A 10-year-old boy arrived at Queen Elizabeth Central Hospital with severe burns on his face. His lips were scorched off and was blinded. 

Over the weekend, the hospital staff pitched in to buy medicine for the family. On Monday morning, nurses discover that the boy was dead.

This was just one of the many cases that nutrition professor Peggy Papathakis dealt with during her 10 months in Malawi, Africa. Located in southeastern Africa, Malawi is known as “the warm heart of Africa” for its kind-hearted and friendly people, Papathakis said. 

Malawi is also one of the poorest countries in the world, with 50.7 percent of the population living under the poverty line, according to a 2017 International Monetary Fund report. 

Since coming to Cal Poly in 2006, Papathakis has sought to build nutrition research in developing countries and to provide students with a global perspective of nutrition in class and in the field, she said.

Papathakis helped send more than 30 students to Malawi to volunteer at community clinics. Her previous research studies were focused on developing methods to increase the nutritional intake of pregnant women.

In 2018, Papathakis received a Fulbright U.S. Scholar Program award to spend 10 months in Malawi. She found that there was a need to improve nutrition education and worked with professors at The University of Malawi College of Medicine in Blantyre.

A 2018 report found 37 percent of children under age five in Malawi are stunted and 12 percent are underweight, according to the Malawi National Statistical Office.

The economy of Malawi is largely agricultural with many families practicing monocropping, mainly depending on corn. Combined with severe climate catastrophes, Malawi continues to be susceptible to malnutrition.

“Families have to trade off between selling produce to allow their children to go to school, or using the food to feed themselves and their family,” Papathakis said. 

There is a fee for secondary school and the need to purchase supplies, which is expensive for many households.

The lack of clinical nutrition experts and registered dietitians is also a leading contributor to malnutrition in Malawi. There are currently only 8 dietitians in Malawi. Papathakis is one of them.

“When I worked in U.C. Davis [Medical Center], I was at a hospital with 350 beds and there were 23 dietitians there,” Papathakis said. “[This hospital] has 1,000 beds and there’s no dietitians.”

With a population of 18.62 million people, there is one dietician per 2.5 million people.

To help increase the number of dietitians and nutritionists, part of Papathakis’ research involves developing syllabi for courses that will be taught in Malawi after she returns to the U.S. 

Besides working with the college, Papathakis also visits Queen Elizabeth Central Hospital in Blantyre approximately three times a week, working mainly in the burn unit and kitchen. The burn unit has, on average, 15 patients of different ages.

Burn accidents are common in Malawi appliances like stoves and ovens are unavailable in rural villages. Open fire pits and bonfires are commonly used to cook meals and provide heat.

The hospital kitchen lacks tools to improve nutrition for patients in the hospital and does not  have a functional stove or refrigerator. This is a big issue because Papathakise said the foundation of wound healing is centered around proper diet and nutrition.

“I always ask myself ‘How I can use what is here to help improve nutrition?’” Papathakise said. “I have made up a formula to give as tube feedings, otherwise it’s porridge going down the tube.” 

Papathakis said the hospital does not have high quality food. Donations are provided through non-profit organizations like the United Nations Children’s Fund, but these donations come sporadically. 

When there is a lack of donations, Papathakis gives patients ready-to-use therapeutic food (RUTF), a dietary supplement used for feeding malnourished children.

That is where some of the Cal Poly students currently in Malawi come in. 

Cal Poly graduate students Emma Scudero and Natasha Wright are working with Project Peanut Butter in Malawi to study maternal and child nutrition and to screen for children who may be eligible for the study.

Project Peanut Butter’s research in Malawi is focused on developing an RUTF that will maximize a child’s neurocognitive development. The “peanut butter” is made of peanut paste, brown sugar, powdered milk, vegetable oil and added vitamins and minerals, according to Project Peanut Butter.

The Project Peanut Butter began in 1999 when Dr. Mark Manary, a pediatrician and professor, spent 10 weeks in Malawi to understand what type of therapeutic food was most effective for its inhabitants.

Project Peanut Butter was officially founded in 2004 and continues research and relief work in Malawi, Ghana and Sierra Leone.

The team in Malawi is currently researching ways for children to reach a higher recovery rate from malnutrition, according to Scudero. Currently, malnourished children who use RUTF have a 75 to 95 percent recovery rate.

A typical day for Scudero and Wright begins at 5 a.m., preparing to visit clinics throughout the day. Drivers will pick them up, along with other research assistants and nurses. The drive to these clinics can take up to three hours. 

They screen children and check their feet for edema the swelling of limbs from low protein levels and measure their arm circumference before deciding if the children are eligible for the study.

Even if children are not eligible for the study, the team still searches for ways to help the family, said Wright.

Papathakis concluded her trip at the end of October and said she plans to return to Cal Poly to continue teaching. 

She said she e hopes to have set a path for further education of nutrition in Malawi and that the hospital will finally receive the resources needed to serve the community. Her hope for the future of Malawi is that the country will be more self-sustaining, she said. By developing a curriculum with the College of Medicine, her goal is to equip future nutrition professionals to share their knowledge in communities and hospitals.

“I’ll find a way to stay connected here,” Papathakis said. “I don’t know what that is yet, but I definitely want to keep the Cal Poly connection going.” 

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