Ho Chi Minh City, This month Geoffrey Cannon writes his second column on causality. This prompts me also to reflect on why we do what we do, and what it is that makes us who we are. Yes, such a philosophical journey does help us to explain why we are in public health nutrition, and also why, in our profession, we become attached to specific beliefs traceable to where we have come from. As a physician and a practitioner in the field, I am well aware that our work has a technical basis. But the practice of architecture is more than the study of the mechanics of steel and concrete. True professionals think about the meaning of what they do. So should we.
To start with, who are we? I illustrate this thought by taking my own case. I do this here, through the eyes and the writing of three of the authors who are my heroes this month. As you see above, they are looking you in the eye although, in reality, they were looking at the lens of a machine. But then again... They are all novelists who have had plenty to write about – in ways that should affect us. So I think. You be the judge. From left to right, above, they are Peter Høeg (1957- ) from Denmark, who is or has been also a sailor, a ballet dancer, and a fencer. Also, Nadine Gordimer (1922 - ) the Nobel Literature laureate from South Africa, and Isabel Allende (1942 - ), originally from Chile where I also come from, who have been deeply engaged in the politics of their countries.
The three passages below are my own extraction and paraphrasing as I was inspired by passages of their writing. As I write this, I realise that they, among other people plus other influences, have shaped who I am. In this sense they are some of the 'causes of me' as I am. As I embrace them, I am being shaped by them.
I invite you to undertake the same exercise. Choose three of the writers who mean most to you, and by study of them, see how much what you believe now comes from them. Write about this, perhaps in the way that I do here, and I will see to it that what you write is published, either within this column, or elsewhere on our website.
Words no longer make much of an impression on many of us. You can take what follows any way you please: as a cri du coeur, as a lament, or as an ode to hope. I look at it as a type of guide that we can all use to come closer to the truth about who we are and what we do.
I admit to a faint feeling of anger. Something is telling me that we need to get to the bottom of all this, to the most intimate hopes and fears of what we do in our vocation and also for a living. In what I read in our discipline there are so many numbers and so few values.
Thoughts like those expressed here occasionally keep me from sleeping. But they make my insomnia meaningful. The citations below are of the books on my shelves; there are plenty of other editions.
On nutrition, the real world, power games,
and the ugly faces of greed
This is inspired, extracted and paraphrased from
Peter Høeg's short story 'Reflections of a young man in balance' (1)
Our work reflects our state of mind. And in that state of mind, those changes we call advances or leaps forward, too often hold only little relevance. Being outsiders to a grim reality, there is often little we say or do that is not, or does not become, stale phrases, a drop in the bucket, or worse, merely clichés.
We tend to see nutrition problems as if they are a series of reflections in mirrors of our own image. But the reflections are actually false. They help us to hide. Yes, we can be justly accused of that. As champions of partial truths, we construct these mirrors on which we project nutrition problems as we would like them to be. So, are these reflections in them dreams? They are based on speculations? – 'speculum' means 'mirror'. Partial truths tend to the two-dimensional.
Do partial truths lead us to visions and reflections that remain mostly unaffected by what we do to address them? What we do represents a half-conscious attempt to realise our hopes and also to allay our fears. The mirror registers our hopes; it gives us a glimpse of an undeniable misapprehension.
We know so little about the real determinants of what we face and what we seek to improve. Are we really taking the right and crucial steps along the path that will alter the world for the better? People ask us to show results. We think we do deliver them. Well, these are results of a kind that often end with the self-serving statement that more research is needed. Is it really? Are we not often merely progressing our curriculum vitae and entertaining people with descriptions of how difficult it is to make any change, or do anything substantial?
Then, on occasions, we get more serious. We look into our mirror and see what we need to see. Or is this what we fear to see? The mirror of nutrition problems that showed things as they really are, would show misery, suffering, anguish, and the so few joys of the malnourished. As we witness or read about hunger, do we dwell on these images, or do we press fast forward and skip them?
Sometimes, I am asked why I engage in the daily ordeal and the political chicanery that public health nutrition involves. Perhaps you are, too. Perhaps the most honest response is that we just have to keep trying. If anyone questioned me further I would want to say that I choose not to say more.
