"Lave Men, Siye Te" (Wash your hands, then wipe them in the dirt).

There are two indicators that the international community uses to judge the extent of a humanitarian crisis. These are Crude Mortality Rate, which measures the rate of death from all causes in a given population per day and Global Acute Malnutrition, which measures the rate of moderately and severely malnourished children in a given population.

Though it is difficult to determine an exact percentage of malnourished children in Haiti, those who have traveled there can see on the basis of sight alone, that it is a serious problem. Thin reddish hair, bloated bellies, and other symptoms of malnourishment are frequently seen.

In fact, Haiti is consistently rated by UNICEF as one of the hungriest countries in the world, grouped together with countries as diverse as Afghanistan, Somalia, and Niger. Malnourishment has medical, educational, and socio-political consequences. Despite this, it is an under-discussed topic. What have we learned and what can be done?

The above quote is a Haitian proverb shared with me by the founder of Partners in Health, Paul Farmer. He was referring to how senseless it was to treat a patient for TB or HIV/AIDS and neglect to ensure that their nutritional needs were met as well. It cannot be stressed enough that malnutrition is a medical problem, a disease. It hampers the functioning of the immune system, reducing the efficacy of many different kinds of medicines while intensifying their side effects. Malnourished children are more likely to die from malaria, diarrhea, and acute respiratory infections, all of which are leading causes of mortality for children in the developing world. But if malnutrition is a disease, it also has a cure. Children, whether moderately or severely malnourished, who are not experiencing complications frequently are able to bounce back with a carefully monitored feeding regimen. Children who are improperly nourished during certain critical growth periods may well have weakened immune systems for the rest of their lives.

There are educational implications as well. It is not easy to realize one's intellectual potential on one, perhaps two meals a day. When the entire family is hungry, the child is more likely to stay home and work than attend classes.

Haiti is still an unstable country. Hunger and instability are intertwined. As people become hungrier, they become less hopeful. It is difficult to think of long-term changes when a person does not know where their next meal is coming from. Gangs and drug dealers hold more clout in an environment where people are starving and they are the only employers.

What then is to be done? There are thousands of feedings programs in Haiti, ranging from churches to large-scale food distribution from USAID's Food for Peace Program. The problem with some governmental programs is that, for political purposes, they must rely on food bought and shipped from the United States. Logistically, this slows down response-time dramatically. The famine in Niger is a case in point. Some food shipments took months to reach the regions where they were needed most. It also weakens local economies and creates dependency.

Clearly, food programs that draw from external resources are problematic. I argue that community based programs that are contextually appropriate are needed. The AK-1000 program that is being set into place by Project Medishare is an example of this sort of program. Akamel is a nutrient rich mixture of milled beans and corns. It is easily shipped and has a long shelf life. With your support, Project Medishare is developing a factory in the province of Thomonde that will hire many people to mill, bag, and ship the Akamel to clinics, hospitals, and schools at an extremely reasonable rate. During its first phase, the notional needs of at-risk populations in Thomonde will be met. Later phases will involve expanding into other provinces with high rates of malnutrition. This method creates jobs, uses local resources, and empowers Haitians to address malnutrition at the community level.

The need for change is great. Innovative programs such as this play an important role in the fight against hunger. What are your thoughts on addressing malnutrition in Haiti and other countries like it?

Bryan Schaaf