FEATURE — Summer 2010

(Courtesy of Meds & Food for Kids)

In Haiti for the Long Haul

After an earthquake rocked Haiti in January, members of the university community answered the call to serve, assisting our beleaguered neighbors to the south. And their work continues...

By Candace O'Connor

On Jan. 12, 2010, Steve Taviner, MSW ’08, operations officer of the nonprofit Meds & Food for Kids (MFK), was sitting with two other staff members in the house they share in Cap-Haïtien, 80 miles north of Port-au-Prince. It was the end of a long day, filled with the routine problems of running a factory in Haiti, the poorest country in the Western Hemisphere. One such problem had occurred the day before when Taviner was late picking up a vacationing associate, Jamie VanArtsdalen, BS ’09, BSME ’09, from the airport. Because of a rainstorm, the deeply rutted dirt roads had become impassible, forcing Taviner to drive across fields en route. When he explained all this to VanArtsdalen, she replied, with a good-humored shrug: “Oh, I see. Nothing has changed.”

Before the Jan. 12 earthquake, Meds & Food for Kids (MFK) produced seven tons of “Medika Mamba” (packets of ready-to-use therapeutic food) for malnourished children in Haiti each month. Since the quake, MFK has increased production, trying to serve as many children and now adults as possible. (Courtesy of Meds & Food for Kids)

On this day, the upheaval wasn’t caused by dirt roads. Taviner and VanArtsdalen were on a computer link tackling logistics with colleagues Patricia Wolff, MD, professor of clinical pediatrics at the School of Medicine, and Tom Stehl, MBA ’07, MSW ’07, operations coordinator, at MFK’s headquarters in St. Louis. Wolff, who founded MFK in 2004, established a factory in Cap-Haïtien to produce a ready-to-use therapeutic food (RUTF) that had shown dramatic results in malnourished children.

The key ingredient of RUTF is peanuts, which MFK acquires from local Haitian farmers. Other ingredients — dried milk, sugar, oil, vitamins and minerals — come to Haiti from the United States via the Port-au-Prince harbor. Once MFK produces packets of RUTF, they return many of them to the capital for storage, ready for distribution to hospitals, clinics and NGOs. Already, this RUTF, called “Medika Mamba” (peanut butter medicine) by Haitians, had saved the lives of some 15,000 children.

Then came Jan. 12. Taviner and VanArtsdalen were in the midst of their conversation with Wolff and Stehl when everything began to shake. For 90 seconds or so the rattling continued, though not hard enough to upset furniture. The event was surprising, but not too frightening.

“When the shaking ended,” Taviner says, “we sat back down at the table and said to Tom: ‘Guess what! There has been an earthquake.’”

Lora Iannotti, PhD
At that moment, Washington University nutrition expert Lora Iannotti, PhD, was sitting with colleagues on the patio of a restaurant in Port-au-Prince, where they had attended meetings that day. She was staying in Léogâne, 18 miles away, at a guesthouse operated by an aid group, the Children’s Nutrition Program (CNP). Feeling the first shocks, she and her group ran to the safety of the street. They could not know it, but back in Léogâne, close to the quake’s epicenter, shocks had caused major structural damage to the hospital and leveled the CNP offices and guesthouse. If Iannotti had been there, she would almost certainly have been killed.

Two days earlier, she had come to Haiti with a research planning mission: to sort out the details of a study to be undertaken with MFK and CNP to evaluate the effectiveness of Medika Mamba delivered in combination with another CNP program, Positive Deviance/Hearth. CNP scours communities to find needy children who are healthy, despite their poverty, and asks those families how they do it; then they incorporate these lessons into prevention sessions for others in the community.

“CNP was using this approach and increasing children’s weight, but they weren’t making improvements in height,” says Iannotti, assistant professor at the George Warren Brown School of Social Work. “That difference probably indicates a hidden hunger problem, deficiencies in critical micronutrients such as iron, vitamin A and zinc. Those are the usual problems of the poor, and those are the nutrients I focus on.”

After the tremors subsided, her group made its way to a Doctors Without Borders aid station, where Iannotti found herself dressing wounds, splinting fractures — and sensing the magnitude of the disaster. Walking to Léogâne the next day, they saw horrific sights: flattened buildings, bodies. Iannotti, who was safely evacuated three days later, had a camera but decided not to take pictures of the injured or deceased, out of respect for them and their families.

