Curiosity, Mud Balls, And The Power Of Play ...

My new friend in the top image is working hard to re-design Malawi's health certificates - a simple task filled with discovery.  Yes.  Those forms are confusing.    

My buddy in the bottom image is finding joy in an evolving match of mud ball.  

There seems to be an international rule.

Kids find a way to transcend challenges each day.

I know the sound of hundreds of hungry children crying will remain with me for some time.

The sound of African children laughing and playing will linger as well

When I see a child rolling an old, rusty bicycle wheel simply for the pleasure of watching the hoop bounce through the countryside, or a young Malawian boy smiling as he samples fresh, hot, roasted corn that has been cooked over a dented, steel car rim filled with burning wood, or a group of kids kicking a tattered, dirt colored ball toward a wooden post that serves as a goal on a field that is converted in their hearts to a great soccer stadium, I think of the power we all hold in our minds.   

I am reminded of the old adage: "One man's junk is another man's treasure."  

This seems to apply both to physical goods and emotional experiences.    

I think about the perspective and expectation we bring to our day.

It is easy to get lost in our reach for what we don't have.  

If we allow it, kids with little to no material wealth, yet a joyful, open spirit shake our world.

Kwashiorkor ...

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

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

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

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

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

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

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

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

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

The Tales Of Our Lives ...

I met Abott Jackson in a small village near a clinic this week.

He has lived fifty five rich, full years.  

Through his eyes the landscape and cultural flow of Malawi has shifted and evolved.

For over thirty years, one powerful leader ruled this country.  

Today, a new form of democracy is being tested.  

Slowly, roads are built.  Health care takes little steps forward.  Industry and the hope of employment calls from the increasingly sprawling cities.  

The sense of "community" Abbot has known for so long is stretched and stretched.  Phones, TVs, and other tools have made the world smaller, more connected.  

Yet, all around Abbot, farming still dominates the flow of life - tobacco, corn, and other crops are grown in one short rainy and semi-fertile season.    

For most of the year, the countryside is brown, barren, and dry.  

Life can be a struggle.  

Abbot's face and eyes reflect much.  

There is a joy, a strength, and a sense of reflection that captured my imagination.

  

Walking, Wishing, Praying For Food ...

At each village clinic this week, the number of children and caretakers seeking food and medical support escalated substantially.  

Today, the team screened about six hundred children at two sites.  

At times, the scene was quite frenetic.  

I can't imagine walking for two hours and then waiting with hundreds of other women and screaming children for two to five hours for a chance to see a young doctor to gain possible admission to a program that provides free magic food that may save my child's life.  

I remain in awe of the determination and spirit these women demonstrate.   

One must learn patience and gain comfort with flexibility in rural Africa.  

I am reminded of a phrase uttered all over the world.  

"Yes.  It is possible.  God willing."  

Rarely, a day flows as expected.  

Surprises are the norm - some pleasant, some not-so-pleasant. 

Fortunately, many of the kids who arrive at the clinics remain outside nutritional crisis.  

Yesterday and today, doctors and nurses associated with the project I am working with "enrolled" about a hundred severe and moderately malnourished children in their monitored, home-based, therapeutic feeding programs.  

Enough nutritionally rich food ("Chiponde") is provided to feed each enrolled child through a week to two weeks, until he/she returns for testing. 

I am told most of the children "enrolled" will die if they do not receive immediate help.  

Right now, Malawi is deep in the stretch of "Hunger Season."

Many mothers I interview share stories of extreme poverty, a complete lack of resources, no food, and many mouths to feed.  

It is common for children to get just one or possibly just two small meals a day.  Often, all children receive are small amounts of corn (nsima) and other vegetables. 

The still images above were taken in between my documentary efforts with a video camera.  I am very challenged to communicate the emotion and character attached to this critical work.  

Each day, I am stretched in many ways - emotionally, creatively, technically, and physically.  My experience, however, is nothing compared to the struggle all around me. 

At many moments each day, I see and feel a sense of desperation and hope in the sea of mothers who come together with a common goal - an embrace of compassion.  

Yesterday, a blind woman with no husband and two young children came to one of our clinics.

Despite her physical handicap, she supports her small family on a tiny farm.  She told stories of tending her crops by feeling her way through the fields with her sensitive hands.  Her daughter led her to the clinic to seek extra food.  

