My first week in southern Malawi flew by. Little sleep. Much heat. Immersion.
Monday through Friday, we completed five intense, day-long sessions in remote villages - "hot spots" for poverty and hunger.
I watched and reflected as small teams of nurses, doctors, and health screening assessors (HSAs) tested several thousand children for health and nutrution issues.
My ability to reflect these experiences in the words of this post is limited. One's heart and head are challenged. Each child seems to have a powerful story.
In Malawi during Winter months, "Hunger Season" unfolds.
For most families, life is dependent on a single, annual, twelve to fourteen week growing season, and a precious crop of corn.
Roughly 80% of the population of thirteen million people survives as "subsistence" farmers.
Harvest is typically in April.
The size of each year's crop determnes the difficulty the family will have eating through the entire year.
In the Summer, a child in Malawi may eat three times a day.
By October, a child may eat just two times a day.
By February and March, a child may not eat every day.
For some children, malnutrition becomes a crisis. Without intervention, their lives are at risk.
When farming yields are low, the country suffers greatly. As a result, each year's growing and harvest season is watched closely. Fertilizer and seeds are subsidized by the government.
As one might guess, politics, curruption, and beauracracy influence the distribution of many cricial resources.
Last year's crop was not robust.
As a result, at this time in the year's cycle, many families in rural areas are running out of food. The impact of poverty and limited resources for government assistance are evident.
At the end of each day last week, a doctor noted the rapidly expanding group of families in desperate need of support.
On Friday alone, we screened about six hundred children and added about sixty children to the enrollment of kids under treatment for moderate and severe malnutrition.
The drug of choice?
"Chiponde" which is comprised of peanuts, oil, milk powder, sugar, viamins, and minerals. These ingredients are mixed into a paste served to children three to five times a day within their home environment. The "Chiponde" is free to all children who need this support.
Fortunately, outcomes when a child receives treatment with "Chiponde" (Ready To Use Therapeutic Foods provided by Project Peanut Butter) are quite remarkable.
Through the last six to seven years, 85% to 95% of the children treated with Chiponde have recovered and remained stable. I watched repeatedly as strikingly thin children and their caretakers began this therapy.
Monday through Friday, around 5 AM, three to four teams pack large boxes of food and simple assessment tools into a group of old four-wheel-drive vehicles and depart from the city of Blantyre toward the countryside in Southern Malawi.
Each vehicle rolls through the dark streets, hugging the left side of the road (a British legacy), headlights tossed up and down by the uneven surface of the road.
At this time of the year, low clouds and fog typically cover gently rolling landscapes in the early morning. The sun and heat slowly rise. By mid morning, I am often dripping with sweat.
After we leave the apartments where the doctors stay, we stop to pick up a team of nurses and drivers. Then, we complete an hour to two hours of travel on paved and dirt roads. The sounds of industry, commuters rushing to work, and city life fade.
Vehicle problems are common. In the last six days, we experienced smoky brakes, a flat tire, a broken differential, problems with the starters, and a series of unexpected challenges with simple movements along muddy roads. This is Africa. One cannot expect travel to roll forward as planned on a regular basis.
Project Peanut Butter works in the same locations on the same days each week - a consistent rotation.
In the countryside, on the day of a specific "clinic," women, older children, and other caretakers walk for hours, some up to fifteen to twenty kilometers, with young infants to arrive at the start of each session.
By the time a Project Peanut Butter team arrives at each site, it is about 7:30 AM.
Long, winding lines of caretakers, often thin, young mothers, each holding one to three hungry, screaming children, await the start of the clinical session.
Mothers come searching for community interaction, support, assessment, relief, reassurance, and hope.
Fortunately, many children, despite the poverty and other challenges faced by their family, are not in need of emergency relief. These kids are screened and encouraged by the health team to continue to check in.
Other children are in a state of crisis. These kids desperately need help - they may be "wasting" (very, very thin) or exhibit "edema" (swelling).
When the Project Peanut Butter teams arrive at each site, the nurses lead the women in discussion of health topics.
