Homeward Bound ...

I write from a small cafe in Johannesburg airport.

If all goes well, my feet will touch soil in San Francisco tomorrow (Sunday) afternoon.

My second trip to Malawi left many colorful impressions.

Emotions tugged and pulled.

Sleep lost and sometimes found.

Intensity, warmth, openness, exploration, uncertainty, inspiration, fear, hope, encouragement, sadness, yearning, creativity, disappointment, and trust were all part of my journey.

My professional capabilities were stretched.

Rich experiences and memories linger.

Thank each of you for sharing this journey with me.

I am grateful for your engagement, your encouragement, and your insight as I find my way.

Simple moments bring much into our lives.

Often, my challenge is to be "present" and open enough to recognize and hold these gifts.

This is certainly true with intense travel and documentary work.

The little boy in this picture reminds me of this opportunity.

I want to bottle his joy and excitement!

May his smile and playful energy add a touch of brightness to your day.

Best wishes to all.

Let The Good Times Roll ...

When you need to brake quickly, you wish for tight, firm control of your finely tuned rig.

Yes, this African cyclist is ready, willing, and able.

Why bother with expensive brake levers and a complex mechanical system used by many bike owners when you can have finger tip power?

My buddy, hand and body shown in the picture above, pulls hard on the wire around his thumb and hopes for the best when he needs to stop.

He often travels long distances on the rough trails and uneven dirt roads of southern Malawi.

One sees large quantities of cargo - wood, pumpkins, sugar cane, flour, tobacco, bricks, people of all sizes - transported on older, "customized" bikes such as this machine.

These two wheeled bicycles provide inexpensive mobility, a freedom we tend in America to associate with a car.

Large weight loads and harsh conditions take quite a toll on both the rider and bike.

It is quite common to see shacks converted into bike repair shops on the side of major dirt roads.

The "mechanics" at these shops proudly display a collection of old tires, mechanical pumps, and beat up wrenches and other tools.

Purchasing a vehicle is generally an unimaginable "stretch" for almost all rural families.

Thus, bike ownership is golden.

For forty to a hundred dollars, a semi-rolling rig with an old saddle and heavy metal tubes may be purchased. As you can imagine, bikes are used for years and years and years.

Pedals and a functional chain are optional. Gears are very rare.

As I reflect on my time in Malawi, I touch visual memories with bikes in a central role ...

Families of three or four people riding together with five or more bags of goods they plan to sell at the market.

Women with their babies tied to their backs and one hand on the steering wheel while their personal possessions are held tightly in their other hand.

Young male riders swerving down a dusty path with three or four giant 75 Kg sacks tied to the back of their bikes.

An elderly man walking along side his old, partially broken bike with thick piles of wood fastened to every imaginable piece of the frame.

One way or another, bikes continue to roll and wobble forward along bumpy paths and roads within Malawi's countryside.

Each day, as we traveled through the countryside, my eyes spread wide and laughter came forward from my gut as I witnessed Malawi's version of a cycling parade.

Sapuleni's Story ...

On Thursday last week, I met Sapuleni.

She came with her youngest son to a roadside clinic near "Chipolonga" where our team provides nutritional assessments and, if needed, "Chiponde."

Unfortunately, her son is quite sick with severe acute malnutrition (SAM).

At the clinic, Sapuleni received advice and a bundle of Ready-to-Use-Therapeutic-Food.

Fortunately, with proper treatment, her son his likely to recover.

Before Sapuleni left the clinic, we had a chance to speak.

Her spirit and warm energy stood out in the crowd of mothers that morning.

I asked her if she would allow me to visit her at her home.

Then, I explained my goal.

Through an interpreter, I told her I am working on a documentary project to support children who are hungry, children who live within families that need food and medical attention. I told her I am taking pictures to communicate how clinics such as the roadside program she attended impact family's lives in Malawi.

I tried to explain that I want to better understand the reality of daily experience in a rural village - to touch the world she knows each and every day in an intimate way.

I asked her if she would allow me to bring my camera and sit with her and her family for a day or more during the weekend.

She smiled and let out a light laugh.

Yes, she must have thought, "here is a crazy azungu (white person)."

The notion of her daily life holding interest to someone from a far away place must have been both unusual and surprising. What could she possibly share?

I told her she didn't need to change or alter anything in her day. I spoke about authenticity and my desire to see her experience first hand in an unfiltered way.

After a short pause, she nodded her head and accepted my request.

As Sapuleni walked off in the morning light with her son on her back, I felt encouraged.

I planned to drive three hours early Saturday morning to meet with the chief of her village and then come to her house.

I did not know much about her family or her village, "Kwilasya," yet Sapuleni seemed to express much that I am drawn to with my photography work. She seemed strong, thoughtful, and expressive in her spirit.

In our first conversation, she shared a raw outline of the circumstances that led her to her son's health crisis.

She is very poor.

She has many children.

She has no food.

She has little opportunity for work.

All common challenges in rural Malawi.

I worked with one of the student doctors, a nurse, and a government health worker (a "HSA") to plan our visit.

After driving to her village from Blantyre, we picked up the local health care worker and drove to the chief's home. The chief was not available, but his wife provided permission for us to walk about a half mile on a small path through several fields of corn to visit Sapuleni's house.

By the end of our first three or four hours together, Sapuleni's life unfolded in bolder, more difficult, and more moving ways than I could have predicted.

I left our time together, torn up, moved, hopeful, challenged, worried, and inspired.

Here is a bit of Sapuleni's life story ...

* * *

At this time, Sapuleni does not know her age. This is common for many individuals who live in rural areas of Malawi.

It turns out, she has a very large family - nine children.

Here's the kicker. She is now a single, divorced Mother.

Her previous husband is a fisherman.

When they married, Sapuleni's parents provided the newlywed couple a small piece of sandy dirt to build a home and start a "garden" (think corn).

Sapuleni came from a Muslim family. Her husband came from a Christian family.

As you might guess, these types of mixed faith marriages are tough in any rural community, especially southern Malawi.

To support unity, she converted to Christianity at the time of her wedding.

Sapuleni and her husband built a one room house out of bricks and mud. For about seventeen years, they lived together in this small home and worked their way through tough times with bits of corn, fish, and vegetables as the primary source of food in their diet.

Sapuleni told me that "Hunger season," the period from about November through March, is always tough.

Unfortunately, when Sapuleni was pregnant with her ninth child, she became very sick. She had to go to the closest hospital, which is about ten kilometers from her home. There, she received medical care for about a month.

