The Barefoot Technologists

by Raj Patel, TEDMED 2015 speaker and guest contributor

Anita carries with Christopher_Fotor

Interviewer: “Have you ever done anything to help your family have enough food or to make food last a long time?”
Child: “Yes.”
Interviewer:“What do you do?”
Child: “I normally don’t eat it that much.” (Source: Fram et al 2011:1117)

It was a hard country. Amid abundant mineral resources and great natural beauty, some of the nation’s poorest women skipped meals so that their children could have enough to eat. The kids were no slouches. They knew what was happening. In a heartbreaking turn, the children skimped on food too. So that there’d be more left for their families. So that they wouldn’t be reduced to begging from their neighbors.

Luckily, I was leaving this country for one filled with entrepreneurs and technologists who’d cracked the problem of hunger.

Luckily, I was leaving the United States for Malawi.

It may seem jaundiced to compare the lot of women in the world’s poorest country with one of the world’s richest. Few would argue that Malawi has ended hunger. Four in ten children there suffer “stunting” – a deprivation of nutrients in the first 1000 days of life that breaks bodies for a lifetime.

Yet it’s true that, when faced with the choice of feeding themselves or their children, mothers around the world skip meals so that their kids don’t go hungry. In the United States, one in seven people struggle with hunger, and in some of those families, mothers skip meals for their kids. It’s true in the United States, and it’s true in Malawi. It’s hard to hear that what we think as third world problems are first world ones too.

The other thing that’s true: people who face hunger can be incredibly smart about solving it. The American child interviewed at the top of this story did what anyone would do for someone they loved. Given their constraints, they shouldered a burden to make it easier for the ones they care about. What I learned from some parents in Malawi is that great technology can, and should, change those constraints.

In Malawi, one of the constraints is that there’s not enough dietary diversity. If breakfast, lunch and dinner is some variation of corn, bodies can break. To solve this, the Soils Food and Healthy Communities Project in Malawi used ideas that are both cutting-edge, and very old: a peer-to-peer network of research and experimentation to find the best crops for human and soil health, the best planting patterns, and the best farming techniques, to get more from the land.

Once they broke through that constraint, they confronted a far deeper one. The new farming practices require more harvest work. Women want to harvest because then they control the crop, and control who it gets sold to. But women also cook, clean, fetch water and firewood – work that is fundamental to rural households in Malawi.

You can watch my TEDMED talk to find out how the farmer research teams broke through this constraint, in spectacular style. What matters more, though, is how they found and addressed the problem. Those of us with access to lab coats can proudly point to years of scientific training, but one of the hardest-won skills – one that my students find hardest to do – is peer review.

Malawian farmers do it better than doctoral students. They run trials, compare findings, confront each other in meeting after meeting and argue, because unlike for academics, this isn’t academic. The results matter. There are plenty of strong personalities at the Soils, Food and Healthy Communities project, but no-one knows who exactly came up with their eventual solution to the problem of hunger. It emerged through a series of meetings, as an exercise in collective technological innovation. Attribution matters less than results, because the stakes are so high.

anita's proteges make sweet potato donuts_Fotor

That’s the great gift of grassroots technologists like those in Malawi. They’ve developed networks of problem-solving skills that have gone on to address other constraints, like limits to grain storage facilities, lack of access to banks, and even climate change. (A women’s collective has emerged to make stoves that use considerably less wood than in an open fire – and the stoves are  called “Climate Change stoves”.) Whether in the US, Malawi, or anywhere else, these ideas can help the world feed itself. Of course, it’s important not to be starry eyed – there are many reasons why things work well here, from an absence of interference by large corporations, to state neglect, a benign village headman and some terrific activism from local leaders.

Yet the lessons remain clear. Too often, experts in white coats won’t believe that people without shoes can develop technology. But if I’ve learned anything from working with farmers in Malawi, it’s that a little humility, ingenuity and a great deal of local science can stop mothers, and children, from ever skipping a meal again.

