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.

 

A Union Of A Different Sort ...

Yesterday, at the airport in Johannesburg, just before my flight to Blyantyre, I made a new friend, John Obongo Mwafulirwa.  

John spent his life growing up and working in Malawi.  

He is a proud father of four children.  This is "wealth" in Malawi, to have a big, healthy family. 

He spent his career in construction in Blantyre and other small cities.  He now serves as the General Secretary of Malawi's Building Construction Civil Engineering and Allied Workers Union.  

Flying to Johannesburg, where we met, was a big, big venture for John.  He had just completed a conference with union leaders from other countries all over Africa.  No surprise, the primary theme of this meeting was "how to enhance wages for union workers."  

Within a few seconds of introducing myself, John reached out his hand to share an embrace.  Throughout our conversation, he expressed laughter and a sense of warm positive, openness.  This is quite common here in southern Africa.

I had many questions.  John had much to share. 

It turns out, John represents about 8,000 workers in labor negotiations with government and private businesses.  He also manages training and education for this community of construction workers.  

We spoke about the reality of unions in Malawi - how hard it is to protect worker's rights and ensure "decent, living wages" when there are millions and millions of people waiting for employment of any kind, at any price.

Eighty five percent of the work force survives through simple, subsistence farming.

In Malawi, there is no formal pension system (a small number of private businesses offer very limited retirement support), there is no social security from the government, and there is no unemployment insurance or training available for almost all unemployed workers from any source.  Bank accounts are primarily in place for a small portion of the population - relatively wealthy individuals who live in the cities.

If you don't have work, you are on your own - survive or perish is the fundamental value. 

John smiled broadly and laughed out loud when I told him about some of the benefits many U.S. corporations and the U.S. government provide.  

Then, we spoke about wages.  

In Malawi, John's union pushed hard through may years for government sponsored commitments to hold wages at a minimum level.

He feels his union achieved powerful milestones.

The current law?  

An employer in Malawi is required to pay at least 129 "Kwacha" for an eight hour day of work. 

Here's a dose of Malawian reality.  This government mandated daily wage translates to about eighty five cents in US currency (150 Kwacha equals about $1 U.S.)!  

Of course, many employers who wish to establish loyalty and a stable staff pay much more, sometimes up to 200 or 250 Kwacha a day.  

This elevates pay up to roughly $1.30 to $1.65 for an eight hour day - a good salary here in Malawi. 

To become a successful, well employed construction worker, one might attend technical school for three to four years, work as an apprentice for several years, and then go on to make full construction wages when employed as a professional member of the union.   

Imagine working in the hot sun all day, five days a week, fifty weeks a year for about $300 in annual pay - a tough haul.  

You may wonder how the union supports its own operation.  

Each union member pays 1% of their salary in union fees.  

It would be interesting to contemplate that level of contribution as a policy for America's unions.  

It was great to hear John's perspective on the future.  

He is encouraged and hopeful - a reminder that joy and happiness have more to do with expectation and perspective than individual life circumstances.