Since her family has no car or bicycle, communication with her husband and children was difficult during the time she was in the hospital.

After, she gave birth to her child, she returned home and found a surprise. She discovered her husband was sleeping with another woman while she was sick and away from the village.

This led to a series of heated conflicts.

Ultimately, Sapuleni asked her husband to make a choice - faithful marriage or divorce.

He chose divorce.

Suddenly, Sapuleni found herself alone with nine children, no education, no profession, no source of income, and few assets outside of a minor collection of old pots and pans.

To complicate matters, one of her children developed mental health issues.

The marriage separation took place about one year ago. Her husband left their home and ceased all communication and support.

Sapuleni's children are now 18, 17, 16, 15, 13, 9, twins at 6, and 1 year nine months old.

Her days involve constant motion and commitments of care.

Two to three times a day, she must walk about a half hour to get water from a bore hole with a manual pump. This, as you may guess, is not the purest of water sources. She pours several gallons of well water into a large yellow plastic can and returns home.

Her family's diet consists mostly of corn flour and boiled water. Sometimes, Sapuleni can sell bits of corn from her garden or find work in her neighbor's gardens to raise money and afford a bit of small fish and vegetables such as pumpkins.

Her previous husband he has not provided support of any kind. He still lives in the "hood," but his commitment to his first family, Sapuleni and all nine children, vanished completely when he left about a year ago.

The full family is now Sapuleni's sole responsibility.

To support her children, Sapuleni works in the only way she knows how to earn money - she provides manual labor in neighbor's homes and gardens.

Generally, she is paid 30 to 40 Kwacha (twenty to twenty five cents) per day for about eight hours of work.

Imagine this compensation as a means to support nine children. What a challenge.

On Sapuleni's best days, she makes about 100 Kwacha (sixty six cents).

With a day's wages, she can sometimes purchase one or two cups of milled corn flour for "Nsima," the primary source of food for her family.

Sapuleni has no brothers and no sisters. Her father passed away years ago. Her mother, who is about sixty years old, lives nearby in a small mud hut with a thatch roof.

So, there is no extended family to offer support.

Sapuleni's older children split their time between work and school.

They too make meager wages for simple manual labor.

As you may guess, it is difficult for Sapuleni to support her children in school.

Much like many other regions of Africa, Asia, and South America, there are requirements for uniforms and other fees in Malawi's public schools.

In some local classrooms there are over one hundred students - quite a student to teacher ratio.

Almost all teachers in rural Malawi are poorly paid and overworked. As a result, these professionals are sometimes far from sympathetic toward children who cannot meet basic requirements.

It is difficult to keep the poorest of the poor in school.

Quite often, Sapuleni's oldest son is thrown out of classes because he has no funds for simple class fees and no uniform. The fact that he needs to leave school early to work on many weekdays creates further challenges. Yet, Sapuleni continues to push hard for his education for all of her children. She believes this is essential for their future. Her oldest child, who is eighteen years old, currently attends second grade. He had to drop out and then re-enter school during the last year.

Poverty has a way of cycling deeper and deeper.

Sapuleni cannot afford fertilizer. She was not able to get a government voucher. So, her corn crop from the small plot of land around her house is weak and fragile.

I asked Sapuleni what her current feelings are about a large family.

She spoke about her love for her husband and all of her children and the evolving flow of life. She mentioned her experience with family planning. Through her years as a child and young adult, she never had any education in this area or understanding of this concept.

She wanted to be part of a large family.

She did not anticipate life would be so hard.

In Malawi, a large family is generally a source of wealth, blessing, and pride.

Unfortunately, the rest of her village is not in a position to offer support.

Each year, Sapuleni needs more and more food to support her growing children.

Through all her experience, even the rough moments, Sapuleni continues to have faith in God. She spoke about her beliefs and her hope that all will evolve in a positive way.

In may respects, Sapuleni's heart is tied to her children.

When she spoke about her dreams, her words were focused on their future.

Education is her main goal.

She described the importance of each child learning to read - a skill she never developed. At this point in time, only one of her children can read and write.

She spoke about the possibility of her children gaining employment. She yearns for this.

In a full year, Sapuleni's income is often only $30 to $50. Think about this. Her annual income is roughly equivalent to the cost of one dinner for one person at a restaurant in the United States.

Sapuleni allowed me to sit and witness her daily life. I encouraged her to act as though I was not present.

I filmed her making corn stew, cooking tiny fish, gathering corn, feeding her family, cleaning her house, and interacting with her children.

When I entered her home in the middle of the day, it was dark. Two small windows provided the only light. Within the brick walls, I found a barren slab of mud that serves as Sapuleni's floor, a few extra pieces of clothing, an old, broken, plastic radio that was dusty and tied with a cord, a few worn pots, several mosquito nets used as a shelf and a hammock, a wooden board that looked much like a old, abandoned door, and a small swarm of unidentified flying insects.

Outside of one worn, wooden chair, Sapuleni has no furniture of any kind. There is no bed and no kitchen in her home - she cooks outside on a small wooden fire in a thatch hut.

My experience with Sapuleni at her home provided an intimate "brush" with poverty.

She graciously provided an opportunity for me to see how she lived and how she cared for nine children with little material resources.

Sapuleni's life is truly tough. Yet, through our time together, Sapuleni expressed warmth, hope, and a sense of resiliency.

I never sensed any remote sense of blame toward others. Nor did I ever feel she held onto the experience of a "victim." She seemed calm and "present."

She seems to work her way through each day, one day at a time.

It is hard for me to imagine the uncertainty she must live with.

It is fortunate her faith is so strong.

As we left our time with Sapuleni our little team of travelers provided several gifts, bundles of beans, corn flour, sugar, and soap - all cherished and graciously accepted.

As we drove down a long dirt path near her village, many questions flowed through my heart and head.

How might we transform Sapuleni's family's trajectory?

I searched for a way to uplift her experience and create some form of sustainable income.

Is there a way to use a "micro loan," a gift, an investment in inventory or equipment to allow her and her family to transcend current circumstances? How might we allow her to grow more food or produce greater income?

I wondered if there are creative and cost effective solutions that can impact her entire village.

Ideas flowed.

We could purchase a hundred small "chicks" for about fifty dollars. But, how would she feed and protect these little birds? Between the wild dogs and other predators as well as a village of hungry people, it is unlikely this idea can work as well as planned.

