Silver Bullets

The world is full of complex problems, few of which have simple solutions.  And yet, simple solutions are the ones we, as humans, it seems like best.  People are overweight (or think they are).  How many buy diet pills, DVDs promising dramatic weight loss in 20 minutes a day, or pay for elective surgery to change their bodies?  I don’t know the figures, but it’s lots.  While some of these approaches are expensive, they are relatively fast and they don’t require dramatic changes in habits.  The idea is that with one pill or a few minutes or a little pain, one can get the results they want without the repetitive and constant hard work that a of changing their diet or adding more exercise to their lives entails.  People prefer the silver bullet.

It’s the same paradigm in development.

People are starving.  This happens all the time, but it something we are more aware of due to the crises in the Horn of Africa where people are living in refugee camps and reliant on food distribution programs run by UNICEF, WFP or USAID.  These programs are doing what they can, but as we address the crisis, we also must think about how we got here.  What causes famine? The problem is dire, and also complex.  Hunger is caused by a lack of food, which is caused by lack.  Lack comes in many ways: land, knowledge of efficient agriculture practices, resources to purchase quality seed, availability of irrigation, access to information about pricing, policies to support trade, transportation to markets, storage…and it goes on.  The lack of food that causes mass hunger isn’t something that can be solved with a silver bullet.  But we try.

One solution that has been touted as a silver bullet to hunger recently is RUTF (ready to use therapeutic food).  This magical concoction of peanuts, milk powder, sugar, oil and micronutrients can transform a severely acute malnourished (SAM) child into one with more than a fighting chance in 6 to 8 weeks.  No doubt, it is amazing.  But, this product is not a solution to mass hunger and we need to be careful about the way it is used so that we don’t ignore the underlying problem and inadvertently cause even more problems.

Things we need to remember about RUTF:

It addresses a very specific condition: severe acute malnutrition in which a person is more than two standard deviations below the appropriate range as measured by MUAC (mid-upper arm circumference).

It is expensive: $60 for the product alone for a 2 month supply

It requires a functioning supply chain: from production to port to community, including storage facilities for heavy and bulky

It requires a community-based management program with healthcare trained and provided the resources to identify children with SAM, teach their caregivers to administer the medication at home, and follow-up with the families.

And, most important, RUTF is not food.  While it does play an important role, it is not the silver bullet to the issue of hunger.  As the wise Paul Farmer once told me, “food is the solution to hunger.”

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