To reach Dr. Patricia Wolff’s Meds & Food for Kids clinic, you go to Cap-Haïtien, in northern Haiti, and weave your way to the back of L’Hôpital Universaire Justinien, passing through wards so crowded with scared, suffering babies, you feel like you’re wading through screams.
But in the back room where Wolff holds her clinic, it’s quiet.
Two little girls stare at each other from their mothers’ laps. One has strawlike, orangish-brown hair, a telltale sign of malnutrition. Her eyelids are heavy, but she holds them open to watch the other little girl. That one has dark hair, fastened by ponytail holders with pink baubles. Her mom removes them before the nurse takes her to the scale, so her weight will be accurate.
Fourteen pounds—at 2 ½ years old. “That is the weight of a 5-month-old at home,” Wolff says, her voice low. “She is below ‘severe’ on the World Health Organization chart.”
The mother will leave with a supply of Medika Mamba (“peanut-butter medicine” in Kreyòl), and the girl will be fed this fortified, therapeutic food for the next six to eight weeks. If she’s like most toddlers, she’ll leave the program at a normal weight, her eyes bright, her immune system already stronger.
The little girl with the orangish hair, Samantha, weighs 8.8 kilograms, normal for her size. That means she doesn’t meet Haiti’s Ministry of Health criteria for the program.
Wolff gives Samantha’s mother the bad news and adds that the child urgently needs vitamins. Just by looking, she can tell Samantha’s health is in danger. Researchers still argue about what’s missing from these kids’ diets. Protein? But some children are severely malnourished and still have black hair. A trace mineral? No one’s analyzed Haiti’s soil carefully enough to know which mineral’s missing.
“We know we fix it with Medika Mamba,” Wolff says. “If we feed that child Medika Mamba, she will have black roots in two weeks. But Medika Mamba has vitamins, protein, minerals, everything. We still don’t know which of those things fixes it.”
For Samantha, the point’s moot: She’s not eligible for the program. Wolff has to follow Haiti’s national protocol.
She gives a quick shake of frustration and moves to the next patient. One after another, babies are slung in a scale like a fishmonger’s and suspended there just long enough to let out a good long wail of indignation. They are laid on a board and measured for length—they’re not wild about that part, either. But eight weeks later, they come back plump and giggling.
Could they have gotten well on their own? “Probably not,” says Wolff, “because they can’t get enough high-quality, super-dense nutrition into their small stomachs. The food available here is not terribly nutritious, and it’s high-volume, big.”
Medika Mamba, by contrast, is powerfully nutritious and easily digested. “Because Medika Mamba is ready to eat, doesn’t grow bacteria, and doesn’t need refrigeration, the family doesn’t need to use up precious charcoal, and the child can eat eight times a day,” Wolff says. “Everybody else in Haiti eats once a day, because they only build a fire once.”
And will a child eat Medika Mamba eight times a day? “Oh yeah—they love it!” Wolff says, her face breaking into a smile. “It tastes like the inside of a Reese’s!”
Medika Mamba and clean water can pull a child straight up out of malnutrition’s spiral: malnourishment, infection, loss of appetite, loss of immunity, more infection, and weakness, apathy, and irritability. Malnutrition causes cognitive damage to those younger than 2 years old and growth delay for all ages. Often, it kills.
Wolff scans hastily penciled charts and notices stats for a child who started visiting the clinic two months ago, weighed 10.4 pounds, and isn’t gaining weight. “So the question is, has she had a fever? Has she had diarrhea? Or is someone else getting the food? Sometimes when parents see their kid is going to live, they start sharing the food with other kids. If you don’t gain and don’t gain and don’t look like you’re sick, we just cut you off and give the Medika Mamba to someone who will actually gain weight with it.”
The stuff’s too costly, and in too short a supply, to share around. “The average malnourished child needs 10 kilos,” she says. “If the malnutrition’s severe, they may need a little more.” Meds & Food for Kids, the nonprofit organization Wolff founded seven years ago, spends up to $8 per kilo to make Medika Mamba, then either distributes it at no cost to patients, raising the funds itself, or sells it to other organizations for only $5 a kilo.
In the coming year, MFK hopes to get both the sale price and cost of manufacturing down to $4.50 a kilo by building a bigger, more efficient factory. Wolff has blueprints for a facility that would increase production tenfold, making it so cost-effective that it could pay for itself by 2015.
When Wolff made her first trip to Haiti, more than 20 years ago, she wasn’t envisioning any of this. She volunteered as a pediatrician, and she saw so many children dying of treatable diseases that she knew she had to return. Fifteen years later, she knew treatment wasn’t enough. Many of the children were already so malnourished that their bodies didn’t have the strength to recover.
Meanwhile, one of her colleagues at Washington University School of Medicine, Dr. Mark Manary, was developing a peanut-butter recipe (peanuts, powdered milk, sugar, oil, vitamins, and minerals) for malnourished children in Malawi. He gave Wolff the recipe, and in 2004, Meds & Food for Kids started hand-grinding Medika Mamba in a church schoolroom in Haiti.
Now there’s an MFK factory occupying the top floor of a small rented house in Cap-Haïtien, a second distribution center in Port-au-Prince, and more than two dozen Medika Mamba programs in place throughout Haiti—plus an Izumi Foundation grant to start several more. All you need, Wolff says, is “a scale, a way to measure length and height, and a metal cabinet the rats can’t gnaw through. The pediatric oversight is minimal; it’s a very nurse-oriented project.”