We could create a maize mill in her village. This would be valued, but expensive and inefficient given the small number of families nearby.

Fertilizer? Even a single bag would make an extreme difference.

Cloth for hand made products? She would need to learn to sew. Who would her customers be? How would her goods make it to market? Wouldn't this continue her cycle of depency on poorly paid hourly labor?

We might provide funds for inventory to start a small vegetable stand on the main path near her village. Would any food and funding support just be consumed?

We don't have a solution yet, but we are trying to find a promising path that Sapuleni wishes to pursue. We want to drive our engagement from her needs and aspirations. We may involve the chief of her village in this pursuit.

A charismatic and engaged nurse, Rosemarie, who came with me to the village for my visit was moved by Sapuleni's story. She is serving as a local "bridge."

We raised a small amount of money. We plan to explore a range of alternatives. There is a bit of hope.

Sapuleni's story is the story of thousands of mothers in Malawi.

There are no easy solutions to the experience of extreme poverty and hunger.

I recognize that sustainable change for Sapuleni's family is just a "drop in the bucket" for this country's and this continent's needs.

Yet, I don't know where else to start. So often, when we wish to impact large human issues, it requires starting at an intimate level. In many cases, we can not get "there," to a new future, unless we build up the broken pieces of our existing, fragile foundation.

We can toss food and other short-term resources into this crisis. And, we may be able to create powerful healing - much like the outcomes of Project Peanut Butter. At the same time, it seems essential to enable truly sustainable change that comes from within Sapuleni's own home and community.

I am not at all sure how to achieve this. I can see problems with so, so many alternatives.

Almost all of the forty to fifty families who live near Sapuleni share her poverty and food shortage. Working through logistics and potential curruption, cultural challenges, training issue, potential jealousy and equity issues from other village members and related parties, and other concners will all play a part in determining if any support for Sapuleni can be successful in the long term.

Clearly, positive, long-term solutions for this community may involve a combination of many changes - micro loans, small businesses, improved farming and crop yields, more accessible and more effective education, infrastructure investments, technology, and improved family planning are all needed.

It is fascinating to reflect on what people who live in extreme poverty say when you ask a simple question :

"What change will bring the most benefit to your life?"

The four answers I hear most often here in Malawi are: roads, education, fertilizer, and employment.

Ok. There are few individuals who go straight for the"gusto." They simply answer "money."

Yes. Wealth, happiness, and prosperity are defined and achieved in many ways.

Despite Sapuleni's lack of material resources, she has many valuable assets.

My hope?

That the future brings brighter days to her doorstep.

Fish Tales ...

A story from Africa's creative spirit ...

A number of lakes and large rivers exist in Malawi.

Many people travel long distances by foot, bicycle, car, or minibus (a type of cheap, shared taxi) to pursue fish - a luxury and desired source of protein.

Nets and lines are used.

Let's just say the "bait" may be unique and colorful.

Sometimes, a quantity of fresh fish are caught and gathered in a bucket or basket.

The big challenge?

How can one get pounds of raw seafood home in the middle of day with high African heat and long distances to travel?

I am told fresh fish will spoil in just a few hours in Malawi if the fish are bundled up in a car or carried in a basket or bucket. The heat and muggy air will prevail.

Some of you may suggest an ice box as a solution.

Great idea. The only problem? Ice is rare and expensive to generate.

We need a quick, simple, low cost solution, a solution that does not require planning and equipment.

A ways back in time, an African somewhere on this vast continent discovered an elegant alternative to the modern ice box.

This solution involves a vehicle of some kind.

The slightly wealthier traveler, the fisherman with enough "coin" to jump in a mini-bus or the good fortune to be successful as a hitch hiker, may strap his/her "catch" to the mirror outside of the vehicle with a rope through the gill and mouth of each fish.

Then, when the vehicle moves along the dirt and paved roads, moisture from the fresh fish evaporates. And, due to the magic of physics, this evaporation causes cooling.

The faster the speed, the faster the evaporation and the greater the "cooling effect."

In this way, fish can be left, without ice or other sources of preservation, for hours in the deep heat of the day as the vehicle drives from an area near the lakes and rivers to the fisherman's home.

Yes, this approach also creates nutritional benefits - the addition of essential vitamins CO2 and road grit. Fortified fish.

When the fisherman arrives home, the need to scale, clean, and boil or fry the fish is immediate.

I am told, when consumed, "roadside preserved fish" maintains a new and slightly "altered" flavor.

It is clear the hygiene around this process may involve a certain degree of compromise. Yet, the fish make it home without spoiling. Clever.

As they say, "Necessity is the mother and father and grandparent of innovation!"

Ester's Path ...

Just before we met, Olive Menyani and her daughter, Ester, walked three hours in morning darkness to arrive at a nutritional clinic in the village of "Mbiza."

Ester is now ten months old.

Unfortunately, her health is compromised by a number of illnesses.

To complicate her life further, like so many families in this area of Malawi, there is little food currently available within her home.

In this case, Chiponde is positively impacting Ester's condition. Yet, she has a rough path ahead.

The hope is to help Ester get through the next month and into the "harvest season." With food and medical support, the Project Peanut Butter team hopes Ester will recover and grow toward normal height and weight.

When I look at this image, it reminds me of my experience on that morning.

There is something in Ester's eyes that held my attention, tore at my heart.

Perhaps, it is vulnerability, a fragile sense of trust, a sense of openness, or the feeling hope that only a young child can express in such pure form.

Soles That Travel Well ...

Bare feet and long, rock filled trails dominate rural Malawi.

Now, imagine if you spent the first thirty five years of your life walking without shoes on hot, uneven dirt.

You too might develop toes that spread widely and travel boldly.

This mother's youngest child is enrolled in Project Peanut Butter's nutrition program.

This image was produced as she paused on her long walk back to her village.

As I looked through my lens, I wondered about the many stories attached to the soles of her well-worn feet.

These ten toes look as though they "evolved" in form and function, through many colorful experiences, through many years!

Chief Waisoni Injesi ...

We met on a hot Sunday afternoon.

I came to ask Chief Waisoni Injesi for permission to allow me into his village.

As an "Azungu" (white person), it is not appropriate for me to arrive unannounced in a remote African community ... especially with strange equipment and lots of intimate questions.

First, there were formal introductions and meet-the-chief protocol - I learned to shake a chief's hand with reverence, bow from the waist, and ensure my head is lower than the "mighty" chief's head. Ok. I am embellishing a touch.

