as a surprise to me. In my mind, I expected everyone to look like skin-and-bones, a la any typical picture of starvation…

Time for a lesson in human health!

Unlike marasmus, or calorie deficiency, which makes a person look emaciated, “kwashiorkor” is a protein and micronutrient deficiency faced by many impoverished areas. As a side note, kwashiorkor is a Ghanaian word literally describing the devil that inhabits the belly of an older sibling when a new child is born. This colloquial juju story explains a real trend among older siblings to no longer receive proper nutrition by drinking the mother’s milk.

Thanks to Dr. Julia for that insightful lesson.

Proper nutrition is still poorly understood by the majority of Nigerians in Anam. One can find signs of improvement. Dispensaries and chemists sell supplements such as zinc and folate. Health clinics are aware of the problem and presumably diagnose it accurately. Most of these efforts are reactive, however – as in, a person is likely to learn about nutrition only when their body shuts down. One of Julia’s goal through the health clinic in Anam City is to provide an educational program about proper eating habits.

It’s a complex challenge, as food is closely tied to emotion, culture, and family. A foreigner can’t just come in and tell everyone they’ve been eating wrong all this time. Disseminating knowledge will require tact and finesse. Traditional meals and behaviors must be acknowledged and appreciated while people are directed to a more balanced diet. Buying and growing habits will need to shift; supply eventually dissipates without demand, so one rarely sees leafy green vegetables at the market. Julia has some innovative ideas about community engagement to develop awareness. Best of luck to her in setting the program in motion.

In the meantime, I will continue to dream of pad prik khing with chicken. Or a spinach salad with pinto beans, tomato, and cheese. Or…

1 comment:

Amber said...

The last paragraph reminded me of a story I read somewhere, about the difficulties of getting an African community to embrace better nutrition. (I believe there was a high fatality rate of children due to malnutrition.) They found a solution that worked: they got all the women of the village together, and essentially recruited them to help solve the problem of bad nutrition. The women went out and assessed the health of all the kids in the community, and they found mostly unhealthy ones...but there were a few healthy ones. So then the women examined what those families were doing differently, and found that those families were cooking in some subtly different ways that increased the nutritional value of the food. So then the women started adopting those cooking techniques themselves, and the malnutrition situation improved dramatically. I'm sure there was guidance/nudging from the scientists, but since the locals were instrumental in finding the problem & solution, they were very invested in actually implementing the findings.