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And without turning a profit, the factory will never be self-sustaining and will, like so many other projects in Haiti, find itself completely dependent on foreign aid.
That is precisely what Wolff does not want.
"Shoot, you need to stay and develop the country," she says. "They don't need to be rescued."
Nothing had prepared Pat Wolff for her first trip to Haiti, in 1988. "It felt as though I was at the scene of an accident," she remembers.
She'd traveled to Port-au-Prince with the Haiti Project, a mission group led by Bob Corbett, a retired Webster University professor who had become an expert on Haiti, and his wife, Jane. Wolff and her husband, Michael, now a Missouri state Supreme Court justice, and their two sons, then 11 and 14, planned to volunteer at Mother Teresa's homes for dying children and adults.
"It was a profoundly awful experience," Wolff recalls. "Most of the people there were dying of something that could have been treated with proper equipment: tuberculosis, malnutrition, infections. All we could do was comfort them as they needlessly died. It was way too little and way too late."
Corbett arranged for Wolff, another doctor and a nurse to travel into the mountains to volunteer at a start-up clinic. They rode horses and donkeys and brought all the medicine they could carry.
"The first day, 300 people showed up," Wolff. recounts. "Some of them had walked miles and miles. They had never seen a doctor before. They had heart disease, kidney failure. It couldn't be solved with a Band-Aid. It was eye-opening and upsetting. I went home bedraggled and grief-stricken."
Over the next 15 years, Wolff returned often to Haiti, mostly to a clinic near Cap-Haïtien. But, she says, "It was like spitting into the ocean. We needed to solve the underlying problem." One in five Haitian children, Wolff learned, is malnourished. One in 10 dies before his fifth birthday.
"Malnutrition leads to immune deficiencies," Wolff explains. "They got diseases because they were malnourished."
One of Wolff's colleagues at Washington University's medical school, Dr. Mark Manary, had been experimenting in the east African nation of Malawi with a radical new treatment for malnutrition. A combination of ground peanuts, powdered milk, sugar, oil and vitamins, it was cheap, easy to produce and high in protein. It was also easy to store, even in a tropical climate. Best of all, patients could be treated at home.
"The only treatment for malnutrition [in developing countries] was in the hospital," Wolff explains. "People would wait in the hospital for months. There was only a 20 or 25 percent recovery rate."
Manary doesn't know why it took so long to come up with the peanut butter solution. "In the Middle East," he says, "they've been using halvah, the same notion, for 2,000 years, but we didn't come to it so fast."
But he and his research partner, André Briend, saw immediate results. From the earliest trials, the peanut butter, known in the scientific community as ready-to-use therapeutic food (RUTF), showed an 85 percent success rate. Amazingly — again, no one is sure why — peanut allergies are rare in the developing world. By 2007 the World Health Organization declared RUTF the gold standard in treating childhood malnutrition.
Manary and Briend decided that if RUTF were to be of any use, it would have to move beyond research studies and into mass production. Briend established a partnership with a French company called Nutriset, which would manufacture the peanut butter, called Plumpy'nut, in its Rouen factory and export it around the world. Nutriset now controls 90 percent of the world RUTF market.
Manary, however, saw RUTF's potential for economic development, and by the time Wolff visited his Malawi clinic in 2001 and 2002, he'd already started his own NGO, Project Peanut Butter. The organization would buy peanuts from Malawian farmers and produce RUTF in a local factory. There was no way Project Peanut Butter would be able to compete with Plumpy'nut on a global scale, but it would provide jobs and pump money back into Malawi's economy.
Wolff liked what she saw, and with Manary's help, she started her own program. She got a grant from Rotary International, and she purchased a peanut grinder. She learned how to operate it, take it apart and put it back together. "It was a little tricky," she says. "But now I was set. I could go to Haiti."
She set up the grinder in a church classroom in Cap-Haïtien and began making peanut butter.
At 7 a.m. Wolff leaves for the factory, a house in the Cap-Haïtien suburb of Mombin Lataille, and arrives in time for the daily morning meeting with the factory supervisor. "We talk about who's going to use the one car because the other car's been broken for a week," she says. "I talk to the quality-control manager. I talk to the product supervisor, and we figure out how much medika mamba we need. We check to make sure we have the right kinds of bags and cups in storage."
A problem that, in the United States, might be solved in a single afternoon can drag out into a monthlong saga in Haiti. MFK's broken Land Cruiser, for instance, needs a rubber seal for its engine. None of the Cap-Haïtien mechanics can afford to keep parts on hand; the seal has to be specially ordered from a dealer in Port-au-Prince. When the part arrives and doesn't fit, a replacement has to be ordered from the Dominican Republic. When that part doesn't work, the mechanic offers to use a lathe to make it fit.