Tom Stehl (second from left), MBA ’07, MSW ’07, operations coordinator for Meds & Food for Kids, was not in Haiti during the earthquake. Battling communication difficulties, he managed operations from St. Louis, acquiring additional raw materials so that MFK could increase its production of Medika Mamba. (Courtesy of Meds & Food for Kids)

Tom Stehl
Back in St. Louis, Tom Stehl was out of harm’s way but soon engulfed by another kind of trouble. As the scope of the disaster unfolded, he had to deal with the operations side of MFK’s work. Its factory and staff in Cap-Haïtien were fine, but what about MFK’s depot in Port-au-Prince, filled with four tons of Medika Mamba? How was Papillon, the depot manager? Had a precious container load of raw materials, newly arrived at the port, survived the quake?

“We were caught in the fog of disaster,” says Stehl, who was frustrated with cell phone coverage being down in Haiti for weeks after the quake. “We were enshrouded in it and didn’t quite know what was up and what was down.”

But Stehl was in a good position to respond. As a graduate student, he had discovered MFK and, with fellow students Scott Elsworth, MBA ’09, JD ’09, and Cynthia Wachtel, MBA ’07, devised a business plan for the nonprofit that won the university’s inaugural Social Entrepreneurship and Innovation Competition. (The competition is sponsored by the Skandalaris Center for Entrepreneurial Studies at Washington University and the YouthBridge Community Foundation.) Also, in his last months of school, Stehl helped Wolff put together a proposal that won the prestigious World Bank Development Marketplace competition; he then joined the MFK staff.

Helping Haitians at a Tent Hospital in Petit-Goâve
Members of the School of Medicine and Barnes-Jewish Hospital (BJH) supported Haitian relief efforts in multiple ways. Some traveled to Haiti themselves. In 2008, Caleb Trent, MD, then a medical student in Tennessee, co-founded a not-for-profit, Aid for Haiti (AFH), to help Haitians with goiter problems. Now a second-year emergency medicine resident at BJH, Trent activated AFH after the quake with a more general mission: to help sick and injured Haitians at a tent hospital in Petit-Goâve, 42 miles west of Port-au-Prince.

Using vacation time and paying their own expenses, he and seven other residents, plus one nurse, took turns coordinating medical care at the makeshift hospital. When they faced a break in coverage, Liza Halcomb, MD, assistant professor of emergency medicine, filled the gap. She and her father, retired St. Louis neurosurgeon Robert Dunn, MD, traveled to Haiti for a six-day stint, helping to treat from 125 to 400 Haitians each day.

Halcomb, who has lived and worked in many parts of the world, was still overwhelmed. “There is no way to describe what Port-au-Prince was like,” she says. “It is an enormous city, heavily populated, and it was flattened — just flattened. The pictures don’t do it justice. And the desperation was palpable.”

In Petit-Goâve, they saw some critical cases, which they had to treat without diagnostic technology. One Haitian man, fighting over water, had a 100-pound jug dropped on his chest; the medical team, guessing he had a collapsed lung, managed to reinflate it just as he stopped breathing. A beggar had suffered with an open fracture of two fingers for a whole month without treatment.

“Doing good for these patients is a pretty fantastic experience,” Trent says.

“In this organization, you see a direct correlation between your effort and the impact. It is not the same as intellectualizing about poverty,” Stehl says. “We make a product that saves children’s lives. The outcome is so tangible, and that keeps me motivated.”

A few days after the quake, Stehl received a scrap of good news. Papillon got through — he was hurt but alive, and heading to the United States for treatment. While the depot had survived, a neighboring school had collapsed, and its debris had damaged one of the depot’s walls. Would it stand until MFK staff could retrieve the contents?

Then Stehl got word from the port: only four containers had made it through the quake — and MFK’s was not likely to be one of them.

Patricia Wolff, MD
Two days after the quake, Patricia Wolff, MD, left St. Louis for Haiti. Since the summer of 2006, she had been traveling to the country on a regular cycle: three weeks there to oversee factory operations, then three weeks back in St. Louis to tend her busy pediatric workload. It is a grueling pace, but Wolff was profoundly shaken by her first trip to the country in 1988 and decided then to help.