One cannot help but reflect on the blessings we experience each and every day.

  

In The Midst Of The Wave ...

Each day, after singing together and listening to health lectures, woman, children, and other caretakers line up to gain a doctor's assessment and, if they qualify, special nutritional support.

The children are weighed.  Their height is assessed.  A review of their health condition is completed.  

The process is quite amazing to watch - hundred and hundreds of kids moving along a well worn path.  

Fortunately, the great majority of the children in the lines are hungry, but reasonably healthy.  The children who are not in crisis do not qualify for the "Chiponde" therapy.  Despite a long walk from their home, often several hours on dusty paths, and hours of waiting, this is "good news."

In the midst of each wave of women, children, and colorful African cloth, one finds little moments of magic.

This morning, this young child caught my attention.  

I love the embrace of her siblings foot and the sense of "Africa" reflected in the procession.

They Come Seeking Help ...

The pictures above show a few of the thousands of children who come each week for screening and support.  

In the first image, Heidi, one of the program's senior doctors, is working with a young child who experienced "wasting."  The child's name is "Kondwani."  She was born on June 30th of 2007.  She ways just 5.3 Kg.  This child has "severe acute malnutrition."  With four to eight weeks of  "Chiponde" (peanut paste, milk powder, vitamins, vegetable oil, minerals, and sugar), children in this type of condition have very high odds for survival.  It is remarkable to watch children with little energy, limp, and somewhat lifeless re-acquire a bit of their "light" when they first taste the magic, nutritionally dense paste.

In the second image, a grandmother is holding a fourteen month old orphan named Amina.  As is true for close to 1,000,000 children in Malawi, Amina's parents died from HIV.  At this point, Amina is quite small for her age and height.  She too has severe acute malnutrition.

The third image portrays "Jirane."  She is three years old.  The man in the picture is her twenty three year old brother.  Her mother passed away last year.  Her father is working in northern Malawi far, far from home.  There are six children in the family.  The two older siblings, a brother and sister take care of the other four children.  Unfortunately, at this time, they have no food.  You may note the incredible swelling on "Jirane's" legs.  This is "Edima."  When a child experiences a prolonged period of malnutrition, their ankles, head, legs, and arms may swell.  In many cases, the swelling is so strong that the skin becomes shiny and sometimes breaks open.  Fortunately, this condition may be corrected relatively quickly with nutritionally dense foods.  In one to two weeks, with Chiponde therapy a child's Edema may be gone.  Then, the child is left with loose skin for a short while.  The clinical team feels hopeful that Jirane will fully recover.

The last image reflects the state a maln0urished child may move toward - little energy, upset, uncomfortable, eyes somewhat lifeless.  This child was able to eat and start on nutritional therapy.

All of these kids are vulnerable.  They don't have access to more than one or two light meals a day - typically mushed corn that is still left from last years harvest.

On many weeks, the clinical team screens one to two thousand children.  As we move farther and farther into the "hunger season,"  more and more children and mothers or other caretakers appear in long winding lines at the daily clinics.  Chiponde and other nutritional support is provided free to all children who appear to be in crisis - qualified as moderate to severely malnourished.  

Taxi A Go Go ...

Throughout Southern Malawi, bikes are quite common.  

When we drive on the dirt roads, bikes and riders continually swerve into the dirt ruts and paths along the main open space to allow the vehicle to pass. 

If one arrives in a congested area where building and pavement exists, dozens of bike taxis stand ready for passengers.  Standard fees are twenty five to fifty "Kwachas",  fifteen to thirty three cents.  

This "driver" and his loyal friends worked me hard to sell time on that coveted rear seat.

 with 

Yesterday, on the way home from our clinic, we stopped in this same village.  I figured it might be worth hiring a bike taxi to roll me through the small outpost with my video camera up on my shoulder - sort of culturally appropriate "dolly."  Humor evolved.  I hired a large guy with a shiny bike and a well padded passenger seat.  The price?  About a dollar for a long ride in the late afternoon sun.  

As soon as we started, I knew my ride would be an adventure.  The bike I rented had wheels of the "not so round" vintage.  We swerved left, right, left, right, left right and bounced up and down.  I remember my efforts to point the video camera in a somewhat straight manner and laugh.  All part of the journey.