I came with a local health care worker and a nurse who works in our program. This provided a link to the Chief's world and a means for me to communicate in the chief's language. We sat for about an hour in conversation.

Chief Waisoni Injesi is quite skilled at nodding and prodding and responding.

There were many "Mmmmms" and "Ohooooos."

It took about thirty minutes for me to feel confident that we were on a positive track.

This picture was taken at the end of our time together.

The chief sits in this portrait with one of his wives. That's his daughter and grandchild in the background.

For me, the chief's face and eyes reflect a sense of thoughtful calmness.

He spoke about the way he leads - apparently, he handles crisis and joy with a sense of consistent, stable, strong emotional perspective.

He said he does not receive gifts or any form of taxes and other forced payments from the families in his village.

Chief Injesi is responsible for forty five households near his home.

He became chief for this community thirty six years ago.

He does not know his age.

Turns out, he has two wives. Each wife lives in a different home.

From what I can tell, the chief shuttles back in forth between each wife to ensure diplomacy and balanced leadership is available across his village. Smile.

Through his eyes, despite the progress in many areas of Malawi, it is much more difficult to live today than it was when he first became chief.

There are more people to feed with the same amount of land. This chief's land is sandy and less fertile than many other areas of Malawi.

Of great importance, over the last several years, the chief has not been able to procure government vouchers for discounted fertilizer.

He said that this is the single most important goal he has at this time - to gain access to modern fertilizer.

Chief Waisoni Injesi said almost all of his village is starving during this year's "hunger season."

Even his own family desperately needs food - one of his own children is using "Chiponde."

This chief never went to school. He said that some children in his village are able to attend school. Other children are not able to go to school because their families have no funds for uniforms and other supplies and/or the children are needed to work in the home and in the fields.

A few years back, the chief tried to establish a community garden, a source of mutual support. He hoped to diminish the village food insecurity. Unfortunately, this did not work. Crops never grew effectively. In this case, much like the many existing gardens of corn and tobacco near village homes, fertilizer was too expensive to afford.

Despite all the challenges in chief Injesi's village, he was open, positive, and warm.

He laughed very hard when I gave him my camera to take pictures of his family. His hand shook and his face became very serious as he attempted to work this modern gadget.

He laughed again with great enthusiasm when I started to play with the three dozen children who gathered just outside the chief's gate while we, the "Azungus" (white people), were working through our introduction and request.

In the end, we were granted the chief's full permission to work within his village.

I spent most of a day with an inspirational, single mom named "Sapuleni," who has nine children.

The chief knew her situation and wished her well.

Beauty And The Mud Hut ...

At times, the vivid colors of African fabric and the expressive curves and of an African woman's body seem eternal, especially in warm afternoon light.

I meet this woman, Margret Chitsulo, a few days ago at her home.

She has four children, two boys and two girls.

She and her husband, who works as a fisherman at a nearby lake, are quite poor. 

At this time of year, her family is often without food for days at a time.  When resources allow, she feeds her children bits of corn, millet, rice, and fish.

Yet, her spirit is bright.  

She did not go to school.  Her mother and father did not go to school.  She is pushing hard for her children to complete a basic education.  Her greatest wish is to see her children complete school and start into jobs far from the village where she lives.  She wants her kids to have a life much different than her life, a life without so much hunger and struggle.  

She spent about an hour sharing the details of her home and the activities of her "everyday" afternoon.

  

Tribal Medicine Rattles And Rocks ...

Around noon, in the full heat of the day, I met Fanny Chikopa and her youngest child, Mphatso, in a small village near Chickweo. 

Fanny has four children.  

Each day, her husband walks for several hours to a nearby lake and works as a fisherman.  When all goes well, he catches "chambo" and "matemba."  

Unfortunately, at the end of the day his nets are often empty.  

To help support the family, Fanny tends a small garden of corn and pumpkins near her brick and mud home.  

During hunger season, like so many other families in their village, Fanny has little food to feed her children.  

Fanny spoke about the challenge of making it through January, February, and March each year.  

Poverty and hunger are not a new experience for Fanny.  She has five brothers and four sisters.  Quite typical for Malawi.  Her parents and her siblings live in the same village.

You may note the charm on Mphatso's neck.  

There is a story behind this piece of powerful jewelry.

A tribal "healer" made this necklace for Mhpatso to overcome sickness at a young age.

When Mphatso was eight months old, he was very sick.  His eyes were infected and he struggled to maintain general health.  

At first, Fanny took her son to the local, rural hospital.  Unfortunately, after weeks of treatment, he did not get well with traditional, western, "allopathic" medicine.  

So, Fanny took Mphatso to see a tribal doctor to gather a "second opinion." 

The local traditional "healer" assessed Mphatso's illness and informed Fanny that "the bones in her son's head were not united."  The "healer" then told Fanny that Mphatso's head would grow large if he was not treated with special herbs.  

Fanny paid a fee of 50 Kwacha (33 cents) and the "healer" mixed a special potion of herbs.  

The "healer" then wrapped the herbs in cloth and tied thread around the "medicine" -  the necklace  shown in the picture.  

Mphatso has been wearing this "medicine" for four months. 

Fanny said that Mphatso has ten more months of treatment to finish his therapy. 

Apparently, ever since the necklace was put in place, Mphatso's eyes improved and his health changed dramatically.  

Fanny is convinced that the traditional medicine led to Mphatso's recovery.

Who knows?   From my vantage point, this may be true.  

Faith and momentum in one's beliefs are powerful tools.

In a few months, Mhpatso, which translates as "gift" in english, will walk about in a colorful, difficult world.   

Harvest will bring plenty of corn and vegetables for the early months of the Spring and Summer, yet the annual hunger cycle and challenges associated with extreme poverty will likely continue.  

Mphatso's early path has been touched by both the old and the new.  

Yet, his future is filled with uncertainty.  

How Malawi will change?  My guess?  Slowly. 

How will his village evolve?  It depends.  Roads and infrastructure can transform a region in a few years, but the resources to create these changes are not readily available.   The tribal chiefs I met with indicated it is harder now than it was years ago for families across the region.

Will there be a solution to food shortages and extreme poverty that is sustainable and effective?  This is complex.  No one has a viable and proven path at this time.  

It may take several generations before electricity and clean water are widely available near Mphatso's home.

  

One thing is clear.  Mphatso needs both traditional and modern faith, a deeper education than his parents and grand parents, and new opportunities to thrive.

  

Chief Mphatso Mati Mati ...