“It was like being at the scene of an accident: You couldn’t avert your gaze,” Wolff says. “You just thought: ‘There must be something we can do here.’”

Wolff, who began taking annual medical mission trips to Haiti in 1991, saw that many children had a hard time fighting disease because they were malnourished. In response, she asked her colleague, Mark Manary, MD ’82, the Helene B. Roberson Professor of Pediatrics, about bringing to Haiti the RUTF product he had pioneered in Malawi.

To help with Haiti’s massive unemployment, Meds & Food for Kids hires Haitian workers. Here, two women sort peanuts for Mamba. (Courtesy of Cory Flanagin, BS ’06)

Her new organization, Meds & Food for Kids, founded in 2004, would produce this Medika Mamba and rescue Haitian children, but it would also focus on sustainability. To make a dent in Haiti’s sky-high unemployment rate, MFK would hire Haitian workers for its factory. They also would buy Haitian products, whenever possible, and bring in experts to teach improved farming techniques. By the end of 2009, MFK was producing seven tons of Medika Mamba each month.

So as soon as she arrived in Cap-Haïtien after the quake, Wolff immediately began trying to increase Mamba production. Already, some 250,000 Haitian children were malnourished, and that figure would certainly soar after this crisis. “This is such a tragic place to begin with, and now it seemed apocalyptic,” she says. “Our mission was to make as much Mamba as we could and deliver it as quickly as possible to people who could use it.”

“Our mission was to make as much Mamba as we could and deliver it as quickly as possible to people who could use it,” says Patricia Wolff, MD.

Right away, Wolff got word that surviving hospitals in the capital — such as Gheskio, which had 6,000 hungry people camping on its grounds — desperately needed Mamba. And these institutions had a new use for it: as a nutritional supplement for adults and children, poorly nourished before the disaster, who now could not heal from huge wounds or amputations without a boost in nutrition. Orphanages and CNP in Léogâne also called for more.

MFK urgently needed access to the Mamba stored in the Port-au-Prince depot. When Wolff heard that a British ambulance driver was planning a run to the capital, some eight hours away due to bad road conditions, she dispatched Steve Taviner to ride along. Once there, Taviner saw the horrifying scale of the damage: buildings — such as the Ministry of Health, where he had helped plan Haitian nutrition policy — lay in ruins; stunned people huddled around fires on street corners; the smell of rotting flesh pervaded the air.

But when Taviner reached the depot, he found a miracle: The damaged wall had not fallen, and the Mamba packets were dusty but intact. In two hours, he managed to deliver all of them to ecstatic clients; CNP alone got 1,600 kilos — enough Mamba to treat 150 malnourished kids for six weeks.

Back in Cap-Haïtien, Wolff faced another dilemma. How could MFK boost production without the ingredients in the missing shipment? She then called in the help of Tom Stehl, still in St. Louis, who subsequently contacted MFK’s suppliers and explained the difficulty. Their response astonished him.

“Everybody who had sold us raw materials donated new supplies,” he says. “It was an incredible expression of generosity and shared humanity.”

And that benevolence was just the beginning. The phone in the St. Louis office started ringing — and didn’t stop for weeks. Companies, especially Scottrade, MEMC, Novus International and Nestlé S.A., made large donations. International Food Products (of St. Louis) donated raw materials; Romer Labs contributed laboratory supplies; and the Izumi Foundation, a longtime MFK supporter, called to help. And individuals, from children who donated bake-sale proceeds to adults who heard of MFK’s story in the news, sent checks. Kelly Scott and Colleen Smith, MFK interns and Brown School students, spent long days processing contributions.

Then on Jan. 27 came the second miracle: The lost container had been found intact — and the authorities expedited its shipping to Cap-Haïtien. Now MFK had plenty of materials to produce more Mamba. When Stehl called back the suppliers with the news, they all said the same thing: “Keep the additional ingredients and use them to help.”

Students and alumni take action
This deep desire to help reverberated throughout Washington University, as students, faculty and alumni all generously supported relief efforts. On Jan. 19, Chancellor Mark S. Wrighton wrote to the university community that “the images and stories emerging from a country that is such a close neighbor to the United States are heart-wrenching.” For anyone interested in donating, the university’s home page listed several links to relief organizations, including MFK.

