Steve Collins, doctor and aid worker, director of Valid International and Valid Nutrition. As told to Colin Murphy. Published in the Irish Independent.

I went to Africa in the summer of 1985, on my holidays from medical school. I travelled through Uganda (where there was a coup), Congo on a bicycle, Chad (where a civil war had just ended), and ended up on the border of Sudan, in Darfur, where a full-scale famine had broken out. I realised you couldn’t be a tourist in a famine, and so I turned up at a refugee camp, and volunteered.

Simon, an aid worker, needed somebody to survey the villages in the surrounding desert, and I said I’d do it, on foot. The first day, I walked 15 miles across the desert to the nearest village. They had received an over-distribution of grain, and made beer with it. Every house I visited gave me some. After about three hours, I passed out. I woke up when it was just getting dark, and started walking home across the desert. I was getting into real trouble when my boss happened to drive past. “Christ,” he said, “you’re going to have to get a horse.”

I did, and would ride out into the desert, visiting communities, for two weeks at a time. I eventually went back to England to finish my medical degree, and then went to Jamaica to do my hospital internship. Luckily, the hospital was next door to a top-flight nutrition research institute. In Sudan, I had realised that nutrition was the basis of everything. If you don’t have the right nutrition in the first two years of life, the brain doesn’t develop properly, and you can’t learn.

In 1992, famine broke out in Somalia, and I volunteered with Concern, and was put in charge of an adult feeding centre. It turned out that this was the first adult feeding centre since the Second World War, and nobody knew why so many adults were dying. I changed the diets in the centre, using some research material I had from Jamaica, and managed to cut the death rate by three quarters.

The adult we were treating were incredibly thin – 20% thinner than the people liberated from Belsen concentration camp. Afterwards, I managed to publish a paper in the top scientific journal, ‘Nature’. So everybody thought I was an expert, and I got sent everywhere to set up other centres.

A few years later, I was in Liberia during the war, with Oxfam, to open a centre. I asked people was there cholera in the area, and they said no, because there wasn’t, at that time. With limited resources you can’t do everything; I decided the priority was to feed people, rather than worry about water and sanitation.

I had asked the wrong question. I should have asked, “What do people normally die of?” There was a subtle difference, and it was fatal.

We set up up a feeding centre, and it attracted more people to the village. But the new people didn’t know the area, and didn’t know from where to take their water. Cholera broke out. Then, suddenly, a fresh outbreak of fighting forced us to leave for a few days. When we got back, the cholera had killed 18 people.

That brought home to me the danger of bringing people together in feeding centres. There had to be a better way, I thought. I knew that this would come from engaging with people better, looking at their strengths, rather than trying to impose solutions on them. I wanted to try fighting starvation by giving people food to bring back to their communities, instead of forcing them to come together in centres, and I set up a research organisation, Valid International.

In 2000, I went to Ethiopia. Their government had forbidden aid agencies from setting up therapeutic feeding centres, because they’d had them for years and realised they didn’t address the underlying problems. That gave us an ethical opportunity to set up community-based treatment programmes, which we called Community-Based Therapeutic Care.

By the end of 2001, working with Concern, we had treated about 300 cases by giving people ready-to-use food to be administered in the community. The mortality rate was just 4%, five times better than the normal mortality rates in developing-country hospitals.

We developed the research over the next few years, working with Concern and with money from Irish Aid, and eventually we had collected data on over 23,000 cases: the mortality rate was still under 5%. We took this to the United Nations and the World Health Organisation, and they endorsed it. Now, all governments in Africa are moving towards this community-based model. We also started another charity, Valid Nutrition, to set up local food production companies in Africa.

I’m 47, and I’m tired. I’ve been doing this for over 20 years, and I’ve been affected, and saddened, by all the death I’ve seen. I got married last year to Claire [Martin], and we have a hill farm near Glengariff, in West Cork. It’s miles off the road. You can’t see our house from anywhere. I met Claire when she was working with Concern, and we worked together in Darfur in 2004. We run the farm together, and she also runs an organisation from home, providing administrative support to ethical organisations.

I now spend about half my time on the road with Valid, and half at home. I’m breeding a small herd of Dexter cattle. They’re very tame, very small, and produce good milk and will raise a calf a year. There’s a lot of people who want to get out of the rat race, and have a little bit of land, and could keep a couple of these miniature cows. I’m going to try to breed them up for that market.

Being able to retreat back to the hills stops me from going mad – it gives me the balance that I need, so I can continue doing the work that I do. But I have a vision for how the world can address malnutrition once and for all, and that keeps me going.

For more information, see Concern’s website,