It long dawned on me that I am a player in a power game that we must win. Anything else is a defeat – not necessarily our defeat, but certainly that of those we are supposed to be helping. When I am invited to work with impoverished communities, as I recently did in Kinshasa in the Democratic Republic of the Congo, I think about these things constantly. I never learned to kill my conscience, which is the first step of being conscious.
Maybe what we see in the nutrition mirror has nothing to do with the actual awful reality. The real world may not be in it. Some of the 'facts' we base our actions on, may have been formed in the mirror as it reflects us. What we fear, the mirror will reflect.
This is a dilemma with which we will always be faced: As different as they may be, the reality you see and the reality that I see, is what makes us what we are, and then what we do. (This is why Geoffrey Cannon's two columns are so important).
The question is, how much each of us is passively subject to a false or partial reality, and how that actively shapes what we do. But this question may be wrongly posed. As soon as we perceive the world, it changes, and so we change too.
The history of public health nutrition – even before its invention as such – is a history of boundless faith in the Western will and power. It is to me undeniable that modern nutrition, as a science applied to poor populations, in part arose as a tool of the dominant powers who were/are afraid of the rebellion of the hungry many. I perceive this in its appalling limitations. So, I have become a harsh critic. I had no choice, it was either that, or forget the whole thing.
The process that leads towards reality comes in stages, like the steps on a staircase. We need to see in the mirror images of the world in flux, activated by ideas, reason, and by hard facts that take into account the ugly faces of greed. We need to envision a world that does not exist yet, a world that recognises human beings as infinitely alike and infinitely diverse, a world we need to steer to a so much fairer humanity.
Getting closer to reality brings liberation. But perceiving what is real does not mean immediately making sense of a situation. It can mean surrendering to a profound transformation in us. Getting closer to reality helps us to discriminate between different types of colleagues. In our profession we are a guild of profoundly different characters.
Who is right in what they are looking for? We can judge. The systems that have been informing the world about the 'truth' in nutrition may have been diagnosing the situation correctly. But has this led to the right solutions? We all know the answer to this question.
All of us have had inspired moments, in which we had a glimpse of reality and also acted appropriately. But such insight and inspiration gets forgotten, erased by fear, apathy and bias.
Now I know the source of my anger. But I am only human. That is the problem. We humans are frail, we forget, we betray, we devalue, we are subject to moral and intellectual inflation.
If only I could remember how it felt to be modest and in command of situations which I was in! But forgetfulness is eroding my effectiveness, and that of my colleagues, as I see them. We are omitting so much of what is crucial in nutrition.
I write this with an increasing sense of awe. What is happening to our stale phrases? May our cynicism fade, our mirrors shatter?
- Høeg P. Reflections of a young man in balance. In: Tales of the Night. London: Panther, 1998.
On morality, freedom, choices, justice,
and the need for people's power
This is inspired, extracted and paraphrased from
Nadine Gordimer's novel A Sport of Nature (1)
I am not lonely. But in my darkest hours, I feel I am alone.
Living without a cause is living without a reason to be.
Those of us who have choices must have morals.
How often are we caught in the thought that we know what is right, even if we do not muster the courage to do it? Many of us spend our professional lives in the midst of inequities. We behave as decently as we suppose we can – in the circumstances. We can spend our lives on our front porches and never be of real use to anyone, especially if we uncritically listen to all the half-truths and foolishness floating around about nutrition, development, justice, human rights and equity.
We can indeed choose to continue to live on 'innocence and ice-cream'. But this would be unethical, simply because we have choices.
We cannot just be grounded on remembering or imagining how good it used to be. We need to create a new style of leadership (more and more based on the inalienable principles of human rights). We need to be taken out of the ranks of 'useful onlookers' and become grassroots protagonists. We say we have been preparing for change. That is alright. But have we really worked for change that is really meaningful to those we say we serve?
The much-invoked freedoms of assembly, of speech, and of the press are not the only ones that count. Freedom is divisible. Most of us want life for impoverished people to be better. That is a freedom too! I still prefer the way freedom is divided in countries in the global South over the way it is divided in the great riches of the countries of the global North.
Some choose to fight through charity (or God). This comes about, in part because we do not know why we are in this world, and religions tell us why. Others decide to go fight with the people, and not through God, who too often changes sides.