In coming days, Student Union — the university’s undergraduate student government — coordinated a campus-wide campaign in which nearly 400 people donated some $7,000 to an online site, while student groups raised around $12,000 more through other fundraising activities. With continuing efforts, says Student Union President Jeff Nelson, they hoped to reach a goal of $20,000.

One Haitian-born graduate student, Andia Augustin, undertook relief efforts of her own. Fluent in Creole and French, she volunteered to serve as interpreter for a medical mission team heading to Haiti in early February. She and other graduate students also organized “speed-dating” events with some of the proceeds to go to MFK.

“With the media and medical people leaving,” she says, “many are turning their eyes away from Haiti, but it needs our help more than ever. The rainy season started at the end of March, and many don’t have tents. How are they going to survive?” (Hurricane season follows, starting as early as June.)

Alumnus Joe Madison, AB ’71, radio host of The Power weekday mornings on SIRIUS (channel 820) and XM Satellite Radio (channel 169), is worried about Haiti’s future, too. In early February, he joined an African-American media group on a fact-finding mission to Haiti, where he spoke with government officials and others to find out what help the country would need going forward. They wanted to keep Haiti in the public eye, even after the immediate crisis passed.

“I have been to Sudan and other war zones,” says Madison, who had plans to return to Haiti in six months to evaluate progress, “but I’ve never seen anything like the massive destruction in Haiti. What is needed is a global Marshall Plan; the United States can’t do it alone. Haiti is a victim of poor planning, poor infrastructure and historic exploitation; this is an opportunity to create a jewel.”

Engineers Without Borders
Washington University’s chapter of Engineers Without Borders (EWB), founded in 2005, wants to be part of the solution. As an undergraduate, EWB member Jamie VanArtsdalen traveled to Tanzania and learned about fixing medical equipment at a rural hospital. In August 2009, she arrived in Haiti on a yearlong fellowship with MFK that began by preparing the factory, currently located in a retrofitted house, for a successful food-safety audit.

Daily, she fixed machinery and sometimes called on experts in the United States to help. Back home over Christmas, she asked two retired engineers to help figure out a thorny problem with MFK’s Hobart mixer, a vital piece of equipment. The glitch turned out to be a faulty bearing, which they promptly replaced.

Cory Flanagin (left), BS ’06, and Jamie Cummings, Class of ’12, helped build a solar peanut dryer in 2009 with Engineers Without Borders. The project was designed to help farmers prevent the growth of a dangerous fungus. Flanagin and Cummings are among those headed back to Haiti this summer to work on an improved model. (Courtesy of Cory Flanagin, BS ’06)

“Sometimes it’s the sealing machine that has stopped or the peanut dryer that isn’t working,” she says. “There’s always the question of how are we going to patch something together and keep going.”

In spring 2009, two other EWB members — Jamie Cummings, Class of ’12, and Cory Flanagin, BS ’06 — along with Robin Shepard, MSMSE ’90, DSc ’96, adjunct instructor in chemical engineering, traveled to Haiti to volunteer at MFK. They wanted to test an idea for turning waste peanut shells into briquettes for fuel. They also tried to build an affordable solar peanut dryer to help Haitian farmers prevent the growth of aflatoxin, a dangerous fungus that ruins some 40 percent of their crop.

Developing the right kind of dryer proved tricky, so Cummings and others will return this summer to continue the work. Engineers Without Borders is also enlisting the help of engineering students Paula Davis, Nora Palitz and Emily Greenseth, along with architecture student Chris Gignoux, to create a prototype idea for a Haitian home as part of their senior design course.

The earthquake only made these needs more acute, they say. Like others who have visited Haiti, these students worry about what will happen next. After the rainy season comes hurricane season — and four hurricanes in 2008 did catastrophic damage to this beleaguered island.

“Haitians have a saying,” Steve Taviner says, “and you see it everywhere, painted all over the public transport: ‘L’homme propose et dieu dispose’ (man proposes and God disposes). The earthquake is a reminder of that. This is just one in a long line of challenges for Haiti, just part of the process.”

Candace O’Connor is an award-winning freelance writer based in St. Louis.

For the latest news on MFK’s efforts, visit mfkhaiti.org.