Hunger underlined by poverty

Just one US $15 was all that Yusuf Kwajedwa needed to buy fertiliser so that he could plant a crop this year. But, even if he had made the 10 reed mats he needed to barter for the fertiliser, and if his wife Sakina had swapped some firewood for seed, he, like others in Nkhonde village in Malawi's impoverished southern Dedza district, would have been too sick with cholera to plant the crops. He was among 33,211 people throughout the country who contracted the water-borne disease. He survived, but by the end of April, 926 people were dead in 10 districts. At least 90 were from Nkhonde and the surrounding villages. The story of Yusuf and Sakina and their five children is the story of hundreds of thousands of Malawians. They battled to survive through food shortages that led President Bakili Muluzi to declare a disaster this year. Then a cholera epidemic which made their malnutrition worse, and now a new struggle to access seed and fertilizer. But behind it all is their biggest enemy, severe poverty. "The reason those people died was because they were hungry and their bodies couldn't withstand cholera," said Sakina breastfeeding their tiny seven-month-old. His stick-thin arms tug at his mother. The older children sit shyly in the doorway, their tummies, like those of the other children in the village, protrude through ragged filthy clothes - a tell-tale sign of malnourishment. A neighbour's tiny child, her hair an orange fuzz caused by the related condition of kwashiorkor, sits weakly nearby on the crumbling mud porch. Sakina explained: "We had a problem with food this year because we didn't grow much - my husband was sick." To keep her ailing husband and family alive from January to March, she dug up banana roots and pounded them into a flour which she cooked into a porridge. "Things are little better now, but we won't have enough," she said. "It was difficult this year because I had no seed, no fertiliser and I was feeling sick," said Yusuf. "Now that I'm better I'm going to the river to get reeds to make sleeping mats and go from village to village to exchange them for food." He was referring to the village at the top of the steep footpath. Up there people are better off - they have crops that they irrigate, they didn't eat all their seed out of hunger and some received help from family who have work. It's there that the people of Nkhonde go for odd jobs to raise cash, and it's there that Sakina swapped a bundle of firewood she scavenged off the mountain slopes for about 10 small pumpkins. She'll use this for all the family's meals over the next three days. When that runs out she has a few of the prickly-skinned wild cucumbers to fall back on and will search for more wood to barter, or will look for more odd jobs. Luxuries are unheard of in their household. According to the Malawi National Human Development report released on Thursday, 65 percent of Malawians are poor and 28 percent are ultra-poor. When asked what his wish was, Yusuf said: "I just want to buy some fertiliser so that I can plant." Yusuf will struggle to put aside the money to buy the fertilizer he needs because the government no longer subsidises this. His weakened body will also have to walk a long distance out of the valley to a shop to buy it. "They have no money at all," said health worker Jennings Balankhondo. It is health workers like him who cycle the long dirt road, and the even longer footpath, to reach remote villages like Nkhonde. There he gives health advice and advises who should make the long trip by foot for treatment at a clinic. He doesn't dispense any medicines. It is also up to him to report cases of severe malnutrition to the local health centre. This information is passed on and eventually villages like Nkhonde are included in emergency feeding operations. Though Yusuf's pride says that his family is coping and that he can provide, the World Food Programme (WFP) has targeted his village for emergency distribution. Dr Yusuf Chellouche, World Health Organisation (WHO) Acting Resident Representative in Malawi, said the link between food shortages, malnutrition and cholera - all daily realities for many Malawians - is pernicious. "When there are food shortages people's hygiene considerations go down – they are trying to fill their stomachs and will eat anything. They get infected with cholera, then diarrhoea. When they have diarrhoea the body doesn't absorb nutritients and this creates malnutrition. It's a vicious circle. "Combined with HIV/AIDS this contributes to excess mortality," Chellouche said. A WHO study found that the main causes of the cholera outbreak was that people were forced to eat anything out of hunger, there was poor sanitation, poorly trained health workers, bad case management, inadequate surveillance skills to respond properly and no coordination between the agriculture, water and sanitation sectors. Also a shock was the discovery that while families religiously kept drinking water clean and separate, they appeared unaware that they shouldn't wash utensils with unsafe water and place "safe" food and water in unsafe utensils. Richard Pendame, Malawi's health secretary shakes his head when asked about mismanagement. He said that with cholera endemic in Malawi since 1973, the health department prepared for it in the same way every year. They order drugs to cure it and send out circulars reminding health officials to conduct their awareness campaigns. Last year they expected the usual 3,000 cases in the "hot areas" and planned accordingly along with WHO and the UN children's agency UNICEF. "But something was happening to water between where it was collected and where it was stored," said Pendame. "Also, we don't make intravenous fluids here so we had to order them from abroad - everybody was jumping up and down because they couldn't get anything." He said Malawi's situation was aggravated by cholera epidemics in Zambia and South Africa. The drug company they ordered from in South Africa was unable to keep up. But the WHO report found that staff were also incorrectly giving the intravenous fluids to most patients instead of the oral rehydration solutions. But while the cholera situation may have improved, Malawi's long term food difficulties have not. According to a recent WFP and Food and Agriculture Organisation (FAO) assessment, 3.2 million Malawians are in need of food aid. The report said: "A poor harvest in 2000/02, very low levels of stocks of maize, rapidly rising food prices, a generally late start to the planting rains for the 2001/02 season, and a dry spell early in 2002, exacerbated the food crisis in Malawi." Malawi's Daily Times reported on Thursday that Agriculture Minister Aleke Banda said the hunger situation was easing with government expecting to get up to 550,000 mt of maize from donors with about 250,00 mt of maize for free distribution to the worst hit areas. But he echoed WFP warnings that the present respite would be short. Meanwhile, in Nkhonde village children ran away at the sight of the "faceless man". Every year he comes in his frightening costume to cleanse the graves but this year he was late. Even sacred rituals were delayed because there wasn't enough food to make it complete.