Next, there are a series of songs, educational in nature with local melodies and much improvization. The harmony, clapping, and sense of unified engagement is powerful, uplifting. If I close my eyes, I can almost forget the sense of urgency and concern all about me. The mothers and other caretakers seem to enjoy the transformational spirit of this ritual.
Then, the doctors and nurses break into pods with scales, height, and other measuring tools. The rush begins.
Hundreds of women pack into lines leading to each "station." The Project Peanut Butter Team works with the local Health Sceening Assessors to weigh, measure, interview, and review the status of each child's nutritional status.
Primary indicators for health assessment and nutrional crisis are height to weight ratios and lean body mass indexes. International standards, two and three deviations off of a bell curve, are used to determine if a child is in need of immediate medical intervention.
Global figures indicate roughly 4% of all children internationally die before they reach five years of age. In Malawi, the figure is close to 18%.
I am told nearly half of all child deaths across the world have a direct relationship to nutrition.
If a child has moderate malnutrion the odds of death go up 400% (four times as likely).
If a child has severe acute malnutrion, the odds of death go up 800% (eight times more likely for the child to die before five yers old).
Project Peanut Butter provides highly nutritionally dense foods for children with these desperate needs. The therapy lasts six to eight weeks.
Throughout this last week, I was inspired and, at times, overwhelmed by the intensity and spirit of this work.
All four of the doctors working with the team are incredible - inspirational skills, commitment, and drive.
I go to sleep reflecting on many moments. I ponder difficult questions that often hold no clear answers.
Is there another mammal sleeping in my room?
Is that buzzing sound inside or outside my mosquito net?
What exactly is the "Hair Fertilizer" sold by the local store?
Then, there are the more serious ponderings ...
What is the true cause of hunger? There are many opinions about this.
Are there long-term solutions to extreme poverty? Simply attaining clean water and adequate food are a huge reach for several billion people on our planet.
What if I lived in a country where the average annual wage hovered around fifty dollars? Many of Malawi's citizens work for $1 to$2 a day. Many other members of the population have no income of any kind - they survive on small plots of land. If I were born into these circumstances, how would I respond to the struggle of each day?
I think of our health care system. We certainly have challenges, but in the U.S., we are blessed with an abundance of resources. The ratio of doctors to citizens is roughly 700 to 100,000. We spend huge levels of professional staff to support our well-being. Can I imagine living in a country where there are just two doctors per 100,000 citizens (Malawi's status), a country where Malaria and Malnutrition are the leading causes of death, a country where health care is free, but access to services is hugely difficult. What if I had to walk for two to three hours to see a lightly trained nurse? What if the closest hospital was a hundred kilometers from my mud hut and my only form of transportation was my own two feet?
What if close to 15% of the U.S. population was HIV positive? Would we view this crisis differently?
Despite deep poverty and difficult daily life challenges, joy and laughter and a deep sense of community can still be found all around me.
Material wealth and professional status are not driving these outcomes.
How do people find happiness when life circumstances are so rough? What do they rely on?
Two days ago, I met a grandmother who works with twenty other generous and compassionate volunteers to support about two hundred orphans. What life stories!
The grandmothers, or in local terminology, the "go gos", work in very low paying jobs (often $1 to $2 a day) to earn enough money to pay for food for the hundreds of children they care for.
Where does this motivation and sacrifice come from? Africa remains a place where "extended family" and kind embrace remain in force.
Fighting to survive has a way of clarifying one's priorities. Expectations drive so much of our emotion.
My documentary work is going well. I am highly challenged to produce video and still images that reflect the power and importance of this work. We are making progress.
My health and energy are holding up. My spirit remains engaged and hopeful.
There are many opportunities for me to learn and try to contribute.
The group I am working with is generous and full of vibrancy.
Jeff! Take care. What a wonderful incredible unbelievable time you are having. I love the pictures. If you can, upload more! I am struck by the incredible vibrant clothes that are worn in such a desperate situation.
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