By Craig Timberg
Washington Post Foreign Service
Friday, November 4, 2005
MBADZO, Malawi -- One by one, the women of this hungry village untied their babies from their backs and hung them on a scale dangling from the limb of a mango tree. As a volunteer called out the weights, Anna Bande, a nurse, grimly plotted the toll of southern Africa's latest drought on Malawi's young.
"It is affecting every child," Bande, 53, said wearily as she drew lines on grubby paper growth charts last Thursday. Instead of the smooth upward arc of healthy, growing children, the babies of Mbadzo had lines that zigzagged slowly higher before spiking down in the past month, as the last of the food from a disastrous harvest disappeared.
A drought across six southern African countries has left 12 million people hungry this year, according to the United Nations. None has reached the acute hunger crisis faced by Niger, in West Africa, during the summer. But Malawi has long been ravaged by malnutrition, AIDS and desperate poverty, and many children are now suffering from all three afflictions.
Bande said she had raised 18 children -- nine of her own and nine orphans. As the head of child and maternal health at Trinity Hospital, she has known thousands of others. Yet rarely, she said, has she seen so many hungry children. With five months until the harvest, admission for severe malnutrition already is running one-third higher than a year ago. A child is dying nearly every week.
"This year, each and every house, there's no food," said Bande, who wore a plain blue uniform and an orange cloth head scarf.
About 12 million people live in this landlocked sliver of a country wedged between Zambia, Tanzania and Mozambique in southeastern Africa. There is little economic activity, especially here in the sun-baked Shire Valley, other than dirt farming on tiny plots to raise corn, or working on a neighbor's farm for about 40 cents a day.
When the rain comes, there is enough food, but only barely in a country where nearly half of all children suffer from stunted growth.
When the rain doesn't come, the bottom drops from beneath this fragile society. Meager food stocks disappear. Casual farm jobs vanish, making it harder to buy food as prices soar because of scarcity. The most desperate start scavenging for wild roots or leaves.
The last harvest, in April and May, produced one-third or less of the corn grown in a good year, farmers here say. Many fields yielded nothing at all.
Among the hungry, diseases such as malaria and AIDS race ahead with scant resistance from weakened immune systems. Malnourished children get sick, and some die.
The U.N. World Food Program is already feeding 1.3 million Malawians and has plans to reach 2.9 million in a few months, though donations are running far short of the projected need as food shortages deepen.
In Mbadzo, a village in south-central Malawi where modest homes built of handmade bricks dot terraced, brown hillsides, the supply of food from any source has slowed to a trickle.
Under the mango tree, Tisunganane Matumbo, 3, dangled from the scale with a look of terror in his eyes. As he hung there in a loose-fitting baby-blue outfit, the volunteer read out his weight.
The news was not good: Tisunganane had lost two of his 30 pounds in the past month. He also had been getting fevers, reported his mother, Patricia Matumbo, 30, who has four other children.
"There's no food at home," she explained. "Last year everything was dried out. Nobody harvested anything."
A few minutes later, in another line beside another mango tree, Bande began examining scores of children. She pulled down their eyelids to look for the yellowish tint of jaundice, felt skin for fever and probed stomachs for signs of severe malnutrition or other ailments.
After Bande had seen about 50 children, she was handed a plump 1-year-old girl. She declared with a bright smile, and a hint of surprise, "A healthy baby."
It was, she said, only the second she had seen all day.
When it was Tisunganane's turn, Bande found a belly that was swollen. Because of the boy's declining weight and recurrent fevers, she diagnosed both malnutrition and malaria. Bande gave Tisunganane's mother a full course of malaria medicine and urged her to somehow find more food for her son to eat.
With luck, Bande said, he would begin recovering soon.
The news was not as good for a 4-year-old girl with skin rashes, mouth sores and a growth chart showing that she had spent her brief lifetime falling short of weight targets. Bande urged the mother to bring her daughter to the hospital immediately.
But she also suspected the child had advanced AIDS, which meant there were limits to what could be done.
Malawi has an estimated 65,000 children under the age of 5 with HIV, the virus that causes AIDS.
While nations such as South Africa have sharply cut transmission of the virus from mothers to children through one-time doses of nevirapine, the antiretroviral drug is only just beginning to be deployed widely in Malawi's rural areas. The country's per-capita income of $170 a year is one of the lowest in the world, and abject poverty makes breast-feeding, which can also pass the virus to infants, a necessity for many.
And though Malawi's rapidly expanding antiretroviral program has delivered free, lifesaving drugs to 30,000 adults, it has not yet reached children, many of whom will die before the pediatric versions of the medicine become available here. Government officials predict those drugs will arrive late next year.
Even for those children who escape infection, having a parent with AIDS is nearly as deadly. Fathers become too weak to earn money. Mothers stop laboring in fields and often lack the strength even to produce enough breast milk to nourish their babies.
Such was the case with the last mother in Bande's line, a thin woman whose 2-month-old twins -- a boy and a girl -- had shrunk from more than 7 pounds to about 4 1/2 . They had the shriveled look of hungry baby birds, with desperate, pleading eyes.
"The mother has HIV. That's what I'm suspecting," Bande said. "These ones, we are going to take care."
As the sickest children examined that day, they were loaded into the back of the hospital's white truck for the short drive back to Trinity Hospital, where they could get treatment and their mother, were she to test positive for HIV, could soon start on antiretroviral drugs.
Once stronger, Bande said, the woman could more easily breastfeed the twins. Even if that increased the likelihood that they too would get the virus, it was their only realistic option.
But the three hours the nurse spent weighing, examining and treating children in Mbadzo came at a price. While Bande was away from the hospital, another mother with another desperately ill child vanished.
Esmie Nyasangudza, 29, had arrived at Trinity Hospital in an ambulance with her daughter, 11-month-old Gertrude, two weeks earlier. Gertrude had the thin, orange-tinted hair of the severely malnourished, as well as diarrhea, fever, mouth sores and thin, floppy arms. She was refusing what little food -- mostly cassava porridge -- there was at home. During her stay in intensive care, an intravenous tube taped to the left side of her head had provided Gertrude with enough nutrition to marginally improve her condition. She had begun to breast feed and was soon to be moved to another ward.
But Nyasangudza, after learning she had HIV, abruptly left the next morning with the baby. They ventured into a parched countryside with the little available food, and Bande said she feared both would soon die.
She paced around the hospital in frustration, asking other nurses if they knew where the mother and baby had gone, or even which direction they had headed.
Even if Nyasangudza had stayed, Bande acknowledged that with a child as sick as Gertrude, her chances of surviving this hungry season were slim.
"But," Bande said, "it's better to do something."