What is Culinary Medicine? Q&A with John La Puma

Nutrition specialist, chef, author, and practicing physician John La Puma lives and works on an organic farm in California. He makes his garbanzo guacamole recipe on the TEDMED stage while sharing his philosophy that the food we eat is as important as the pills we take, a key component of preventive health and our well being.  On the TEDMED Blog, John elaborates on culinary medicine and what role patients may have taking charge of their health and even educating their physicians about how to consider nutrition as part of the treatment plan.

John La Puma on culinary medicine
“Food is the most important healthcare intervention we have against chronic disease.” John La Puma, TEDMED 2014. Photo: Jerod Harris for TEDMED.

Why does this talk matter now?

Patients who ask their doctors, “What should I eat for my condition?” really want answers. Meanwhile, clinicians are clamoring for more and better information and training on nutrition. Culinary medicine is a new evidence-based field in medicine that blends the art of food and cooking with the science of medicine to yield high-quality meals and beverages which aim to improve the patient’s condition. It is already being taught in both undergraduate and postgraduate medical education.

What impact do you hope the talk will have?

I hope that the talk will help accelerate the cultural shift in healthcare towards wellness and well-being as primary goals in medicine. People need to know that some physicians care deeply about helping them become well with what they eat.

What is the legacy you want to leave?

Our mission is to inspire health-conscious consumers to look, feel and actually be measurably healthier by what they eat. The opportunity to use culinary medicine to prevent and treat disease is substantial, and culinary medicine should be considered as part of both the medical history and treatment plan in medicine.

How would medicine change if your ideas become reality?

All clinicians should be able to write culinary medicine prescriptions and know how food, like medicine, works in the body. I’d like to see condition-specific food and lifestyle measures become something that clinicians can offer, effectively, before prescription medication for most chronic conditions.

What is your core belief about culinary medicine?

Everyone has a right to clean, healthful, delicious, real food that both satisfies their appetite and makes or keeps them well…before it may be too late to offer more than comfort food.

Please share anything else you wish you could have included in your talk.

70% of heart disease, stroke, diabetes, memory loss, premature wrinkling and impotence are preventable. 80% of cancers and much of asthma and lung disease are preventable, and from environmental causes, like toxin exposure or diet.*  Knowing more about what’s in your food and how it got there can help you take your own health into your own hands, save you money and provide joy and energy for those you love. With culinary medicine, health-conscious people can live life to its youngest.

Ask your doctor, “What do I eat for my condition?”  If he or she doesn’t know, do your own research- here’s my list of resources.

Now it’s time to try John’s Luscious & Rich Garbanzo Guacamole recipe!

1 ripe medium avocado, preferably Haas

1 medium clove of garlic, peeled, diced and creamed with lime zest

1 medium serrano chile pepper, stemmed and diced, but not seeded

1/4 teaspoon minced lime zest, preferably organic

2 tablespoons fresh lime juice (about 1 medium lime)

1 tablespoon extra virgin olive oil, COOC preferred

1/2 cup cooked chickpeas, rinsed and drained

1/2 teaspoon yellow curry powder, such as Madras curry

1/4 teaspoon black pepper

5 sturdy springs cilantro or Italian flat leaf parsley (optional)

Cut the avocado in half long-wise around the pit and separate the halves. Remove the pit.

Use a spoon to scoop around the flesh and remove it in one piece.

Place upside down on a cutting board, dice into large chunks. Scoop up and place in a large stainless steel bowl.

Add the garlic, chile, zest, juice and oil, and mix by hand with a fork or a tablespoon.

Smash the chickpeas with the flat side of a chef’s knife, to break the skin. Sprinkle the curry and black pepper on the garbanzos, add to the bowl, mix again, and top with herb garnish if desired.

Serve with corn tortillas or toasted chips, sliced jicama triangles and sliced cucumber circles. Enjoy!

Nutritional Data Per Serving (3 servings):193 calories, 17 g carbs, 14 g fat, 3 g protein, 125 mg sodium, 7 gram fiber.

Adapted from La Puma J. “ChefMD’s Big Book of Culinary Medicine”, Crown, 2008.

(c) John La Puma, MD, Santa Barbara, CA, 10.2013

*See John’s TEDMED bio page for references and resources that support these claims.