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Food Is Not Enough

By Debra Saunders

A world away from the fires of California, harvest is beginning in Niger. "The fields are green. Everything's green. It started raining in June and rained regularly through September. The millet fields are doing pretty well. Families are going about their daily business of fetching water and firewood and doing laundry and making things to eat. People are selling firewood by the roadside. The women will gather leaves for making sauces," recalls Susan Shepherd. And fewer children are going hungry, as often happens before the harvest is done.

You may have seen Shepherd, a Montana pediatrician, on "60 Minutes" Sunday. Shepherd has just returned from 18 months in Niger working on a project sponsored by Doctors Without Borders that fed 63,000 malnourished or starving children on a monthly basis. It was, as "60 Minutes" noted, the rare good-news story on hunger, as Doctors Without Borders has found a way to treat not only the worst cases, but also to help prevent children from the sort of malnourishment that leads to disease and even death.

The reason: Plumpy'Nut and Plumpy'Doz -- two versions of a sweet-tasting paste made from peanuts, peanut oil, powdered milk and powdered sugar, and fortified with vitamins and minerals. A serving of Plumpy'Nut is the equivalent of a glass of milk and a Flintstones vitamin. Plumpy'Doz is a take-home supplement of Plumpy'Nut for the moderately malnourished.

Plumpy'Nut represents a revolution in the treatment of hunger and malnutrition. It is an RUF, or ready-to-use food.

As the folks at Doctors Without Borders (which is the English name for the French humanitarian group MSF or Medecins Sans Frontieres) explain in a recent paper, "Food Is Not Enough: Without Essential Nutrients, Millions of Children Will Die," humanitarian workers pioneered the use of powdered-milk formula to treat severe malnutrition. But these formulas required clean water and often had to be prepared in hospitals.

In search of a better and more practical way, a French medical researcher and the French company Nutriset invented Plumpy'Nut in 1997. It has the nutritional value of the old powdered-milk formula but does not require water, does not have to be mixed, requires no refrigeration, can be stored in hot climates, has a long shelf life and is easy to transport. Because it's sweet and peanut-ty tasting, even children so deprived that they have lost their appetite will eat it.

With the development of Plumpy'Doz, Doctors Without Borders has been able to treat more children, and not just the worst cases. Shepherd explained, "Instead of waiting for kids to get gravely ill, we decided to act earlier."

The "Food Is Not Enough" report is highly critical of the corn-soy blend still used by major humanitarian organizations to feed the starving, as it requires water and with that there is a risk of contamination. At a Doctors Without Borders press conference this month, nutritionist Milton Tectonidis called for a "paradigm shift" away from corn-soy blends and toward more RUFs, not only for acutely malnourished but also for the moderately malnourished children. Tectonidis also wants more companies to develop more RUFs.

USAID officials told me that they've funded Plumpy'Nut programs for about three years and consider it a successful tool in treating severely malnourished children. They also believe corn-soy blends have their place and want to see more data on Plumpy'Doz.

What about others taking the child's food? "We are under no illusion that the malnourished child is the only one who eats the ration," Shepherd told me. If a child does not gain weight, workers look for a medical reason or put the child in a secure setting, where he is sure to get the nutrition he needs.

For the most part, Shepherd noted, the Niger program relies on "a mother feeding her child nutritionally appropriate food." Precious few families dropped out, as mothers have seen their children gain weight quickly.

Only 3 percent of children with severe malnutrition have access to RUFs. In developing countries, 146 million children under the age of 5 are underweight. A daily dose costs about a dollar.

"If you feed them well until they're 2 or 3 years old," Tectonidis told "60 Minutes," "it's won. They're healthy; they can get a healthy life. If you miss that window, it's finished."

Copyright 2007 Creators Syndicate Inc.

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