Chief Mphatso Mati Mati, which means "Gift Tomato" in English, agreed to meet with me a few days ago.

You may note his regal "flip flops."  

Yes.  He recognized I am a very, very important visitor.

Chief Mphatso Mati Mati leads 1,600 families in a area near "Chipolonga."

As an "Azungo," I sought his permission to visit three families within a nearby village.

The blue bag near his feet is the "offering" I brought for our meeting - beans, soap, corn flour, and sugar.  

After a long introduction and explanation of our work by the nurse and translator who traveled with me, the chief and I held a warm conversation.

It turns out, Chief Mphatso has been "chief" for fifteen years.  

He was appointed at age twenty one years old to his current role by the village community.  Apparently, he had the "right stuff."

Despite options to expand his marriage options, the chief has just one wife and seven children.

He spoke about how he leads.  He uses old school tools such as messengers and town hall meetings to communicate with his constituency.  He spoke about poverty and conflict.  He spoke about crops and harvest.  

The thatch structure on the left side of the image above is his own drying hut for tobacco.  Few individuals in Malawi smoke, but tobacco is known as a sturdy crop that produces cash.

The brick and mud structure behind him is his home.

Fortunately, he knew about Chiponde.  

During our conversation, he reflected on the ongoing work the non profit group I am associated with completed over the last few years.  He assessed our small caravan.  He listened and asked a few hard questions.  

Then, with a nod and a light smile, he granted me access to his village.

Off we went ...

In The Early Morning Light ...

As mentioned in earlier posts, each weekday during "Hunger Season," which stretches from November through April each year in Malawi, hundreds of mothers and children from dozens of rural villages in central and southern Malawi gather in the early morning light to attend a once a week, or in some areas, every-other-week nutrition clinic.  

By 6:00 AM, informal lines and small discussion clusters form as mothers and children await the arrival of the Project's team of nurses, student doctors, and volunteers.   

Despite what may be a long, long walk, often in the dark, typically with bare feet across uneven, rocky trails and rough dirt paths, young, middle age, and older women come together with a common emotion - hope.

The rich emotions in the eyes and faces of many mothers linger in my memory. 

There is strength and purpose in their spirit.

They often express a sense of quiet kindness, an openness, and a depth of patience that generally eludes our daily experience in "more developed" regions of world.

Calm Within The Storm ...

I remember the feel of this moment.

Hundreds of mothers gathered early at a "Chickweo," a rural clinic site to receive testing and consultation for their children.

Rain fell softly in the courtyard.  Children were crying.  The village was just lifting into the full motion of the day.  Yet, the scene felt calm almost surreal.

I slipped between two tightly packed lines of Moms and faced toward the front of the colorful procession to produce this picture, a memory from this busy day.

You may note the health cards on the dirt which are used to mark each mother's place in line. 

One mother did not have a card.  Her spot is marked with a rock. 

Bare feet, umbrellas, loose cloth bags, and brightly colored cloth ("Chitenjes"), fill my view.  

Patience And Hope ...

This image was produced a few days ago at Chickweo, a small village about three hours from Blantyre, the home base for Project Peanut Butter.

For several years, Project Peanut Butter served this site once every two weeks.

Yes.  If we had an "audio" button, and you hit "play," you would hear dozens of children screaming and crying at high volume.  The atmosphere can feel quite frenetic.  

Yet, there is a simple flow and a natural calmness at this clinic.  

Mothers and other caretakers seem to exhibit great patience, perhaps this skill is nurtured by their everyday life experience.  Long lines, long walks, bad weather, and unpredictable health and economic circumstances may bring a certain calm to one's path. 

The medial team's commitment to serve every mother and every child "in need" with an assessment and to provide every qualified child (a child in crisis) with RUTF (Ready To Use Food) may also contribute to the character of this site and other sites.  

It may take two to six hours for a mother and child to receive care and, if appropriate, to receive therapeutic food, but everyone is served. 

Moms wait patiently with a sense of hope.  They wait without a sense of scarcity that enters other moments in their lives.

Reaching Toward Harvest ...

In the image above, a young girl sits on a pile of freshly picked "maize" (corn).  

Her brothers and sisters are gathered around her - everyone is involved in pulling the kernels from the husk of the corn and celebrating the start of an early harvest.

At this time of the year, corn is just starting to finish the critical growing season.

After the kernels are pulled from the husk, the corn is dried.  

Then, the dried corn is taken to a corn mill.  

After the family pays a fee based on the weight of the corn, the kernels are turned into flour.

Much like many other regions of the world, such as central and south America, one can hear local corn mills grinding hundreds of kilograms of flour early in the morning.

The corn flour is then used as the center piece of most meals.

In southern Africa, typically, twice a day, this corn flour is mixed with water and vegetables to create Nsima (corn stew). 

A quick side note ...

In areas such as central and south America, corn flour is used for tortillas and other traditional foods.  With beans and rice, this often produces a nutritionally rich and balanced diet.

  

In America, we use corn in a central role as well.  Most of our cows and chickens are fed corn.  Corn flour is used in a tremendous variety of foods.  Corn oil is used to fry foods and as an additive in many products.  The feature role for corn in America is even larger.  We also use corn syrup as one of the dominant ways to sweeten our food and our omnipresent processed beverages.  When you drink a Coke or a Pepsi, you are drinking processed corn.  

Our diet, unfortunately, is not typically so "balanced" or nutritious.  Thus, many medical professionals and policy makers argue we produce a escalating crisis with diabetes, heart, and other illnesses.  

We tell ourselves, we are "sophisticated" and modern, yet we continue to pursue some unhealthy paths with vigor!  The power of our commercial engine is strong.   

Back to Malawi ...

Each year, this country moves through a common cycle.

During most months, the weather is hot and the ground is dry and parched.

From November through about March or April, the country receives rain.  Some years, there is a great quantity of rain and water for crops.  Other years, there is drought.

Over 80% of the population survives as subsistence farmers.

By far, corn is the dominant crop.  

Tobacco and a range of vegetables fill in the agricultural mix.

Fertilizer is of tremendous importance.  Without this rich addition to the dry soil, many "gardens" produce a tiny yield.  Thus, farmers throughout the country seek access to this resource.  

I am told a single 50 Kg bag of fertilizer, if used sparingly, will provide support for a garden that is roughly two hectors in size.   As a geeky side note, a hector is about 2.5 acres or roughly 108,000 square feet.

