Rachel Nears Sixth Birthday

Rachel Namazongo lives with her mother and grandparents in Ligowe, Malawi, in the remote district of Neno. The young girl, who turns 6 next month, helps her grandmother at home and pumps water from a well in their garden. When she’s not with her grandmother or at school, the cheerful first-grader plays with other children in their compound.

Her grandmother never thought Rachel would reach this age. At 2, she was HIV-positive and severely malnourished. With antiretroviral therapy and a peanut-based, high-calorie food provided by Partners In Health, she quickly recovered. But last year Rachel was readmitted to the hospital, malnourished and infected with tuberculosis. With more treatment, she eventually became well enough to return home. In all, Rachel has been hospitalized six times for malnutrition.

This is not uncommon. Most rural Malawians are poor subsistence farmers and grow maize outside their homes. If a family isn’t able to harvest enough maize to last them the year, they go hungry.

Without food, an individual’s immune system weakens and the body becomes more susceptible to disease; malnutrition therefore goes hand in hand with diseases such as pneumonia, tuberculosis, and HIV. Illness can then worsen malnutrition, compounding both problems.

This year is likely to be harder than usual for Rachel and others in rural Malawi. January, February, and March—a period known as nthawi ya chilala, the “hunger season”—are often when people run out of food they harvested the previous May.

But the hunger season is expected to come much earlier this year. Excessive rains last January caused devastating floods in many parts of the country and washed away crops and fertilizer, such that maize production has decreased by 28 percent, according to government estimates. The Ministry of Finance, Economic Planning and Development predicts that 3 million people—17 percent of Malawi’s population—will not be able to meet their annual food requirements.

PIH is already seeing the effects. Dolifa, an elderly woman with failing eyesight, came to have her eyes checked at a recent health screening in Matope. PIH clinicians diagnosed her as malnourished. “A lot of people have no food; our crops were washed away,” Dolifa shrugged. “We are just trying to make ends meet day in and day out, letting tomorrow’s worries remain tomorrow’s worries.”

Another patient, a father named John, came to the screening with a persistent cough and learned he was also malnourished. “I am not surprised,” he said. “My family and I usually go days without eating. When we have food to eat, we spare bigger portions for the younger ones.”

PIH provides malnourished patients with bags of blended corn and soy flour, and cooking oil. Patients suffering from severe malnutrition receive nut-based formulas that are high in calories, and they are referred to clinics for further care and medication. If patients are suffering from additional diseases such as tuberculosis or HIV, PIH incorporates nutritious food into their treatment. To prevent malnutrition in HIV-positive mothers and children, PIH provides them food in addition to antiretroviral therapy.

For Rachel and her family, it will be an ongoing challenge to stay healthy. But they’re hopeful. Rachel’s mother, 24-year-old Mphatso, thinks back to a year ago, when she feared she would lose her daughter.

“I remember sitting on the hospital bed and seeing other children die. I was scared Rachel would also die,” she said. Now, Mphatso thinks her daughter will go far in life. To inspire hope in others, she often tells Rachel’s story.

Blessings Banda, PIH’s nutrition manager in Malawi, has watched Rachel grow from a toddler to a young school girl, and helped care for her each step of the way (read more about his friendship with Rachel and her family here and here).

“We track her and act quickly to ensure we support her in all ways possible—both medically and nutrition-wise,” he says.