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Text File | 1993-04-08 | 6KB | 124 lines

                                                                                COVER STORIES, Page 36

OPERATION RESTORE HOPE

It Takes More Than Food to Cure Starvation


The biology of malnutrition makes rehabilitation difficult,
and for children it often means lasting scars

By MICHAEL D. LEMONICK - With reporting by Farah Nayeri/Paris
and Dick Thompson/Washington


    An alarming sight greeted American health officials
visiting the town of Hoddur in Somalia. Relief workers had
distributed unmilled wheat to starving villagers, and scores of
living skeletons were pounding the wheat by hand in order to
make an edible mush. To the casual witness, the rhythmic thuds
might have seemed the music of deliverance, but to those
familiar with the grim calculus of starvation, they formed a
dirge. The energy expended in grinding the wheat vastly exceeded
the nutritional benefit of the mush. Relief supplies were
killing the starving.

    The tale underscores the difficulties of helping people
who are dangerously malnourished. Starvation is a complex
biological process; the more advanced it is, the dicier the
treatment. During the famine in Somalia, perhaps the worst ever
recorded, average food intake for adults has dwindled from a
satisfactory 1,700 calories a day in 1988 to a hopelessly
inadequate 200. A majority of children under the age of five
have already died in some regions. "The mortality is higher than
that of the Irish potato famine," says Daniel Miller of the U.S.
Centers for Disease Control and Prevention. "It's the worst
nightmare you could think of."

    Children are affected more severely than adults by famine.
The reasons are tied to the biochemistry of starvation, which
has been documented both in the fields of human tragedy and in
labs with fasting volunteers. In essence, the starving body
consumes itself, devouring its own fat and muscle while shutting
off less important systems to keep the brain and the rest of
the central nervous system operating. Children simply have less
fat and muscle to consume.

    The first, mild stage of starvation begins within hours
after food intake stops. The body quickly burns through its
reserves of sugars in the blood and starches stored in the liver
and muscles. It then begins raiding fat deposits for
triglycerides, compounds that can be broken down into fatty
acids that the body can use for fuel. After days or weeks,
depending on how meager the rations, these raids result in a
condition known as marasmus. Without fat to support it, the skin
begins to lose elasticity and sag. Loss of fat around the eyes
gives them a sunken look, and the face starts to wrinkle in what
starvation experts call the old-man syndrome. The other
principal form of starvation, kwashiorkor, is largely a
protein-vitamin-mineral deficiency. Its most common symptom:
swollen legs and ankles, caused by fluid leaking from blood
vessels into the body.

    If people could survive on stored fat alone, those who are
well padded could survive quite some time. But human metabolism
is not so simple. The brain, consumer of about 20% of the
body's energy, cannot burn fatty acids. It needs glucose, a form
of sugar. And the major source of glucose in a starving body is
protein. The first proteins to go are digestive enzymes in the
stomach, pancreas and small intestine and nutrient-processing
enzymes in the liver, no longer of much use anyway. Then the
muscles begin to wither away, giving limbs a sticklike
appearance.

    As starvation advances, the body tries to conserve energy
by limiting all but the most vital processes. Cell division
slows drasti cally. Even hair stops growing. Reduced fuel
burning drives body temperature down; that, combined with the
loss of insu lating fat, can lead to death from hypothermia --
a threat on a cool Somalian evening. The shutting down of the
intestines can lead to the paradox of death by diarrhea. Reduced
production of white blood cells weakens the immune system, a
kind of starvation-induced AIDS that turns diseases like measles
into killers. Eventually the body begins burning muscle tissue
wholesale: victims become too weak even to move, and the heart
muscle begins to shrink. By then death is almost inevitable.

    Because starving bodies are so severely disrupted, it
takes more than good meals to restore them. In fact, too much
food too suddenly can kill victims by triggering shock. The
process of refeeding, which in Somalia will take place mainly
in huge feeding camps, usually starts with fluids to counter
dehydration. Then comes a high-calorie, high-protein mixture
such as the U.S. government's Unimix, made of ground beans,
ground rice or corn, sugar and vegetable oil. This is given in
frequent, small meals so that the out-of-practice digestive
tract can handle it. Severely malnourished children may require
hourly feedings. "They are hard to rehabilitate because they are
lethargic and lose their appetite. They turn their head when
spoon-fed," says Dr. Graeme Clugston, chief of the World Health
Organization's nutrition program.

    Within weeks after refeeding begins, even those adults who
were on the verge of death will have largely recovered. But
children, especially those under five, can carry the scars for
life. They can go blind from lack of vitamin A. They may never
achieve their full height. Girls may never be able to safely
bear children because of malformed pelvises. And mental function
is often impaired. "Even when they are fed and back on their
feet, you'll have a generation of kids with a considerable
degree of retardation," says Michael D'Adamo of Catholic Relief
Services.

    The feeding camps will operate until the Somalis regain
enough strength to start producing their own food again. Herds
of cows, goats and camels and stores of seeds, all long since
eaten, will have to be replaced. After that, Somalia has a
chance to be self-sufficient once again -- as long as social and
political stability are restored.