Paul's dad has a great smile. His warmth captures me as I
observe his obvious care for his young son and his attempts to get
the shy toddler to smile for me.
But when I look at Paul, a smile is not the first thing I
notice. Instead, I notice all the signs that his little body is not
getting the protein that he needs to grow.
In poor places, young children often suffer from a particular
kind of malnutrition when they are weaned from their mother's
breast milk. Very often, they move from breast milk to very basic
starches. They may get little protein, even if they are taking in
enough calories for survival. Meat or eggs are too costly, and
their parents may not realize the difference that other proteins
Paul's father loves him very much, but he can usually only
afford to feed Paul ugali (the corn meal mush that is the staple
starch here) and a thin form of porridge. Ugali fills Paul's belly,
but it does not give him what he really needs. Without the protein
that he needs, Paul's belly is big, his face and hands are swollen,
and he is no longer growing. Paul is very malnourished.
Paul's little body needs protein right now. This is the critical
time when his bones and brain are growing. We know that being
deprived of what he needs right now will likely affect how big he
gets, how he learns and does in school, and how his body
metabolizes food for the rest of his life. Paul cannot wait.
Malnutrition is far too common here in Kenya - and far too
common all around the world. 150 million children in developing
countries around the world are malnourished. A number that defies
understanding. A quarter of Kenya's children are malnourished. In
our HIV clinics, almost every child coming in qualifies as being
malnourished. In the area where Paul lives, there has not been
enough rain, and the families are poor, poor, poor. The children's
bodies are the first to show this deprivation.
Child malnutrition: a huge and overwhelming problem.
But Paul is the child in front of me today, and his father is
smiling at me, convinced that we can solve his son's problems. And
maybe we can. It takes more hours than it should for phone calls
and tracking down the right pharmacist and begging social work for
assistance, but I manage to get Paul a supply of a special paste
made from nuts that will give his body back some of the protein he
Another one of the research studies we presented last week at
the International AIDS Society in Malaysia was about the difference
that food supplements like this make for children with HIV.
"Ready-to-use foods" like this nut paste significantly cut back the
chance that a child like Paul will die or will get other
infections. They save lives.
When I finally get them, I carry the packets of this nut paste
into the clinic like they are pure, squishy gold. And, truly, they
could not be more precious for this child's body.
We're going to find Paul's smile.