Donors send Plumpy'nut® to change the world. In the meantime, some get power. The important thing is to be on the side that gets the power. You will never come to power on Plumpy'nut®. You have to be in power to be able to feed people living in chronic food insecurity.
The privileged stay in power through their money. For them it is not justice and reason that count, but their power. Justice is high-minded and relative. The prevailing system can give the people justice or withhold it. But they have to find out how to become empowered by themselves, through circumstances that arise from the actual conditions of their lives. This is why textbook revolutions fail.
So what is our role?
We need to support and act for social justice. We can ignore what is happening now. But we can never get away from our moral responsibility. We need to be fully engaged with the world as it actually is, based on a concrete historical past. Then, there is no need for too much reflection. The past then prepares us for action.
- Gordimer N. A Sport of Nature. New York: Penguin, 1988.
On good manners, hidden fears, serving the needy,
and the persistence of disillusions
This is inspired, extracted and paraphrased from
Isabel Allende's novel The Daughter of Fortune (1)
Some of us have for too long lived surrounded by four walls, in an immutable environment, where time rolls in circles and the line of the horizon where we are heading to in our work is barely perceptible. We have grown up professionally inside armours of good manners and conventionality.
We have been trained to please and serve, and ended up limited by our own routines, the prevailing social norms and our hidden fears. For too long, fear has been our companion. So many fears! Fear of authority and of what people will say, fear of the unknown and of what is different, fear of the unpredictability of social justice, fear of leaving the protected cocoon and facing the dangers of the real world out there, fear of our own fragility and of the ultimate truth, fear of fear itself.
Our truth has been a sweetened-up truth, made of omissions, courteous silences, well kept secrets, order and discipline. While masses of the poor share the same space and time with us, yet it is as if they did not exist for us. And under such circumstances, our aspiration has really been more to achieve virtuosity and academic standing. But now we are beginning to doubt the significance of these words.
As this doubt assaults some of us, we are waking up. We do not know in what turn of the road travelled we lost the person we used to be. Looking back, we are not sure anymore which of the causes we championed were meaningful, which we won and which we lost. If we made some mistakes and had uncertainties and fears about the future, we feel we have paid dearly for them already.
Do you feel new wings growing on your shoulders? That you can fly like a condor and are suddenly empowered? A new righteous arrogance, allowing us to make meaningful decisions in our professional lives, is overtaking us in public health nutrition. We are willing to pay the consequences. We feel we do not owe an explanation to anyone for these changes.
A seldom before felt sense of optimism and commitment invades some of us. We have lost that sensation of multiple fears always sitting in the mouth of our stomachs. Our fears have melted as we lose our fear of fear. We now find new strengths as we face new yet old risks. We are finding new forces within ourselves that we always had, but did not know we had, because we had never used them. We are ready to join the growing number of explorer-doers seeking new ways out to the problems of the world. We feel pride as women and men who are reinventing equity. Is this starting to emerge in our Association? There are indeed some signs…
Some of us are starting to walk victorious. Others still carry disillusions, mostly having early defeats and lasting wounds and scars to show. But we have finally realised we own our destinies, our future and our own irrevocable newly acquired professional dignity. We finally understand talk about liberation, about the right to nutrition, about empowerment and about freedom from want in new ways, and we yearn to discuss with others what we see and feel about each of them.
We can now live each day without necessarily making plans of no lasting meaning or value. We feel we have a blank sheet in front of us where we can write our new plans and, in the process, become whoever we want to become, without anybody judging our past. In short, we can be reborn.
Thomas Henry Huxley said: 'Irrationally held truths may be more harmful than reasoned errors'
- Allende I. The Daughter of Fortune. Barcelona: Plaza y Janes Editores, 1999
Acknowledgement and request
Conflicting or competing interests: I am a member of the Council of the People's Health Movement. I do not regard this as a competing interest. This commentary has been reviewed by Geoffrey Cannon.
Readers may make use of the material in this commentary if acknowledgement is given to the Association, and WN is cited. Please cite as: Schuftan C. On nutrition, the real world, power games, and the ugly faces of greed, and other items. [Column]. Website of the World Public Health Nutrition Association, October 2012. Obtainable at www.wphna.org
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