We’ve all seen it. Some, up close and personal but most on the television in some documentary or on a nightly news show. I’m talking about the ravages of starvation. Starving babies clinging to their mothers or worse yet, abandoned to a single bedroll, left alone to suffer a fate that could be easily avoided for the price of a candy bar.
But few of us live in such a neighborhood or are on a first name basis with a bloated bellied child so what’s the fuss?
The fuss is that there is so much in the world that we are powerless to change so we learn to accept it as nature’s way or god’s will for the more religious minded. But that’s not the case here.
If you haven’t heard about , you’re about to. But I must warn you that this knowledge will forever nullify any excuse or rationale you previously had to not take action to help eradicate bloated bellied children in far off locales.
I first learned about Plumpy’nut on a recent 60 Minutes episode where they showed cased after case of children they were written off as starving and beyond the help of modern medicine (as if that too was available to them!) They were bone thin, listless with no appetite and most times hours away from death. Until Plumpy’nut was introduced into the equation.
Plumpy’nut requires no preparation or special supervision, making it easy to deploy in difficult conditions. Plumpy'nut is very difficult to over eat and keeps even after opening. It has a 2 year shelf life when unopened. The product was inspired by the popular Nutella spread.
The ingredients are: peanut paste, vegetable oil, milk powder, powdered sugar, vitamins and minerals combined in a foil pouch with each pack providing 500 calories. It contains vitamins A, B-complex, C,D,E, and K along with minerals calcium, phosphorus, potassium, magnesium, zinc, copper, iron, iodine, sodium, and selenium. Médecins Sans Frontières (known as Doctors without Borders in the US) has been dispensing fourteen packets (1 week's worth) of Plumpy'nut in 22 centers in Niger since May 2005, but only to those children who are dramatically underweight and sufficiently well to benefit from outpatient care.
Plumpy’nut is frequently used as a treatment for emergency malnutrition cases. It is known to increase weight by one pound in as little as two days, which can make the difference between life and death for a young child
A standard plumpy'nut treatment goes for four weeks (two to three times a day for about 40 days) at a cost of 12 Euros in Africa and was first used during the crisis in Darfur in western Sudan. There, it was fed to some 30,000 children and aid officials there say it has helped cut malnutrition rates in half.
Rivers of women flowed into the site and within minutes there were more than a thousand of them, all waiting to get packets or tubs of Plumpynut. In a land where plastic bags are a luxury, they carry the food home in their scarves, their hands, or simply stacked on top of their heads.
"When you see some of these kids they don’t look sick. They don’t look malnourished. They don’t have bloated bellies or little stick arms," Cooper remarks.
"The ones that we're used to seeing on TV, that’s the worst of the worst of the worst. It's the tip of the iceberg. And then below that, there’s the iceberg. So, there's a whole spectrum of malnutrition," Dr. Tectonidis says. "And when we go and check these kids, well, they’re way off in height or in weight. They’re way off."
"There's many countries in Africa now saying, 'We want a factory. We want a factory.' Well let's give it to them," he says. "We just have to focus on these areas. We don’t have to feed the whole world. We have to go for the jugular. Where are they dying? Where are they wasted? That’s where we have to intervene. If you feed them well until they're two or three years old it's won. They're healthy, they can get a healthy life. If you miss that window, it's finished."
In Niger, most children need help now during what’s called the "hunger season," just before the new harvest. Old food supplies have run out and about all that’s left is millet, a basic grain women pound for porridge. But millet doesn’t have enough nutrients to keep kids alive; in America we use it as birdseed.
Normally a children's hospital 60 Minutes visited would have more patients than beds. But now, thanks to Plumpynut, it has empty beds. Dr. Susan Shepherd, a pediatrician from Butte, Mont., runs Doctors Without Borders in Niger.
She says children that would have been hospitalized in the past can now be treated at home. "The reason we can do that is because we can give children Plumpynut here in the ambulatory center, and they take a week’s ration home. Moms treat their children at home and come back every week for a weight check," Dr. Shepherd explains.
That's what Sahia Ibrahim has been doing. She’s already lost four children to malnutrition. Now her six-month-old twins, Hassana and Husseina, are malnourished and she’s worried they might die too. So she’s been coming to the hospital for Plumpynut.
