Plumpy’Nut

 A Pastor friend, Bonnie Wilcox, a veteran of Tanzania trips, asked how Plumpy’Nut came to be at Ilula Hospital.  This is a story that bears endless repetition (if you ask me!), so I am happy to oblige.  She mentions an organization called Edesia that uses Plumpy’Nut around the world.

In 2011, one of our first med students, Kelsey Watt, MD, now a Pediatric Resident in Colorado, and I were the last to go home from Ilula.  While we were here, we were stuck by several very ill children.  I have photos of two of them, but truly, they are gruesome and for the eyes of medical personnel only.  You will need to use your own imagination, but I think you can hardly overdo it.  One of the children died 2 hours after admission.  She was two and looked like a bag of bones.  This is marasmus.  The other, about 18 months, was swollen all over, with puffy cheeks, puffy hands and feet and tremendously swollen genitalia.  This is kwashiorkor.  This boy was here for our entire stay.  I do not think we did anything for him that helped.  Both would have been fine with a six-week course of Plumpy’Nut.

Someone told us of this product.  Kelsey and I looked into it.  We even developed a talk centered around malnutrition.  Well, Kelsey did most of the work, I edited it, but I get credit due to being the “professor.”  Call or write me if you want to hear it!

I brought the story home to my congregation at St. James, who graciously had a special offering for us to share with our local food shelf.  In a conversation with my lovely mom, I told her the Plumpy’Nut story.  Her circle at Zion Lutheran in Anoka graciously made another contribution.

We were able to buy about ten cartons of Plumpy’Nut, 13.8 kg, each with about 150 sachets of the stuff.  For children between 6 months and 3 years, our target population, 1-2 sachets (packets) per day is the dose.  The full course is six weeks.  But only 2% of children die of malnutrition directly.  But it figures prominently I 80% of deaths in children under five.  Malnutrition kills by potentiating any other illness.

Of course, there are varying degrees of under nutrition, both acute and chronic.  The average need for Plumpy’Nut is about 2 weeks and one packet per day.

For Tanzania, the national statistic is that 38% of children under five are stunted (low height for age).  This is a sign of chronic malnutrition.  Thirty-eight percent! 

All children admitted to the hospital are nutritionally stressed.  And furthermore, since the families provide food for their loved ones who are patients, anyone undernourished when they are admitted are likely to remain so.

We developed a protocol for prescription of the Plump’Nut and a concept paper for a program, too long to present here, but a description of it might be good for another post.  Many children relapse in 3 – 4 months.  So treatment at the hospital is the easy part!

My dear church and others have provided enough Plumpy’Nut for about 1/3 of the need for the worst cases, but I would like to expand its use if possible.  For example, some of you have met Amri Lubawa, a young lawyer who is paralyzed and with terrible bedsores.  We think he looks wasted compared to last summer.  I was hoping to get a grant to supply it ongoing for Ilula Lutheran District Hospital, but so far no luck.  “I have not yet begun to fight!” to quote John Paul Jones.  (And I would gladly accept help and advice.) 

What the heck is this magical formulation anyway?  It is (by weight) approximately one part peanut butter, one part powdered milk, one part powdered sugar, one-half part oil, like sunflower oil and necessary micronutrients (vitamins, etc.).  Plumpy’Nut is a brand name.  The WHO has a recipe and I would love to see a version made here locally!

Anyone want to help or donate or point me toward the funding?