A Haitian girl from Zanmi Agrikol's Family Assistance
Program (Photo: Partners In Health)

Overview

In 2008, Steamboat made a three-year commitment to its second Special Grantee, Partners In Health (PIH), an organization founded in 1987 by Dr. Paul Farmer, Dr. Jim Kim, and Ophelia Dahl, and dedicated to addressing global health inequities and social injustice.  Steamboat's multi-year investment in Zanmi Agrikol - a program designed to treat and prevent child malnutrition using locally grown therapeutic foods in rural Haiti - is ably managed by Marie Flore Chipps, a long-standing staff member of Zanmi Lasante, the community clinic that Paul Farmer set up in the village of Cange, Haiti in 1985.

Timeline

• 2004: Zanmi Agrikol was born, and leased a 40-acre farm in Corporant, Haiti. Planted 14,000 banana trees and grew beans, corn, spinach, and other vegetables.
• 2006: Started local production of Nourimanba and Nourimil, treated 30 children hospitalized with severe malnutrition, and enrolled 20 families in the Family Assistance Program (FAP).
• 2007: Zanmi Lasante treated 3,464 children suffering from malnutrition, using 22,280 kgs. of Nourimanba and 87,213 lbs. of Nourimil. Zanmi Agrikol enrolled 40 families in FAP.
• 2008: 3,500 children treated; 32,782 kgs. of Nourimanba and 126,708 lbs. of Nourimil produced; 240 families enrolled in FAP.
• As of May 2009: 6,000 malnourished children treated in FY 2009 to date; 240 families continued in FAP.

Related Links:

• Partners In Health

The impact of food insecurity on the health and well-being of communities in Haiti cannot be overestimated. One of the most tragic manifestations is malnutrition in children. According to UNICEF, Haiti has the highest rate of mortality for children under five in the Western hemisphere. It is estimated that 28% of deaths of children under the age of five can be directly attributed to malnutriton. When not fatal, chronic malnutrition stunts children's physical and intellectual development, causing irreversible harm that follows them through their lives. According to the World Food Program of the UN, 9% of children in Haiti suffer from acute undernutrition, while 24% suffer from chronic undernutriton.

More broadly, food insecurity pervades almost every facet of life in impoverished rural Haiti. HIV and TB patients cannot access or adhere to treatment because medications are difficult to take on an empty stomach, and because travel to clinics becomes impossible when patients are weak with hunger. Education suffers because money that would be used for school fees is diverted to purchasing food for the family, and even when children do attend school, they often cannot concentrate or learn due to hunger and insufficient nutrition. Families may be forced to sell meager assets to pay for food, and women, lacking other options, may engage in transactional sex to provide food for their children. The global food crisis, which has brought international attention to Haiti's starving poor, has made daily life even more difficult. The costs of basic staples like wheat and rice have risen nearly 100%, causing three-quarters of Central Haiti and the Artibonite to be extremely food insecure.

Marie Flore Chipps

Marie Flore Chipps in front of a water source
built by Partners In Health
(Photo: Partners In Health)

Since Marie Flore was a teenager, she has helped her father, Father Lafontant, Founding Director of Zanmi Lasante, Creole for "Partners In Health," manage different churches and school activities in the Central Plateau of Haiti. She left Haiti to study in the United States and came back in 1990 to work as the coordinator of Zanmi Lasante's community projects. For almost two decades, Marie Flore has been extraordinarily dedicated to the resource-poor communities where Partners In Health and Zanmi Lasante work, spending most of her time in rural villages across the Central Plateau, worlds apart from her home and family in Port-au-Prince. She has helped to create systematized approaches to overcome daunting issues such as adult illiteracy, malnutrition, and water-born diseases; thousands have benefited from programs that she has helped launch. Today Marie Flore oversees Zanmi Lasante's non-clinical and community development projects, including education, water, social support, and agriculture.

Q&A with Special Grantee, Marie Flore Chipps

Below is a transcript of a conversation between PIH's Haiti Program Coordinator, Ali Lutz and Marie Flore Chipps, which took place in January 2009.

Participants in Partners In Health’s Zanmi Agrikol
program gather for a training with an agronomist.
(Photo: Partners In Health)

Overseen by Marie Flore Chipps, Zanmi Agrikol works to reduce childhood malnutrition by bolstering community agriculture practices. Through this initiative, PIH is able to respond to the significant number of malnourished children in PIH's catchment area in Central Haiti and the Artibonite and also train hundreds of Haitian farmers to stimulate the local economy.

The program improves the livelihoods of farming families in two specific ways: 1) by employing farmers and families to grow the ingredients needed for locally produced nutritional treatments called Nourimanba and Nourimil, and 2) through the Family Assistance Program, which provides agricultural training and seeds, tools, and goats to the families of malnourished patients, leading to improved food security.

Nourimanba and Nourimil:

Through Zanmi Agrikol, local farmers are trained and equipped to grow basic crops that are then purchased by PIH and used to produce two nutritional treatments called Nourimanba and Nourimil.

For the most severely malnourished patients, PIH and Zanmi Lasante use Nourimanba, a "Ready to Use Therapeutic Food" (RUTF) that is made from a peanut butter base combined with milk powder, vegetable oil, sugar, and a specially formulated vitamin mix for malnourished children. Because of its oil and peanut butter base, Nourimanba has a low water content, which resists bacterial growth and allows it to be safely stored for months. As it is "ready to use," no cooking is required, allowing parents to easily feed it to their children at home, eliminating or reducing the amount of time children need to spend in the hospital. Zanmi Lasante was one of the first organizations in Haiti to begin treating severely malnourished patients with RUTF, although it is more widely used in Africa and Asia.

(Left) A severely malnourished boy named Louis Juste Antony, presented to Partners In Health in November 2008. (Right) The same boy, Louis, in January 2009, after he has been treated with Nourimanba, a high-energy food product. (Photo: Partners In Health)

Moderately malnourished children are prescribed a cereal-legume blend made of beans and either rice or corn called Nourimil. Once severely malnourished children have responded to Nourimanba, they receive Nourimil as a part of their treatment plan.

Family Assistance Program:

This program provides agricultural trainings, tools, land, goats, and individualized support in order to build the capacity of vulnerable families to grow and to sell food. Ajans agrikol, or community agricultural agents, work directly with families to teach them agricultural techniques to improve their yield on their own land. The ajans agrikol conduct extensive interviews with families in order to establish a baseline of needs, conduct an initial land assessment, distribute seeds and tools, and began advising families about soil conservation measures. In addition to providing monthly trainings for families, each ajan agrikol is responsible for visiting ten families in their fields once every two weeks.

Zanmi Agrikol was launched as a pilot program at two sites in November 2006. At the start of the program, PIH and Zanmi Lasante set initial outcome goals for the Zanmi Agrikol project. These goals were, first, to produce Nourimanba/Nourimil to treat 2,080 malnourished children, and, second, to supervise and train four ajans agrikol and conduct trainings for 40 participating families through the Family Assistance Program.

In 2008, the program was scaled up to all PIH sites in Haiti. As of June 30, 2008, PIH has more than exceeded their goals: they have produced over 32,782 kgs. of Nourimanba and 126,708 lbs. of Nourimil, and have used both to treat over 3,500 malnourished children across all nine sites. In addition, the program has hired and trained 24 ajans agrikol to provide support to 240 families who have received trainings and supplies through the Family Assistance Program. As of June 30, 2009, 6,000 malnourished children had already been treated.