She leaves the clinic, hops into a truck, and drives through Cap-Haïtien’s honking traffic, bouncing along rutted dirt roads between white U.N. tanks and battered tap taps (taxis). At the MFK factory, she removes her jewelry and shoes and dons booties, a lab coat, and a hairnet.
“You roast the nuts in here, and then air conditioning cools them down,” she says, pointing toward the main floor. “It’s not grid electricity; we have generators.”
Upstairs, a huge, donated restaurant mixer that once made pizza dough in St. Louis whirls peanut butter, powdered milk, and sugar together, while a Haitian man pours a stream of oil into the mixture. He’s wearing a donated Wash. U. lab coat, embroidered “Dr. Tanya Wildes, Hematology/Oncology.”
MFK employs about 30 Haitians—factory workers, a public-health nurse, and a team of agronomists. MFK buys as many Haitian peanuts as possible, only buying U.S. peanuts as a fallback—if there are, say, four hurricanes in a row, as there were in 2008.
It would be a whole lot easier to just make Medika Mamba in the States. A peanut farmer in Georgia can grow nearly 3,000 pounds of peanuts per acre, compared to a Haitian farmer’s 700 pounds. But the point is to make this a Haitian enterprise, thus creating jobs, improving conditions and food quality, and encouraging self-reliance.
Wolff has applied for a U.S. Department of Agriculture grant to start a “farmer school,” teaching Haitians how irrigation, fertilizer, and fungicide could increase their yields. There’s also a bitter lesson to be taught: the prevalence of a dangerous mold called aflatoxin.
In children, aflatoxin causes immune deficiency, impedes protein absorption, and slows growth; in adults, after extended exposure, it can cause liver cancer. “People get sick, their bellies swell up, they turn yellow and die, and nobody ever knows why,” Wolff says. “When we got a toxicologist to test for aflatoxin in Haitian peanuts, we found it was sky high.
“American food-safety standards allow for up to 20 parts per billion of aflatoxin,” she notes. “Medika Mamba is subject to even stricter European standards, given its use with extremely sick children, of five parts per billion. The peanut butter you buy in a Haitian market can be as high as many thousands of parts per billion. So we started an aflatoxin abatement program, with faculty from the University of Georgia to help us.”
Abatement’s simple: Keep the peanut seeds dry, irrigate the plants, dry the peanuts completely after harvest, and store them in a dry place. But in the humid tropics, none of that’s easy. MKF makes sure to buy its peanuts right at harvest and dry them on-site, using a hopper that blows hot air. Then people sift through the shelled peanuts by hand. “The bad ones are shriveled up,” Wolff says. “If the shells are broken, you throw them away.” Workers deshell the remaining nuts, run them through the splitter, and then lab-test them.
With a new Haitian government in place, Wolff’s hoping for continued close cooperation. She’s already working with Haiti’s Ministry of Health; next, she hopes to work with the Ministry of Agriculture to improve peanut farming and eradicate aflatoxin. She also thinks construction of a new MFK factory could “start a national dialogue on food-safety regulations—because there are none.”
MFK recently joined the field network of Nutriset, the world’s largest producer of ready-to-use therapeutic food. Nutriset will provide equipment, plus the quality assurance necessary to win UNICEF’s food-safety certification.
That makes the new factory all the more urgent. “We need to continue to be credible with UNICEF and the World Food Programme,” Wolff says, “because we’ve been talking about this for a couple of years now.
On June 30, 2010, she resigned from her St. Louis pediatric practice to devote all of her time to MFK. “I can be replaced in an instant as a pediatrician in St. Louis,” she notes, “but so far I haven’t found anyone who wants to be executive director for no money in Haiti.” She’ll spend half her year fundraising in the States; MFK has already raised more than $1.9 million of the $3 million to build the factory. Thad Simons, president and CEO of Novus International, is leading MFK’s capital campaign, and Peter Raven, president emeritus of the Missouri Botanical Garden, is its honorary chair. Their goal is “$600,000 in six months.”
But why should St. Louis’ corporate leaders fork over money to help make peanut butter for a poor island that’s always in crisis?
“Because the world isn’t fair,” Wolff answers instantly, “and we all are blessed with more than what we need.”
All it takes is a little peanut butter to spread that wealth. It’s not a temporary fix, either; not one more “rescue” that will have to be repeated again and again. “This program is sustainable,” Wolff emphasizes. “It will make a difference in Haiti forever.”
Two St. Louisans, Frank Popper and Lori Dowd, started filming a documentary about MFK several years ago. A short version, made to raise money for the full-length documentary, was shown last year on Oprah. Its focus? Social entrepreneurship, and the difficulties associated with it.
“And oh, there are many difficulties,” Wolff says. “This is the most difficult thing I’ve ever done.”
She drives back to the Cap-Haïtien clinic, where mothers wait patiently, cradling dazed, unnaturally quiet children. Some are so bony that their skin looks embossed. Others, further along in the program, chatter happily.
“This little one looks like she’s about done,” observes Wolff, scooping up a round-cheeked toddler in a pink sun hat and flouncy aqua skirt. Her white top says “Cutie.”
Now it’s true.
