Corresponding autor: María Nieves García-Casal Venezuelan Institute for Scientific Research . Apartado Postal 21827. Caracas, Venezuela. Email mngarcia@ivic.gob.ve
Conferencia presentada por la Dra. García-Casal en el II Congreso Mundial de Salud Publica y Nutrición y el I Congreso Latinoamericano de Nutrición Comunitaria en el Centro de Congresos de Alfadenga en Oporto , Portugal los días 23 al 25 de Septiembre de 2010.
Thank you for the opportunity to be here remembering the life and legacy of Dr José María Bengoa in Venezuela. Thanks to Dr. Solomons and to the people responsible for the organization of this meeting and thanks to Bengoa Foundation, for their help in the preparation of this talk.
José María Bengoa arrived to Venezuela in 1938 as a rural doctor, when he was 25 years old. He was accepted, as he indicated, “At the University of Sanare”. Sanare was, and still is, a small rural community with important health problems, poverty and under nutrition. When José María Bengoa arrived there he faced the social drama of malnutrition and he described his experiences in his book “Social medicine in the Venezuelan rural media” (La medicina social en el medio rural venezolano). He had an incredible observational capacity and an enormous social conscience that along with the integration of health problems, produced a pioneer in social medicine. Dr. Scrimshaw refers to José María Bengoa as the “global consciousness of Community Nutrition for over 60 years”.
As soon as he started seeing patients in his rural practice, he realized that complains of patients had little to do with what he learned at the University of Valladolid and the Basurto Hospital in Bilbao. He started to treat problems such as edemas from Kwashiorkor, liver damage and children with enormous eyes and a sad look. When he arrived to Sanare, 3 apparently independent things, called his attention: the short stature of most of the population, that he thought had a racial origin, then he observed than school children did not play during their free time, and he thought that was because they did not have toys and finally the arrival to his medical practice of small children (1 to 3 years of age), swollen, with dermatitis similar to burns and a sadness that “make the soul aches”. After a few weeks, he realized that the 3 observations had the same origin: hunger.
Dr. Bengoa wrote: “My exile began in a small Venezuelan town: Sanare in the Lara State. When I arrived in 1938, I found a town stopped in time. Possibly, the life style there was exactly the same than in the XVII century. I saw children severely undernourished, that needed 3 or 4 meals a day. There, I organized a center for nutritional recovery, where I attended several children every day, educating the mothers at the same time. They stayed in the center 8 hours a day. One day father Quintana, the parish priest of town asked me: When do you release those kids, Doctor? When they smile, father, when they smile” I answered. Many years later he was able to extend those nutritional recovery centers towards Asia, Africa and Latin America.
He was also interested in making knowledge available to people, even rural physicians in the most remote regions. He also though that the data and knowledge generated at those places, was of great importance, and usually nobody published it. That was the seed for Venezuelan Archives of Nutrition (Archivos Venezolanos the Nutrición) that he thought was a need for the amount of work and knowledge accumulated over the years. In 1965, this jour nal was officially transferred to the newly born Sociedad Latinoamericana de Nutrición as the official publication of the society, and eventually became Latin-American Archives of Nutrition (Archivos Latinoamericanos de Nutrición).
He was sent to Caracas in 1940, after what he called his “social medicine stay in Sanare”. In 1942 conducted an investigation about nutritional requirements of Venezuelan population. Those results were eventually used for planning the public policies of the country in the following years.
In a joint initiative with the National Institute of Nutrition, the private sector and FAO, they founded the committee to fight against under nutrition (Comité de lucha contra la desnutrición (COLUDE)). In the same timeframe he was designated Chief of the Nutrition Section of the Ministry of Sanity and Social Assistance and later as Chief of the Technical Division of the “Institute for Popular Nutrition”
In 1950, he co-founded the National Institute of Nutrition and collaborated with local initiatives of publications such as “los cuadernos azules” or blue notebooks, while acting as Director of the Technical Division of the National Institute of Nutrition. In those books were published, for the first time in Venezuela and Latin America, the caloric formulae, food balance sheets, surveys of consumption and the results for the first studies by Dr. Werner Jaffé on PL, a dairy product that was delivered as a social program in Venezuela.
Also in 1950, José María Bengoa along with other prominent physicians from Venezuela such as Drs Coll, Vélez Boza and González Pucci founded the first School for Nutritionist and Dieticians in Venezuela, which is nowadays a regular College career, offered in at least 3 Universities in Venezuela.
During those years he obtained an important international impact, especially in Pan American Health Organization (PAHO or OPS in Spanish) and World Health Organization (WHO or OMS in Spanish), that will be presented later by Dr. Nevin Scrimshaw.
Back in Caracas in 1974, he was assessor in social politics in CONICIT (Consejo Nacional de Ciencia y Tecnología National Council for Science and Technology) and directed 2 programs in health and nutrition. He also had teaching experience in a post-graduate course of Nutritional Planning, directed by Dr. Werner Jaffé in the Central University of Venezuela. This post-graduate course in Nutritional Planning was pioneer in Latin America.
