The Riddle of Malnutrition. Jennifer Tappan

period of fieldwork in 2003 and 2004, I participated in cooking demonstrations and out-patient meetings at Mwanamugimu. Mothers and guardians of rehabilitating children, who had good reason to mock my lack of skill in peeling plantains, helped me learn firsthand how to prepare a nutritious local food mixture for young children. In the group discussions with those who came to the unit on an out-patient basis, I listened as mothers and guardians expressed a wide range of concerns relating to the nutritional health of young children. One discussion, for example, concerned the gastrointestinal illnesses that appeared to come from milk that was potentially diluted with water of questionable safety. In 2012, my interviews sought to both augment the evidence gathered years before and to ask a number of questions that emerged from the intervening period of reflection and analysis. Thus specific questions replaced the photographs that I initially used to spark conversations and rekindle memories. I gave a number of my informants copies of a group photo taken during the initial years of the Mwanamugimu program, in addition to the sugar, eggs, tea, salt, and other foods that served as parting gifts. Although some took a moment to recognize themselves in an image that was over forty years old, as soon as they did, this photograph became a gift that was clearly treasured. The analysis that follows paints an image of biomedical research and public health programming in Africa that may, at first, also be difficult to recognize. In the end, I hope, it will be illuminating and valuable to those with an interest in African and global health history, and in the future of public health programming in Africa and other regions of the world.

      ACKNOWLEDGMENTS

      There are many who have made my work on the history of severe acute malnutrition possible—too many to sufficiently acknowledge here. Given the international scope of the nutritional work conducted in Uganda over nearly a century and the region’s colonial past, this project entailed multiple visits to Uganda and the United Kingdom and I owe a great deal to those who provided hospitality and assistance along the way. I am indebted to the many helpful archivists and librarians at the Ugandan National Archives; the National Archives of the UK; the Wellcome Library; the London School of Economics; the Bodleian Library of Commonwealth and African Studies at Rhodes House, Oxford; the Cadbury Research Library at the University of Birmingham; and the Rockefeller Foundation Archive Center in Tarrytown, New York. With institutional affiliation from the Makerere Institute of Social Research, I also conducted archival research in Uganda at the Albert Cook Medical Library as well as the libraries of Makerere University and Makerere’s Child Health and Development Centre, and I owe particular gratitude to Jessica Jitta for allowing me to consult the resources held at the Child Health and Development Centre, and to the exceedingly accommodating librarians at Makerere University and especially the Albert Cook Library on Mulago Hill.

      Although I collected most of the oral evidence for this study in Uganda, I was fortunate to also have an opportunity to interview a number of very generous people in England and Scotland, including Margaret Haswell, Paget Stanfield, Mike Church, and Elizabeth Bray. I will not soon forget Elizabeth Bray, the daughter of Hugh Trowell, who not only deposited, at both the Rhodes House and the Wellcome Libraries, an extensive interview she conducted with her father, but also spent an entire afternoon with me sharing her memories, as well her own work documenting her father’s life, and a reprint of his pioneering text, Kwashiorkor. In the evening following an exceptionally long interview, Stanfield and Church allowed me to photograph and record the material in several boxes, brimming with notes, reports, correspondence, music, and, importantly, images documenting their work in Uganda and Africa’s first nutrition rehabilitation program. Together with the memories that they generously shared over two full days of conversation, their personal papers allowed me to piece together the establishment and evolution of the nutrition rehabilitation program that is at the center of this study. Moreover, Stanfield has, over the years, continued to insightfully and patiently answer my many additional questions, and at times his ongoing correspondence and support have served as an inspiration to me and a reminder of the remarkable dedication to child health and wellbeing exhibited by people like Paget Stanfield and Mike Church, to whom this history must in part be dedicated.