The government provides subsidized packages to a portion of the poor population - a 50 KG bag of high quality fertilizer that sells for 10,000 Kwacha in a store (about $60) is sold by the government to individuals with a "voucher" for 800 Kwacha (just over $5).  Big advantage.  Big opportunity for discriminatory practices and for corruption.  As one would guess, vouchers are difficult to get, even for very poor families in desperate need of help.  

In the villages, families control the use of land that is passed down from one generation to the next generation.  I am told a village chief may provide additional land to a needy family.  

In the countryside, almost every bit of visible land is used to produce corn.  When the soil is weak and parched, the corn grows to a small height.  These plants are often light green or yellow and brown.  When the soil is enriched with fertilizer and there is a healthy amount of rain, the corn grows much taller, sometimes to eight or ten feet, and holds a rich, dark green color.

When we drive into the countryside it is quite common to see on "garden" with very robust corn then a garden a few hundred yards away with fragile, lightly leafed, dry, and poor growing corn.  One family has access to fertilizer.  The other family is trying to grow corn without support.

There is an entire art to the number and type of seeds used in the fields at the start of the growing season.

While the single crop of corn is growing, many families run out of food from the harvest in the previous year.  This is the source of the "hunger season."  

Thus, there is a strange contrast.  One sees lush, green vegetation throughout the country during December, January, February, and March, yet there are massive food shortages.

During these critical and stressful months, everyone is waiting for the corn to grow to its fullness.  

The baby in the picture lives in Mbeza, a small, poor village in southern Malawi. 

She is sitting on her family's first production of corn for this year.

For her family, relief from the experience of hunger is in sight.  Most other families throughout the central and southern regions of Malawi have not started the harvest yet.  Hunger is still in full "swing."

 

Merchant Of Light ...

Just after the sun dropped beyond the horizon, our four wheel drive vehicle rolled slowly down a hill on a rocky path toward a small village named "Namindangi."

We stopped near a group of wooden shacks and small concrete structures.

Dozens of children ran from their homes to gather near the side of our dusty car.

Along the dirt path to our left, several older women wearing colorful clothing presented neatly organized piles of green, white, and orange pumpkins and bright red tomatoes for sale.  

For just a few precious dollars, a visitor could purchase tens of pounds of food.

Further ahead, in an open area near the center of the village, a merchant named  "Casim" called for our attention.

Here, we found a source of light.

"Casim," at thirty-three-years old, is a colorful salesman of "paraffin."   He packages his beloved "paraffin" in small plastic sleeves and sells "bundles" of product in two different sizes.  

Small bundles are 10 Kwacha (6 cents).  Large bundles are 20 Kwacha (12 cents).  

What are these carefully displayed packages of "paraffin" for? 

None of the homes in the village have electricity.  

So, basic utilities such as lights and refrigerators are not an option.

When the sun goes down, the village is very dark.  Often, wood burning fires produce the only light.  

Many homes are made of thick mud walls without windows.    

If villagers can afford the luxury, small candles and rustic paraffin lamps are sometimes used as a source of light just before bed.  

In countries such as the United States, we assume power and light should be available at all times.  Take our power away for an hour or two and we move into a frenetic, confused, emotionally charged, demanding state.  We are outraged.  

In a rural areas within Africa and other regions of the world, access to electricity and light are special gifts.  

For "Casim," the need for light offers an attractive business opportunity.  The money he makes selling paraffin complements his only other source of income - a major endorsement deal with Nike.  Note the proud display of the globally omnipresent "swoosh."  Smile.

  

A Fashion Statement : Malawi Style ...

Women in the rural areas often have little in terms of material resources, yet they find a way to present beauty and individuality through a hundred small personal touches each day.

Even little children in torn rags evoke this impression.  

Babies are dressed and wrapped in cloth that often matches with a mother's outfit.  Even the young children seem able to clap in unison with melodic chants and songs.  Five and six year old girls sing with voices that are light, elevated, "in tune."  

If one looks beyond poverty and stress of daily life, one finds warmth and richness.

As a photographer and filmmaker, I am often swept away with the color, motion, and sense of beauty African women and children bring to life.

If I wish to create deep laughter among a large group of African moms, I just need to provide a few steps of bouncy motion while they are in the midst of a morning celebration.

Fortunately, my camera is focused away from my own pale, sweaty, fashion statements and my not-so-finely-tuned capacity to sing and dance.  I can use some consultation! 

Shared Spirit ...

The swirl of motion and color continues ...

An Albino's Journey ...

Last week, I met a young boy, Ikra Jailos, the "albino" child shown in the picture above.

Beatrice, Ikra's mother, is shown in the background.

Ikra is squinting due to his extreme discomfort with bright sunlight - a common experience for an "albino."

Ikra's father is also black.

Try to imagine Ikra's life experience both today and in the future.  

He is now two years eight months old.  

As he grows older, he will face the world surrounded by brothers and sisters, extended family members, and a village full of families who hold a common and powerful difference - the color of their skin.

It's one thing to be a white child in a white family in a black world or a black child in a black family in a white world.  

Imagine being a white skinned child in a black family in a poor black village in rural Malawi.

How will Ikra be treated?  

His skin tone will make it very difficult.  His peers and family spend almost all of their waking hours in the hot, African sun.  There are many challenging cultural stigmas and spiritual beliefs around Albino's in Africa.  Different tribes view this skin condition in very different ways

Stories exist from Tanzania and other areas of tribal healers ascribing special powers to an albino's body parts.  This, of course, can lead to bad outcomes.

In Malawi, Ikra is likely to feel a sense of separation and discrimination that few of us can fathom.  

Perhaps, an African American in a white neighborhood with racist tendencies in America may feel some of the same emotions.  I want to believe that our community in the United States has moved well past this, but I recognize our fear and our ability to inflict silent and visible pain continues.  As a global community, we are not great at seeing past the color of another person's skin, especially when this individual's skin color is different than our own.  It is hard to be conscious of all the ways we discriminate, the emotion and history we attach to our view of skin color.   

In this case, Ikra has the same parents as his brothers an sisters, yet he is vastly "different."  I want to believe he can be accepted and embraced as fully as his siblings, but I know this is difficult. 

When I met Ikra, I was reminded of a conversation with a good friend about ten years ago.  We were in the midst of idealistic pondering.  I asked him how he would change the world if he had just one wish.  He said he would create a new condition for all human beings.  He proposed that on January 1st of each new year, each of us agree to wake up with randomly modified skin color and, if we were not married, accept the possibility of a shift in sexual orientation.  

