New diet, new threat in Uganda

TWICE A DAY, Kasomo Suraiman loads his one-speed bicycle with 200 pounds of bananas from his field, wobbles it down a mile of deep, erosion-rutted red-clay paths and onto the road as part of a 9-mile journey to a produce collection center in the rural south.

That is the easy part, given the perilous, crumbling asphalt roads with vans and trucks barely missing him. He rides the bike when the road is flat or downhill. Uphills require him to get off and walk, reaching across the handlebars to push his crowns of bananas. The physical demand on the arms and calves brings a grimace to all the men like him on the roads, no matter how fit they must be from the years of doing this.

For these 36 miles a day to push a tenth of a ton of fruit to market, Suraiman earns $2. With it,he purchases soap, salt, fuel, and paraffin for lighting. If his bicycle were to fall apart, he said through a translator, it would take one-and-a-half years of saving $75 to replace it. He has six children, ages 2 to 13. He pushes the bicycle from his subsistence farm and his papyrus-thatched mud home because, “I want to have opportunities for my children. I wish for them to get jobs in offices so they can get cars. It will bring pride to my family.’’

Suraiman’s desire for his family is ages old. But in the complicated lurch toward modernity, medical observers wonder what Ugandans will physically look like years from now. Even for those like Suraiman who are hidden from the roads in the banana, sweet potato, and coffee fields, Western-style foods and slow but steady loss of resources are chipping away at their diets. While old-fashioned malnutrition persists, area doctors are seeing the creeping advance of mis-nourishment, with thin villagers showing up in clinics with hypertension and diabetes.

“We really have double jeopardy,’’ said Robert Kalyesubula, a physician at Mulago Hospital in the capital of Kampala. “We don’t have the resources to make early diagnoses or the resources to manage it. And the changes are happening so fast.’’

In a parish two hours from the nearest town of Mbarara, Adeodata Sanyu, mother of seven children, said she thinks girls and younger women are already not as healthy as she. Through a translator, she told me and a team of Harvard University public health researchers that when she was younger, fish was plentiful and cheap. Now it is so scarce and expensive, she has it only on holidays.

She eats mostly beans and groundnuts now. “Long ago, we didn’t fry with oil,’’ Sanyu said. “Now, everybody fries their food because it is quicker than boiling. Now, people buy more rice, maize, and flour packed in bags. It is not a good thing because it is expensive. It is not as healthy.’’

Mugisha John Bosco, 34, and Kyosimire Maxencia, 25, are raising three children in the same parish, with John Bosco patching a living together growing crops and bricklaying. But he said a wilting banana disease leaves him none left over to sell at market after feeding his family. They too often resort to maize and flour they buy with their precious shillings. While he said life in the village is better than in the city, he feels “insecure’’ in ways he did not years ago.

Nzenia Kamugisha, 54, has already buried five of her 12 children, mostly from measles, fevers, and poor maternity care. When she was younger, she ate lots of vegetables and legumes and avocados every day. Worn down from childrearing, she feels too weak to plant a more varied set of personal crops, settling mostly for bananas and beans. But she sees much younger women and girls already eating the foods more weighted to sugars and starches rather than vitamins and protein.

“She feels the younger women’s health is worse than hers is,’’ Kamugisha’s translator said. “She feels they will die sooner than her generation.’’

It’s a new, silent danger for Uganda.

Derrick Z. Jackson can be reached at jackson@globe.com.