      Oral testimony recorded in interviews with biomedical personnel in Uganda and the United Kingdom as well as conversations with elderly residents in the region surrounding the Luteete Health Center furnish the human side of what would otherwise be limited to the dry technicalities of a biomedical history. Several physicians who made time in their busy schedules to answer my tedious questions deserve special mention, including Roger Whitehead, who spent hours, just before he left Makerere to return to England, making certain that I understood the politics of protein deficiency in the post–World War II period, and the complex relationship between the British Medical Research Council and the nutrition rehabilitation program in Uganda. Drs. Philipa Musoke and Louis Mugambe Muwazi did their best to relate their memories of their fathers and predecessors, Latimer Musoke and Eria Muwazi. I am also grateful to Professor Alexander Odonga, Drs. Josephine Namboze, Chris Ndugwa, and John Kakitahi for their willingness to discuss their personal histories of their medical work in Uganda. The director and staff of Mwanamugimu not only made certain that I felt welcome, but took the time to teach me the principles and allow me to observe the nutrition rehabilitation program in its present form. Jennifer Mugisha has, since the very first day that I visited Mwanamugimu, been a welcoming friend whose ongoing work to improve nutritional health in Uganda serves as a reminder that hope for the future lies within the able hands of skilled and dedicated Ugandans.

      Among my greatest debts are those that I have incurred in the region surrounding the Luteete Health Center. It is not possible to fully acknowledge the remarkable hospitality of the many people in and around Luteete who invited me into their homes and with great patience answered my many questions. Among those who shared their memories with me, I was especially fortunate to have had the opportunity to meet and interview Florence and Wilson Kyaze, and Kasifa and Bumbakali Kyeyunne, who are no longer with us. I will never forget the many conversations that I had with Ephraim Musoke and how he embraced me when I last visited him and his wife Catherine in 2012. Nabanja Kololi, my “Mama Mukono,” and her daughter Caroline Nalubega, like many of the women in and around Luteete, will serve as an inspiration for years to come. Nor would these interviews have been possible without the guidance and translation services provided by the medical officer in charge of the Luteete Health Center, Jackson Ssennoga, a local teacher, Jemba Enock Kalema, and Hajjarah Nambwayo. Hajjarah’s mother, Fatuma, whose laughter and friendship will be missed until I am, one day, able to return, and Jackson’s wife, Sarah, will always remain dear friends. Finally I must also thank the primary midwife at the Luteete Health Centre, Susan, and the Community Health Worker, Stephen Maseruka Mulindwa or “Ssalongo,” for their seemingly infinite hospitality and kindness.

      The financial support that has made this project possible includes several traveling fellowships awarded by Columbia and Portland State University. I also received support during the initial writing process from Columbia University’s Institute for Social and Economic Research and Policy, now known as the Interdisciplinary Center for Innovative Theory and Empirics (INCITE). Finally, an American Council of Learned Societies/Social Science Research Council/National Endowment for the Humanities (ACLS/SSRC/NEH) International Area Studies Fellowship provided the support needed take a leave from my teaching responsibilities in order to analyze additional evidence and thereby significantly revise and extend the project. I am also grateful to the Friends of History at Portland State University for their support, specifically in the production of the map situating Uganda, Buganda, and Luteete. Although the flaws are clearly my own, my work has also been significantly influenced by conversations with and encouragement from Marcia Wright, Greg Mann, Nancy Leys Stepan, Tamara Giles-Vernick, Holly Hanson, Sheryl McCurdy, Carol Summers, Neil Kodesh, Rhiannon Stephens, Barbara Cooper, Cynthia Brantley, Alicia Decker, Brandon County, Wendy Urban-Mead, Mari Webel, and especially in recent years, Melissa Graboyes, among many others. I have had the distinct honor of recently working with many insightful and generous students who have all influenced my thinking, but Cathy Valentine, Emily Kamm, and Jessica Gaudette-Reed deserve special mention. Over the years, my work has also been significantly influenced by one of the most generous scholars that I have been fortunate enough to meet, and I doubt that Jim Webb will ever fully realize the extent to which this and my future scholarship are indebted to him and his support.

      The greatest sacrifices