Imagine ...

One of the villages where we work is about thirty kilometers from the nearest road.  At this time of the year, it is wicked hot with short afternoon rainstorms and flash floods.   Within this village, much like many of the small communities in rural Malawi, life revolves around subsistence farming. 

Many families have a small plot of land.  Their entire year's food supply depends on one crop of corn.  The big rains came in November and December.  Right now, the corn is growing near it's mid to full height.   Harvest in about four to six weeks.  

Most of the families in this village are currently our or nearly out of food.

Generally, they live in small, one room structures with dirt or concrete floors.  Fires are used to cook - inside and outside their home.  Often, cloth thrown over the floor is used as a bed.  It is unusual for an individual to have more than one or two sets of clothes.  Shoes are a luxury.  Days are long.  Women work incredibly hard.  Water is often several kilometers away  Firewood and food are challenges each meal. 

Illness is common.  TB, HIV, Malaria, colds, coughs, and infections of other kinds seem to be daily partners for so, so many of the children and adults we work with.  

Last week, there were several cases of Cholera in this child's village.  A tent with an informal barrier to visitors was established near the tiny health center. 

My impression is that the community drives forward with each day.  There is no expectation that life will be radically different tomorrow.  Despite the hardships, one finds a deep sense of community and the type of joy and curiosity children display all over the world.  Culture and customs are strong.    

If you allow yourself to be touched, your heart is stretched.  One feels the deep sense of the many blessings so many of us experience, the unconscious benefits we hold each day in most of the world.  

Poverty is rough.  Solutions to many of these issues are complex.  Yet, there are bright moments.  In areas such as malnutrition, there are major breakthroughs and a sense of progress.    

I constantly feel humbled and encouraged by the experience of watching the doctors and nurses I am traveling with complete each day's clinic.  They are tireless, hopeful,  and committed.  

Even after screening and supporting three to five hundred children in a five to six hour period, they engage further outreach.  We often transport three to six children to the hospital at the end of a long, exhausting day.  

In Malawi, the caretaker and the child check in to the hospital together.  Often, a mother sleeps under the bed of the child.  The nutritional recovery units are packed.  Kids may need to stay for a week to several weeks to recover from crisis.  The great news is that with support and dense nutritional food supplements such as "Chiponde" (the food developed by the doctor I am working with, Dr. Manary), most children survive and move on to stable health.

 

The Precious Bond ...

Over and over, I am struck by the intimacy and bond between African mother and child.  

Kids are wrapped and carried throughout the day - establishing a powerful connection.  They are rarely outside the embrace of their caretaker.

One often sees rows of mothers, each with a child or two children wrapped on their back, walking along dirt roads and small winding paths, gathering wood, water, and food.  

They seem to be in constant motion.

Six to twelve year old girls often walk beside their mothers and carry an infant on their backs if their mother has twins or two young children at the same time.

Many children in Malawi are breast fed until they are two to three years old.  The kids seem to develop the capacity to "self serve" whenever hunger strikes.  

This, fortunately, provides vital protein to many children who might develop malnutrition if they ate only crushed corn, pumpkin seeds, and other common, indigenous foods.

Many of the children treated by the nutrition program I am working with experienced disruptions in this supply of breast milk.  

Often, their mother has become sick, their father has died and the left the family with no resources, or some other event has disrupted the normal flow of their home.  

In rural Malawi, many families live on a thin edge.

Joy Is Where We Find It ...

Yesterday, just before we started work at the clinic, it rained lightly.  Our second vehicle with equipment, the primary doctor, nurses, and other staff was still in transit.  A large crowd of women gathered under a large tree near the open space we work in.

I left my video equipment in the truck and took the opportunity to wander for a few moments near Chikadza Village.  

A charismatic young boy, Marizan (ten years old), and his younger sister, Namiziya (eight years old), offered a warm welcome.   Their father has a small plot of corn nearby.  The survive on little.  Yet, they seem "present" and filled with hope. 

In just a few moments, we shared laughter and a sense of shared discovery.  

I couldn't help but feel their strong bond of closeness.  

I admired their sense of play.  

They stayed near my side for several hours observing the flow of the clinic and my efforts at documentary work.  

I remember their captivating smiles and the bright light in their eyes.  There is magic in our lives if we can hold this sense of "wonder."