IN CAP-HAÏTIEN, Haiti, everyone rises with the roosters, and by 8 a.m. the unpaved streets outside Hospital Justinien are jammed. Taxicabs and pickup trucks, some painted with religious slogans and turned into makeshift buses called taptaps, jostle for space on the narrow thoroughfares, dodging potholes and negotiating chaotic corners unregulated by traffic lights.
Amid the exhaust and swirls of dust, pedestrians hustle alongside the roar of traffic. Men push wheelbarrows filled with electronics and blocks of ice. Women balance trays of eggs and bananas atop their heads. Little girls hurry on their way to school, dressed in neat white blouses, kilts, and lacy socks, half a dozen bows in their hair.
On Tuesday, trash day, towers of raw garbage stand on the sidewalk, ready for collection. Goats and the occasional pig scale the piles and nibble at scraps of food and cardboard. Shopkeepers sweep carefully around the waste before raising their storefront grilles.
Here on Haiti's northern coast, 150 miles from Port-au-Prince, life goes on in the country's second-largest city much as it did before January's earthquake, and another working day has begun.
Inside Justinien's pediatrics ward, high barred windows keep out the harsh morning light, and thick concrete walls seal off the noise. Hot, humid air settles over rows of cribs where babies, some attached to IV drips, lie near watchful mothers.
A small room off to the side is bare except for an examination table, a makeshift desk piled with folders and bottles of medicine, and two narrow wooden benches pushed up against the walls. A tall Haitian nurse wearing a white dress and a cap and stockings, straight out of the 1950s, confers with a smaller, wiry American woman over a pair of height-and-weight charts.
The Haitian is Miss Gourges, head nurse of Justinien's infant malnutrition clinic. The American is Patricia Wolff, a St. Louis pediatrician. Wolff has large blue eyes, short blonde hair, a pointed chin — and a commanding presence. As her friend Mary McElwain puts it: "Pat is a person who feels people should listen to her."
Wolff has a black belt in Kenpo karate and usually carries a stun gun and a can of pepper spray in her purse. She is a woman to be reckoned with. Two months ago, when someone snatched her iPhone from her front pocket, she hopped aboard a motorcycle taxi and chased the thief through the streets of Cap-Haïtien until he disappeared into a market.
One of the charts Gourges and Wolff are studying shows that a healthy 10-month-old baby should weigh 5 1/2 kilograms, a little more than 12 pounds. "That's not right," Wolff says. "I know how much a 10-month-old is supposed to weigh."
The child in question is Robenson Yean, who sits on a narrow bench beside his mother. He wears a dirty brown T-shirt and a pair of shorts. He is unusually small for his age. His face and belly are swollen and there are tiny dark spots on his feet, all telltale signs of malnutrition.
Gourges, with the aid of the height-and-weight chart provided by the World Health Organization, has determined that Robenson is indeed malnourished and eligible for Justinien's treatment program sponsored by Wolff's organization, Meds and Food for Kids, also known as MFK.
Over the next month and a half, Robenson will make weekly visits to the clinic. Gourges or another nurse will wrap him in a sling and hang him from the scale suspended from the ceiling inside the clinic door. They'll stretch him out beside a ruler on the examination table to calculate his height — a delicate operation, because, as Wolff points out, even a centimeter can alter his ideal weight.
The nurses will mark the boy's progress on a chart they keep in a file folder on the table; Justinien, like most institutions in Haiti, has no computers. Then they'll hand his mother a green plastic packet containing half a kilogram (1.1 pounds) of medika mamba — "peanut butter medicine" — which she'll feed to him throughout the week. By his next visit, he'll likely have gained a few ounces, and within a month or two, he'll reach a healthy weight.
It is medika mamba that brought Wolff to Cap-Haïtien. For the past seven years, she's been working to build a factory where Haitian workers will use the peanuts grown by local farmers and transform them into peanut butter, enhanced by vitamins and minerals, which will be distributed and fed to malnourished children in clinics throughout Haiti.
A few minutes before Robenson and his mother arrived, Wolff and Gourges were studying the medical chart of another child, an 18-month-old boy named Blaise. He weighed 13 1/4 pounds when he entered the program, and his goal weight was set at 16 1/2. At his last visit, though, he weighed in at a little more than 14 pounds; the week before that, he'd been at 13.
The numbers make Wolff suspicious. When used properly, medika mamba has a 75 percent success rate.
"Maybe he had diarrhea," she speculates. "Or maybe his family was giving [the medika mamba] away. He missed two visits. They gave him a warning. He was supposed to be kicked out if he missed a visit, but the kid probably looks so sick and scrawny they decided to keep him in."
A nurse hired by MFK used to monitor the patients at the Cap-Haïtien–area clinics and make sure they ate their medika mamba. But the nurse resigned, overextended from her other full-time job. Now Wolff must find a replacement. "Without an enforcer from MFK to make sure they're using medika mamba correctly, the outcomes aren't as good," she explains.
But when the peanut butter is used the right way, "it's a marvel," exclaims Dave Polage, an American who runs a clinic in Terre Blanche, Haiti.
"After we got the product and began using it, we were just amazed by the results," Licia Betor, who runs the Real Hope for Haiti Rescue Center in Cazale, writes in an e-mail. "After living here for fifteen years, you hear lots and lots of stories of products that are good for malnourished children. Many of them are great, but the kids do not like the taste. But the kids loved the medika mamba, and it works so well for those who were so sick."