It’s Summer 1972. I’ve just finished college and I’m spending the summer in Haiti. When I finally reach l’Hôpital le Bon Samaritain after an 8-hour journey in a rickety camion, I know nothing about malnutrition. One month later, seeing toddlers with oddly red hair, cracked skin, and swollen limbs no longer shocks me. Nor am I shocked that some of them never return home.
Malnutrition, an age-old killer and accomplice in the deaths of impoverished children, is my first introduction to tropical medicine.
Seven years later, I attend the London School of Tropical Medicine and Hygiene and take a deeper dive into malnutrition’s history, physiology, and perilous synergy with infectious diseases. Nonetheless, my fellow students and I are still “looking through a glass darkly.”
Then come science and strategies that fuel hope. When experts in the 1980s and 1990s champion micronutrients plus diverse, balanced diets; WHO’s initial package of Expanded Programme on Immunization vaccines; and oral rehydration for childhood diarrhea, child survival rises. Over time, re-feeding regimens meant to rescue children from death are replaced by ready-to-use therapeutic foods, which often forestall it.
Today, global experts also parse proximate causes of malnutrition from colonialism to climate to monoculture, as well as lifelong consequences such as stunting.1 Plus, they have a better handle on burden. Sadly, in 2020, we backslid. During the first year of the COVID-19 pandemic, the United Nations estimates roughly 150 million children under 5 were stunted, 45 million were wasted,2 and more than 800 million people were hungry. A year later, as the WHO Director for Nutrition and Food recently told The Lancet, global food insecurity had continued to grow and worsen malnutrition. So is the glass half empty or half full? And how should a public-facing author weigh discouraging facts against the past three decades’ otherwise quiet-but-steady progress?
In Within Our Grasp—Childhood Malnutrition Worldwide and the Revolution to End It, Sharman Apt Russell weaves modern nutritional science with interviews and blueprints for hope. Looking back, what especially inspires hope are stories of people determined to fight malnutrition, like those who developed the nutrient-rich paste Plumpy’Nut (in Malawi, it is called Chiponde). Does Russell’s book also carry a whiff of cultural tourism? Yes. But, to me, this was far outweighed by the book’s sincere and illuminating conversations with newly empowered farmers, organizers, and teachers (almost all of them women) during the author’s 2016 field trip to Malawi.
“Russell’s passion for citizen science and her jargon-free presentation of information relating to malnutrition will open worlds for most readers, from high school students to sociologists” is how Library Journal describes Within Our Grasp, and that’s just one of many glowing blurbs on Amazon. A professor emeritus in humanities at Western New Mexico University and associate faculty at Antioch University, Russell previously authored Diary of a Citizen Scientist (winner of the 2016 John Burroughs Medal), Knocking on Heaven’s Door (winner of the Arizona/New Mexico Book Award), Teresa of the New World (winner of the Arizona Authors Association Award), and (with funding from the Rockefeller Foundation) Hunger: An Unnatural History.
In short, Within Our Grasp is an excellent book to recommend to undergrads majoring in global development, students of medicine and public health, and post-graduate trainees embarking on overseas rotations in low- and middle-income countries. Or anyone else, for that matter, who wants to explore modern solutions to the age-old problems of hunger and survival of the weakest.
After finishing Within Our Grasp, I turned to three American Society of Tropical Medicine and Hygiene colleagues for further perspective. For 35 years, Dr. Terrie Taylor has done malaria research in Malawi, where Russell did her grassroots reporting. Dr. Natasha Hochberg currently studies the nexus of undernutrition and tuberculosis in India. Dr. David Hamer’s work is largely focused on implementation research designed to advance maternal, newborn, and child health in real-life settings in low- and middle-income countries.
Russell SA, 2021. Within Our Grasp—Childhood Malnutrition Worldwide and the Revolution Taking Place to End It. New York, NY: Pantheon.
Bhargava A, Pal M, Bhargava M, Marais BJ, Menzies D, 2012. Can social interventions prevent tuberculosis? The Papworth Experiment (1918–1943) revisited. Amer J Respir Crit Care Med 186: 442–449.
Hoyt KJ et al., 2019. Effect of malnutrition on radiographic findings and mycobacterial burden in pulmonary tuberculosis. PLoS One 14: e0214011.
Sinha P et al., 2021. Nutritional supplementation would be cost-effective for reducing tuberculosis incidence and mortality in India: the Ration Optimization to Impede Tuberculosis (ROTI-TB) model. Clin Infect Dis, doi: 10.1093.
Sinha P, Lonnroth K, Bhargava A, Heyseli SK, Sarkar S, Salgame P, Rudgard W, Boccia D, Van Aartsen D, Hochberg NS, 2021. Food for thought: addressing undernutrition to end TB. Lancet Infect Dis 21: e318–e325.
Hamer D, 2021. Short-term and potentially long-term negative impacts of COVID-19 in sub-Saharan Africa: evidence from the Africa Research, Implementation Science, and Education Network Rapid Monitoring Survey. Am J Trop Med Hyg 105: 269–270.
Rockers PC, Zanolini A, Banda B, Chipili MM, Hughes RC, Hamer DH, Fink G, 2018. Two-year impact of community-based health screening and parenting groups on child development in Zambia: follow-up to a cluster-randomized controlled trial. PLoS Med 15: e1002555.
Semrau KEA et al., 2016. Effectiveness of 4% chlorhexidine umbilical cord care on neonatal mortality in Southern Province, Zambia: a cluster randomised controlled trial. Lancet Global Health 4: e827–e836.