This one change in our lives, he argued, would not transform any aspect of our personality or our inner spirit, but it would radically impact predujuce and the pain of discrimination.  Wow.  This would, I admit, be powerful medicine.

Until we are able to feel empathy, to walk in another man's shoes (or skin), it is hard to come together as a global, national, or local community.  We tend to act as though we are radically different, unlike each other.  Yet, in many ways, at the core, we all seem to share more than we differ.  

Ikra faces a tough path.  

Unfortunately, in addition to his skin tone and the other complications of being born as an "albino," Ikra's family is very poor.  

As a result, Ikra's parents has little food to feed their children.  

Yes.  Poverty and malnutrition are color blind.

A month and a half before this picture was taken, Ikra exhibited the symptoms of severe acute malnutrition.  He was in the midst of crisis.  Without treatment, he was likely to die.  

Fortunately, he is recovering on a promising path.  Over the last six weeks, through the use of "Chiponde," Ikra gained close to four pounds.

Now, Ikra's footsteps into the world continue.  

I hope for the best.  

Belly Signals ...

In rural areas of Malawi and other regions of the world with extreme poverty, children often exhibit swollen and extended areas of their body that stand in strong contrast to their lack of access to food and thin body frame.

This young girl presents a typical case.  Her name is Violet White.  

She is two years and eight months old.

As you can see, her ribs are visible.  Yet, she holds many signs of malnutrition and her mid section is quite full and puffy.  

She receives treatment at a temporary health care site named "Chamba."

I met Violet under a large mango tree near several tables and bench that are used as a outdoor medical office.  

Nurses and two doctors from Project Peanut Butter arrive once a week at the same time, on the same day of the week to offer support.  

Village health care workers from ten to fifteen miles away are paid a stipend to encourage children in crisis to travel to this location.  These village health care workers (HSAs) maintain active contact in almost all villages across the country side.

During "Hunger Season," hundreds of mothers and children walk for hours with their young children to attend each clinic. 

For the last three months, Violet's mother, Magret, received "Chiponde" to use as medicine for Violet's moderate malnutrition.

Fortunately, Violet appears to be recovering, but her progress is slow.  

In this case, Violet's stomach area appears to be swollen by a number of health factors.  

Parasites may be part of the story.  In many rural villages, clean water is a challenge.  Food is often stored in less than ideal circumstances.  As you might guess, broad education about health and hygene is still a "work in progress."  

For Violet, a recent severe case of Malaria may have caused the spleen and other organs to swell, which extends the stomach and groin. 

Sometimes, when a child's body is very weak, their muscles lose the capacity to tightly hold the organs within the chest and stomach area.  One of the doctors feels Violet may suffer from this challenge as well.

In a few weeks to a month, the annual harvest will take place throughout Malawi.  This will be a promising transition for Violet.  Food will suddenly be more prevalent.  

With further medical care, improved nutrition, and good fortune, her health holds promise.

From my short time with her, I sensed both sadness and hope.  It is encouraging to imagine her as an energetic and vibrant little girl.  

This is a future to wish for.

Only In Africa ...

The slightly broken, wooden structure in the foreground of this picture is an old door.  

This door had a second life, a history that is difficult to fathom.  It was used as a bed, a bed with a special purpose.

This picture was taken yesterday near a rural health clinic in southern Malawi.  The nearest hospital is about ten miles away.  Few families have any form of transportation outside of their bare feet.  A few families own bicycles.  Occasionally, a car drives by on the nearby dirt road.  Food is scarce.  Poverty is extreme. 

Unfortunately, in this part of the world, health issues are serious and systemic.

Right now, in addition to Malaria, TB, and HIV, there is a major outbreak of Cholera in nearby villages.

Cholera, as you may know, is a nasty infection.

Many people with Cholera die in several days from dehydration.

Rural health care workers use this old door as a bed for Cholera patients.  

You may note the hole in the middle of the wooden structure. 

This hole is positioned in an appropriate place for the patient, an African solution to the need to measure all of the fluids that are lost with massive, constant diarrhea.  

Through every hour during the heart of the infection, rural health care workers attempt to provide an equal amount of fluid back into a Cholera patient's body as the amount of fluid the patient loses through diarrhea through an IV (assuming a needle and appropriate fluids are available).

Imagine laying on this hard, wooden door in a dark, isolated building.  Not a comfortable thought.

The building in the background currently houses Cholera patients.  This small building is "off limits" to anyone outside of cholera patients and a small group of village health care staff.  

These government workers are paid about $50 a month to serve the rural areas.  They have light training in vaccinations and basic health issues.

Despite all of the challenges with modern medicine, it's moments like these that make one grateful for both the quality and availability health care in many regions of the world.

In Africa, you make the very best out of what you have.  

Impressions That Linger ...

Each night as I fall asleep, a tapestry of young faces and moving expressions flow through my thoughts.

Here are a few visual moments from today's clinic.  

Joy, uncertainty, hope, pain, and calmness are all found in the eyes of children in crisis.

Despite their deep hunger, these kids hold a special gift - their mother's love.

A Flow Of Color, A Lasting Embrace ...

One of the many memories I hold from my time in Malawi is a strong, positive impression of young children comforted by the embrace of their mother or older sister. 

It is rare to see a young child under the age of three who is not tightly bound and supported with human touch.

There is great power in this cultural norm.  

In this region of the world, kids must feel a deep and lasting sense of intimacy and connection that is quite different than a child's experience in cultures where children are more often separated from their mother and spend many more hours without this closeness. 

In this picture, you see a mother and three children moving in typical form - one child on Mom's back, one child in older sister's arms.    

Young girls learn early in life to partner with their mothers.

Two African Scorpions And A Bucket Of Rain ...

Monday was crazy, long, wild, colorful, memorable.

Up at 4:30 AM.  Quick breakfast and early morning organization.  Left for "Nkhate Market," a rural clinic in Southern Malawi, about 5:30 AM.

It started to rain about 7:00 AM.  By 8:30 AM, it was pouring.  Then, it poured some more.  

Light brown, clay-like, dirt roads turned to soft, dark mud.  

Water began to pool up everywhere.  

We moved the clinic from an outdoor area under a large tree to a small concrete and brick structure that serves as classroom part of the week and a health clinic part of the week.  

Our normal location is currently being used as a cholera isolation area.  Not a comfortable "zone" for us to work in.

In the first several hours of our clinic, about four hundred mothers came to "present" their children.  

