Kwashiorkor ...

The image above reflects a child in a state of nutritional crisis - in this case, "Kwashiorkor."

Before this trip, I had never seen a child's skin stretched and swollen like this.  It is quite incredible to see the body's response to food disruption.  

A portion of the children who experience a substantial nutrient deficit for a sustained period of months develop this type of painful "edema."

The impression (dent) shown in the child's right foot remained visible for several minutes after Dr. Manary, the Founder and Director of Project Peanut Butter, pressed his thumb against the skin on the child's foot and held this pressure for about five seconds.

Fortunately, this child's condition, "Kwashiorkor," may be relieved in less than a week with a nutrient rich diet of "Chiponde."

Several of the children at yesterday's clinic were not able to walk because their feet, ankles, and shins hurt so much.  

At this point in medical history, scientists and doctors do not know why some children develop this condition and other children grow very, very thin and lose lean muscle and other body tissue.  This is a mystery that has been debated for decades.  

Dr. Manary is conducting a series of research projects to better understand and prevent these conditions.  He has a team with a Malawi born nurse, a U.S. doctor, and a volunteer collecting stool samples from hundreds of twins in Southern Malawi.  This medical team transports liquid nitrogen in the back of a four-wheel to one local village after another to immediately freeze the "specimens."  Through this process, Dr. Manary hopes to determine if certain flora or other "gut" conditions influence symptoms and conditions associated with severe acute malnutrition.  Each of the twins in the test are provided with special nutritional support.

It is incredible to watch this type of intensive research and treatment occur in a remote, isolated, and poor region of the world.