Hassana, at six months old, weighs only seven pounds. While that's what a newborn should weigh, the little girl has put on a pound in just a week thanks to Plumpynut.
Children are weighed and measured at the distribution sites. They're also examined to make sure they don't have any serious infections. Malnutrition destroys a child's immune system, so they're more susceptible to diseases and less capable of recovering from them.
"Often these kids aren't even hungry. It's the opposite. They are anorexic because of the deficiencies they have. They lose their appetite," Tectonidis explains.
That's what happened to Mansour Miko and Maroufee Mazoo. Less than a year old, they had stopped eating and became listless and weak -- so weak that when their mothers brought them to get Plumpynut, the nurse put them in a van and sent them straight to the hospital. Three days later however, they were smacking their lips on Plumpynut, almost ready to go home.
"Have you seen kids who were on the brink of death brought back by Plumpynut?" Cooper asks.
"Oh, yeah, for sure. Again and again and again and again," Dr.Shepherd says.
But not always. Sometimes parents wait too long before bringing their child to doctors. 60 Minutes found Rashida Mahmadou in intensive care, barely clinging to life.
Rashida's condition was very serious. Her skin was literally peeling away -- one side effect of malnutrition, as skin becomes thin, pliable, cracks easily, and bacteria invade.
Just two hours later, Rashida's little heart stopped beating. She was just 19 months old.
"She died of severe, acute malnutrition," says Shepherd, who says she sees this happening every day.
Asked how she deals with so many kids dying, Shepherd tells Cooper, "It breaks your heart. It can break your spirit. It can ruin your confidence in your ability to be a good doctor. And it is sad. And I carry memories of many, many children with me and I'll carry them with me for my entire life. But you certainly cannot indulge yourself in that kind of sadness. We need to do something about this."
If Plumpynut is the answer, how come kids are still dying?
"The answer is getting to kids earlier," Shepherd says. "Once children are as sick as she is, Plumpynut is not gonna save her."
Rashida was buried in a nearby cemetery, where the grave digger told 60 Minutes he is burying fewer children than he used to.
Two years ago this region had the highest malnutrition rate in Niger. But now, after widespread use of the Plumpynut, it has the lowest. Dr. Shepherd told Cooper they’ll be able to treat more than 120,000 kids this year, up from just 10,000 children three years ago.
What about peanut allergies?
"We just don't see it," Shepherd says. "In developing countries food allergy is not nearly the problem that it is in industrialized countries.
It's hard to imagine a less industrialized country than Niger. On a list of 177 developing countries, the United Nations ranked Niger dead last -- least developed. More than 70 percent of the people don’t know how to read. Most work in the fields and earn less than a dollar a day. Nomadic goat herders still roam this land -- their children and their kids travel by camel. Goats seem to be the main garbage disposal, but clearly the goats are falling behind. You can still spot a skinny guard dog, but we were told all the cats have been cooked.
In the countryside, where 85 percent of people live, girls start marrying as young as 11 years old. By the age of 15 most are wed, and by 16 most have already become mothers. The average woman here will give birth at least eight times in her lifetime. But largely because of malnutrition, one in five of their children will die before they reach the age of five. Of those who survive, half will have stunted growth and never reach full adult height.
But now, with Plumpynut, more children are surviving and thriving.
"And kids are doing better. Moms say their child's skin is brighter. Their appetites are better. And they’re less sick. You know, what more could you ask for," Shepherd remarks.
Doctors Without Borders is asking for more of this type of food. Their success in Niger proves, they say, that fortified ready-to-eat products, like Plumpynut, save children's lives. Dr. Tectonidis says if the United States and the European Union were willing to spend part of their food aid on this, more companies will start making it.
"Even by taking a miniscule proportion of the global food aid budget, they will have a huge impact, huge impact!" Tectonidis says. "We're not even asking for billions. It will solve so much of the underlying useless death. So we gotta do that now."
"It's useless death," Cooper remarks.
"Wasted life. Just totally wasted life for nothing. Because they don't have this product, little a bit of peanut butter with vitamins," Tectonidis says. "What a waste."
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