He put his leadership to action during those times and contacted private industries to make alliances to solve nutritional problems with the participation of big, private enterprises. With his help, were created important institutions such as the Polar Foundation, The Center for Children Nutritional Recovery of Antímano, known as CANIA. The experience of this institution will be presented later today in this meeting. He also helped to create the CAVENDES Foundation and was its Executive Director for 15 years. When referring to the activities of this Foundation he indicated that…”The message from the Foundation is clear: to improve nutrition is not our goal, it is the way to achieve the whole development of Venezuelans….We try to indicate to the Venezuelan society, that under nutrition and hunger were the silent emergencies that impeded the country to get out from underdevelopment”
He also promoted initiatives from and with the public sector. The creation of the Program for Strategic Foods (PROAL), a program to deliver staple foods at low prices, and also to promote local produced items to improve food security. He also supported the creation of the National Council of Alimentation that intended the highest level coordination of public policies to reach food security. The initial Assessor Committee was composed by Héctor Hernández Carabaño, Hernán Méndez Castellano, Werner Jaffé and José María Bengoa.
During those years, between 1983 and 1989, he consolidated his greatest achievement in the diffusion of knowledge: acting as Executive Director of CAVENDES Foundation, projected nutrition activities that gave Venezuela updates and experiences in nutrition through meetings, reunions, symposia, workshops, inviting experts from all over the world. He also promoted the publication and divulgation of journals, teaching materials and books, many of them with impact and interest for Latin America and the rest of the world. Some of the include: Nutrition a National challenge, Nutritional goals and food guidelines for Latin America, Food guidelines for Venezuela, Food guidelines for school children, Food guidelines for preschool children, Advances in clinical nutrition, Nutrition in times of crisis, Iodine deficiency and its prevention in Venezuela, Updates in Nutrition and Dietetics, Community nutrition, Food and Nutrition, Persons and Institutions, Venezuela: between the excess and the deficit, Nutrition for health and life, Nutrition and aging.
The series “Nutrición base del desarrollo” (Nutrition as a base for development), compiled a wide vision about nutritional policies in Venezuela and also the revision of the recommendations of energy and nutrients for the Venezuelan population.
In 1985 “Avances Venezolanos de Nutrición” (Venezuelan advances of Nutrition) was published as a journal for divulgation of science with the guidance of José María Bengoa in collaboration with the School of Nutrition of the Central University of Venezuela. It was edited for 15 years, up to 1999.
In 1988, José María Bengoa was founder and editor of the journal “Anales Venezolanos de Nutrición (AVN)” (Venezuelan Annals of Nutrition), while he was Executive Director of Cavendes Foundation. In his first editorial for that journal he commented the “AVN was created to fill an empty space for Venezuelan nutrition experts to publish their local works, for diffusion in the country”. Eventually AVN acquired Continental acknowledgment due to the quality of the publications.
His many publications over the years show his interest and concern about children, hunger and under nutrition, the importance of nutrition in public health, and the relationship of nutrition with chronic diseases and the life cycle. During his last years of activity his main concern was the problem of pregnancy in undernourished adolescents that he referred as “mother children with high health risks for themselves and their own children, that we must attend”
In 2000 he published “Hambre cuando hay pan para todos” (Hunger when there is bread for everybody)”. The prologue for that book was written by his best friend Nevin Scrimshaw who indicated that this publication “captured and transmitted his vast experience about nutritional problems in the world, in the same way that he´s though all his life and before most of his coetaneous, that the social, human and economic effects of mal nutrition in early stages of life have consequences too serious to be ignored”.
In 2005 published the book “La ruta del Hambre: Nutrición y Salud Pública en el siglo XX” (Towards the path of hunger. Nutrition and Public Health in the XX century), with a presentation from Dr. Bernabeu Mestre who considered that “this book offers a singular introduction to the process for the historic configuration of the modern community nutrition. Bengoa is one of the voices that was raised in the seventies, highlighting the importance of combat the hunger and solve the problems of poverty and injustice….Bengoa is part of this select group of men and women whose “little battles” have contributed to establish the bases to allow us in the future, to win one of the worst wars: The one produced by hunger”
During his lasts years he devoted part of his time to support the activities of Fundación Bengoa to face the challenges of the present that we are living in Venezuela now. His wise orientation guided much of the actions of Fundación Bengoa in community nutrition and nutritional education. One of his biggest concerns, as mentioned, was the nutritional status of children born from undernourished adolescents.
With his wife Amaya, the daughter of the poet Gorgonio Rentería, constructed a beautiful family. Their sons, daughters, grandchildren and great grand children live in different parts of the world, at least in Venezuela, Switzerland, USA and Spain. This is a little tribute also for them, with appreciation and gratitude.
In an interview in 2005 he pointed out that he felt very Venezuelan, very integrated to the lifestyle of this country that he considered his “first and second homeland”. “I am Basque and Venezuelan in the same proportion”, he said.
Dr. Bengoa´s life was full of personal accomplishments, help and caring about people, especially children. His main concerns in this field were about hunger, and under nutrition. His work is a celebration of a complete, useful life. Either as a leader or as part of a team, he supported initiatives with a high impact to help others, to create community work and to generate, communicate and publish knowledge in Venezuela. Fortunately his “area of influence” touched many other countries, especially in Latin America.
We can say, without a doubt that José María Bengoa helped to create, to construct, the nutrition in Venezuela. Gracias, Maestro!!!
He died in Spain on January 16, 2010, with a big part of his heart in Venezuela, where his legacy remains among us.