DEATH BY STARVATION: A PAINFUL WAY TO GO

One more time the resilience of the Kenyan people is being put to the test. As a people, we embrace fundraising for all manner of reasons because we believe in never leaving a brother behind.

However, in the recent past, the call to fundraise for our starving brothers and sisters in the drought-stricken Counties has been met with mixed feelings. The images of the afflicted in the press are evoking very raw emotions from all of us, ranging from sympathy, sadness, horror and anger.

The reactions on social media are as varied too. While some have gone into overdrive to mobilise all of us to fundraise for our own, others are taking a step back and asking the tough questions. There is a call for accountability by the governments, on resource allocation, accountability and disaster mitigation.

While all this is playing out in the public arena, one wonders, who is paying attention to those who have been rendered ill by way of starvation. Starvation does kill. What many of us are unaware of, is the progressive, miserable course that leads to eventual demise.

According to The World Health Organization (WHO), malnutrition is a state of cellular imbalance between the supply of nutrients and energy and the body's demand for them to ensure growth, maintenance, and specific functions.

Essentially, when one is feeding well, they have enough nutrients to run the daily requirements of the body, to replace the wear and tear of tissues, to cater for the extra energy needed for our daily activities and to continue the growth of our bodies when young.

With malnutrition being categorized into chronic (long-standing) and acute, as a developing country with huge socio-economic disparities, we are not doing too well. Chronic malnutrition, (which includes children who are stunted, wasted or underweight) in Kenya is endemic, affecting  22% to 56% of our children. The most affected age group is babies between 12 to 23 months of age. This is according to a study carried out in 1999. Unfortunately, the trend is getting worse with time.

These are children who are walking a tightrope at all times. They, together with the elderly, are the most vulnerable when we have drought. Their food security is not assured and any small catastrophe that tips the scales pushes them into life-threatening acute malnutrition.

Once acute malnutrition sets in, the body is unable to cope. For those who develop marasmus, they are regarded as having adapted to the state of nutrient deficiency. They have to dig into their body storage to maintain daily functions. They are scrawny thin, with fine sparse discoloured hair, a head that appears bigger than their body, dry skin and grossly wasted legs and arms with loose hanging skin. They are perpetually hungry, and will literally run after food.

The ones who suffer Kwashiokor probably safe a worse fate. Their bodies are completely unable to adapt to the state of deficiency. This leads to swelling of feet, skin changes with translucent thin skin that is easily bruised, listlessness and a characteristic moon face. They have absolutely no interest in food and will require a lot of patience to re-initiate normal feeding.

While most of us may only be aware of the outside changes, the physiologic changes are so profound and are the ones that cause mortality. Inadequate energy leads to inability to generate adequate body heat that results in hypothermia. The body stores for glucose are severely depleted, leading to hypoglycemia. Unfortunately, the brain uses glucose exclusively as an energy source. Low glucose results in the brain being starved hence dullness, listlessness and irritability.

The lining of the gut wears out since there is inadequate protein to repair the wear and tear. In addition, most digestive enzymes are protein-based, hence even the little food eaten is inadequately digested and leads to diarrhea. Nutrient inadequacy also means that vitamins and minerals are also inadequate. The few that are taken are inadequately absorbed due to the diarrhea, setting up a vicious cycle.

Key mineral deficiencies such as iron result in anemia, which when prolonged, will cause the heart to fail and will most certainly lead to death if there is no intervention. Lack of phosphorus will result in bone and muscle weakness and pain. Lack of zinc causes skin damage, which is obvious in kwashiorkor.

There is an overall vitamin deficiency resulting in a multitude of systems failure, from bones, nerves, blood, eyesight, gums, brain mucous membranes. The lack of protein also results in inadequate immune system function as the body cannot manufacture antibodies that protect us from disease.

Malnutrition essentially becomes a progressive multisystem failure that will eventually result in death if not arrested and reversed. Death will surely happen from infection, heart failure or other essential organ failure. It is for this reason that our interventions as a country will be deemed inadequate, if our focus is going to be restricted to providing food and water.

Food security is paramount in preventing chronic and acute malnutrition. Disaster management interventions in the face of a full-blown drought becomes extremely costly because it must also take into account the expensive medical interventions required to restore normal function. These are children who need prolonged hospital admissions to address the attendant complications while feeding them back to health.

Poverty is the sole cause of malnutrition. Our social protection measures must provide a safety net for the most vulnerable in society. It is not just about feeding programmes!