(Republished with permission from the St. Louis Post-Dispatch. This article originally ran on Monday, Dec. 11, 2006.)
By Eric Hand
St. Louis Post-Dispatch
In the moonless African night, it is difficult to see your own hand. A fuzzy outline emerges only by the spectral glow of the Milky Way.
A rooster’s cackle rips the silence. Mark Manary stirs from his sleep to change a flat tire in the pre-dawn gloom.
By 6 a.m., the sun has rocketed above the horizon. As Manary drives to one of his feeding clinics on the Malawian frontier, people from unseen paths fill the fringes of the road. They carry parcels and water and children. They push carts and pull goats.
Manary, a Washington University pediatrician, is proud of his feeding clinics but disgusted by the prevalence of hunger in Malawi, where a third of the nation is malnourished.
Eventually, Manary hopes to test the nutrition of a cassava plant genetically engineered by the Donald Danforth Plant Science Center in Creve Coeur. Until then, he is treating hungry children on his own by feeding them peanut butter at home rather than milk in hospitals.
The logic for peanut butter is simple: It’s dense and energy rich. It doesn’t spoil. Because it keeps so well, mothers go home with two weeks worth of peanut butter for their children. That reduces hospital costs, eliminates the risk of hospital infections and gives mothers more time to care for their families. In one study of malnourished children, less than half of those treated in the hospital recovered, while four-fifths of those receiving peanut butter got better.
Manary’s nonprofit organization, Project Peanut Butter, has proven the benefit of the technique to the World Health Organization, which in 2005 gave its stamp of approval.
“The international nutrition community recognizes that this is the way of the future,” Manary says.
It’s catching on so fast that the peanut butter factory Manary founded in Blantyre, Malawi, can’t keep up.
Factory manager Liyaka Nchilamwela says, “We’ve been getting so many phone calls from outside the country — Botswana, Namibia, Zambia, Mozambique — asking if we can supply them. I’ve been telling them I don’t have the capacity.”
New equipment will allow Nchilamwela to double production of the little half-pound jars labeled “Plumpy Nut.” Every day, the plant turns pallets stacked with ingredients into two tons of the stuff.
An impatient idealist
In many ways, Manary is like Lawrence Kent, the Danforth Center nonscientist charged with gaining permission from African governments to test biotech cassava.
Like Kent, Manary is an interventionist, an idealist who thinks change can help. He says things like: “I signed on to make the world a better place. That’s why people should live — to make the world a better place before they leave.”
But there are differences. Kent wears suits and doggedly pursues the permission of people in power. Manary is more impatient. He rolls up his sleeves and does things, sometimes without permission.
“You’re most likely to get acceptance and success when you deliver the remedy to those who need it most. You don’t start with the Ministry of Health. You start on the ground, at the grass-roots level,” he said.
En route to the feeding clinic, he pulls his sport utility vehicle over in a bustling town of fish hawkers, coffin makers and butchers who slaughter goats. He finds a tire shop to fix his fifth tire; driving in Malawi without a good spare tire is a bad idea.
Two men slather soapy water over the tire and pump it full of air. They look for telltale bubbles. The tire fixers find the leak and splice a patch over it. The SUV is off again, bouncing and bucking. Manary drives fast. It’s easy to see how flat tires accumulate.
Lines and lifelines
After an hour’s drive on dirt roads, the landscape hasn’t changed: deforested hills in the distance, hardscrabble fields of corn and cassava, people walking on the road or sitting in the shade.
Towns with main streets appear suddenly, miles from a paved road or a phone line.
One of these is Chikweo. Boys and girls, caked with dust, play with bicycle rims. All are bare-chested, for in Malawi, modesty is more about covering the leg than the chest.
Dozens of women wait in line at the feeding clinic. All have walked here, some for many hours beginning before dawn. Here they will wait most of the day for peanut butter.
Children hang off the women in slings knotted from chitenji, the colorful scarves the women use for clothes and satchels.
Manary patrols the line looking for malnourished children. He finds a sleeping girl pressed against the back of her grandmother, herself as small as an American child.
The child’s mother died the previous week from a “long-standing problem,” code for AIDS. She is 15 months old but weighs less than a normal 4-month-old. She isn’t getting breast milk and is shriveling fast. Manary squeezes a swollen foot to show the trapped fluid that signals kwashiorkor, a disease caused by malnutrition.
“This has been going on for 6 months. This child is going to be severely malnourished,” he says.
The weathered women of Chikweo wait in line to unwrap their bundles for inspection. The children scream as they are weighed and measured.
If the children are too small, the women are given extra grain. If the children are precariously tiny, they get peanut butter.
Manary knows that peanut butter, though effective, is only a Band-Aid that keeps children alive for an uncertain future.
The peanut butter line is a lifeline. But until the women of Chikweo can grow more food, the line also is a tether: to peanut butter, to aid, to the intervention of a foreigner.
“The aim is not to grow and stay there forever,” Nchilamwela says of his factory. “The aim is to eliminate malnutrition.”
ehand@post-dispatch.com | 314-340-8250