The image above was produced in the mid-section of the morning.  

As you can see, women are packed into a small, dark room.    

It is very, very muggy, hot, and uncomfortable inside.  

Babies are wrapped on women's backs or held tightly by the hand as mothers push to move forward in line.  

Breasts are exposed everywhere to support infant feeding.  

Many mothers left home early in the morning.  

Some mothers walked for over four hours to arrive at this location. 

Hundreds of children cry continually.   

Some women sing and chat with their friends.  

Every mother seeks attention and an assurance that their child is safe.  

The doctors and nurses work continuously for five to seven hours.

Hunger Season is now in full form.

Unfortunately, many of the children who arrived at this clinic were extremely thin and "wasted" or swollen with edema.  

In most cases, there is absolutely no food in a mother's home.  The mothers of these sick children are doing the best they can.

Twice, we had to stop the clinic suddenly.  

Both times, a large, dark red, African scorpion appeared on the wall above the doctor's head.

Not a nice surprise.  

We were told these frightening creatures are quite poisonous.  

One was about eight inches long and the other was about ten inches long.  Each scorpion had about forty black legs moving in rapid fire.  

I am not sure how the scorpions grew so big or learned to move so fast.  Perhaps, they had a secret supply of "Chiponde" hidden somewhere near the roof.  

Each time a scorpion appeared, one of the male staff members removed his right shoe and had a rather violent conversation with our intruder.  That was that.  Not pretty.

At the end of a long clinic, I began a series of follow up interviews with three children I met during my first trip to Malawi.  Rough.

One child encountered a bad case of cerebral malaria and lost weight during the first two weeks after the "Chiponde" treatment began.  This child's health is now greatly improved, but the arc of his therapy with "Chiponde" will take longer than a typical case.

A second child recovered from edema and severe malnutrition and gained about a kilogram of weight since my last visit, but now suffers from what the doctor believes to be TB.  He had a cough that sounded terrible.  His father is TB positive. 

The third child encountered a severe bout of diarrhea from some type of infection a few days after starting "Chiponde" treatment.  Here too, there was great improvement, but the path was bumpy.  

We spent about three hours attempting to locate one of these children in his village.  One must get comfortable with patience in Africa.  

We traveled to the hospital.  We drove all over the country-side.

As we left to travel home, the fog rolled in.  Very thick.  Very damp.  

After all the rain, several river crossings were almost beyond our reach.  

We returned to our apartment around 7:30PM.   

The medical students and other project staff had several hours of additional work to prepare for the next day.  

I went off to download and archive images and video from the day, reformat my storage drives, and recharge my video and still camera batteries. 

I scarfed a plate of rice and beans and took a quick shower. 

Late night.  Early wake up call the next day. 

This trip is just starting to roll.

 

The Little Kitchen That Whispers and Roars ...

What's with the bunny suits?  

All in the service of ensuring clean, high quality food production, Malawi style!

Many of you ask : 

Where does the nutritional paste, Malawi's magic "Chiponde," a rich mixture of roasted peanuts, milk powder, vegetable oil, sugar, vitamins, and minerals, come from?

About five years ago, after experimenting with the European production of "Chiponde" (also known as "Plumpy Nut"), Project Peanut Butter's team created a small, local plant within Blantyre, Malawi.

USAID donated a major portion of the equipment.  

A portion of an old shoe factory was leased and converted to serve as a new manufacturing plant.

A talented plant manager from Malawi was recruited.

About eighteen staff were hired.

A new stage of Project Peanut Butter began.

Today, most raw materials for "Chiponde" are sourced right in Malawi.  

High quality milk powder, vitamins, and minerals are the only components of "Chiponde" sourced from Europe.

In all fourteen clinics where Project Peanut Butter's nurses, doctors, and other staff work, "Chiponde" is provided free to all qualified clients.  Qualification is based on international standards for Severe and Moderate Malnutrition.  

For outside corporate customers, such as Doctors Without Borders, The Clinton Foundation, UNESCO, and other charities and government organizations, the entire plant runs on a "cost recovery" basis.  The only charge for "Chiponde" is the actual cost of manufacture.

To keep costs very low, Project Peanut Butter's team strives to achieve donations of quality ingredients from international partners.  Many organizations provide support.  For example, WFP (The World Food Program) provides milk powder from Europe.   

As a result of the plant's efficiency, local labor, and donated ingredients, a full four to eight week treatment for malnourished child costs between $20 and $25 for "Chiponde."

Right now, the plant produces about two tons of "Chiponde" a day.  This translates into about 500 tons of product a year.  Yes, that's a lot of peanuts!

As a result of food shortages across the world and the increasing success and broad use of this therapeutic approach, demand for "Chiponde" (and "Plumpy Nut") is growing rapidly.  

Over the next six months, Project Peanut Butter will expand the Malawi plant to provide roughly three times the current capacity - up to six tons a day.

During the hunger season, which runs from about December through early April, the plant often operates at "full throttle."  Night shifts are common.  

The biggest manufacturing challenges come from the realities of Africa.

Sometimes, there is no electricity for days at a time.  Sometimes, suppliers run out of critical raw ingredients.  Bottling materials may be scarce.  Inventory management requires much forward planning.  

Each bottle of "Chiponde" is made with a commitment to eliminate water from the final mixture.  This ensures there is no capacity, no fluid support for bacteria.  Thus, "Chiponde" maintains a shelf life of roughly nine to fourteen months.  

A new packing machine with high-tech foil containers will be installed in the next year to push this shelf life to nearly eighteen months.   

You may have noted the different colored caps on the bottles in the second image above.  

For Project Peanut Butter's own clinical sites, bottles are sanitized and reused over and over again.  Thus, the rainbow of tops and scuffed labels on the bottles in this particular manufacturing "run."  All part of an environment friendly path!

For major customers, such as Doctors Without Borders, the plant uses shiny new bottles with crisp red lettering.

Each finished bottle of "Chiponde" contains about 1,200 calories of food and a broad spectrum of vitamins and minerals.  

Dr. Manary, the founder of Project Peanut Butter, refers to this product as an "atomic" food, designed to replenish a long-term deficit in a child's nutritional history.  

A young child with severe acute malnutrition will use roughly a bottle a day as therapy to heal from edema or "wasting."

As mentioned in earlier "posts," this approach allows a mother to avoid a hospital stay and return home where she can care for her other children and maintain her regular daily routine.  

Fortunately, this therapy is generating successful outcomes 90% to 95% of the time.