Valentine's Day Lovin'

Roses are just so overrated. What better way to express love and personal affection than...3 major pee-all-over-your-hands-and skirt and 1 very generous bout of...yeah the other stuff. Over all, the days have been going super well. Here are some of the highs and lows:

Since the preliminary results from the first 770 children to complete the program showed that soya chiponde was the most effective therapy for moderate acute malnutrition (or in the world of alphabet NGO soup - MAM), my team and I have started to roll out "operational" programs in each of our centers. This means that we are in the process of training all the village health assistants to be able to identify and classify the different levels of malnutrition, to properly enroll the children on the correct types of food, distribute the necessary quantity for the child's weight, and to do all the follow-up and record keeping. I've put together a 15 page manual and a short quiz to help gauge how the training is going. Slowly, all the study children will complete the program and all the new children that we see will either be enrolled on either milk/peanut food (for severely malnourished kids) or soy/peanut food (for moderately malnourished kids). The ultimate goal is to have soya chiponde adopted as the national protocol for this type of malnutrition, just as the milk version has been adopted nationwide for the severe malnutrition.

The newest challenge is finding a supply of soy. Theoretically, Malawian farmers grow tons of soy and we should have no problem sourcing it. But, this is Africa. All the farmers have apparently made arrangements to sell their supplies to other people and the harvest is not until April. I have been running around like mad looking for soy - at the local markets, at the small holders union, at different distributors, etc. On Tuesday, I managed to find 480kg at a very busy working class market, which will yield between 3.5 and 4 metric tons of soy peanut butter (7,000-8,000ish pounds). But, to give us a bit more cushion, I'm paying a guy who knows a guy who knows a guy in Mozambique for 1 ton of soy. Dodgy, maybe, but it will make heaps and heaps of soy chiponde. [Thanks to Hannah for the new lingo - dodgy, heaps...Aussie expressions!]

Yesterday, Hannah was asked to visit a man, and father of 3, in his house because he too ill to walk down to our clinic. I pulled up to the house as she walked out, and could see the man being carried down from his house on the back of his father. The man was thinner than any person I've ever seen. His cheek bones jutted from his face, his ribs were so exposed that Hannah could not hear his lungs with her stethoscope. His mother sat in the back of our red truck and his body just crumpled onto her lap. Hannah had walked into his house to see him, and as proper Malawian custom, greeted each person in the room with the proper Chichewa greeting. He responded, in English, "I am doing well, and how are you?" I think hearing his straining voice, his rehearsed English response, and seeing him find enough strength to lift his arm out to her was emotionally very challenging. She got into my car and we left the man to be driven to the hospital some 50 kilometers away. Rosemary, our nurse, travelled with him and told us later that he made it there, but that there was not a single nurse or medical officer to be found. It was around lunch hour, and they could not find even a stretcher to lay him on. Perhaps we should have left him at his home to die with this family around. In the moment, we could only hope that the hospital could alleviate some of the pain he was feeling. ARVs and TB treatment will not save this man now, but perhaps just simple tylenol and a blanket could make him more comfortable.

On a much lighter note, Chelsea has arrived! Chelsea is a recent graduate from Lambuth University in Jackson, TN and has joined the PPB team - in Sierra Leone. She has been running small clinics in Sierra Leone since September and has come to Malawi to learn about making chiponde and running clinics on a larger scale. Dr. Manary will be going to Sierra Leone this spring to help get things rolling for her. She is living in an even less developed place- no electricity, limited water, and more eminent safety concerns. She has been extremely resourceful in finding ways to get PPB started in SL. I'm excited to have her visit for these 2 weeks and hope I can help her learn everything there is to know about chiponde. At least then I will feel part of making PPB multinational!

There are so many other things I want to write. Every time something funny or strange happens I always say, "That has to go in the blog." Of course now, I can't remember any of them. Anyway, this is a bit long and I'm beat. Hannah and I have been doing super killer work outs, which has been awesome. We are such masochists.

Happy Cheesy-American-Holiday Day.

-dkm