(Do you see Zambia on this map?)
One of the main focuses of my ministry here is the Feeding Program. Three times a week, children gather at a local church to eat a decent meal and take a multivitamin. One day a week, we play games, have a Bible story, and work for a few hours on math and English skills. Most of these children are HIV-positive. Some are referred by the local clinic, some are found through the community, and some are from within the church itself. More than 3/4s are orphans. Many live with a grandparent. It is tragic and hard. It is good and redeeming.
But is it enough? Is it ever enough?
My personality is always searching for more information and better ways of doing things. I think one of the great tragedies of modern missions is the lack of practical application of modern research. So much outdated theory is being practiced for decades without evaluation and refining.
The Copenhagen Consensus (a think tank of Nobel-prize winners who gathered together to analyze massive amounts of data and to determine which global problems were causing the most harm and could have the greatest effect if solved) prioritized measures to control HIV/AIDS and to combat micronutrient deficiency during the early years of life.
By the time a child is in our feeding program, they are generally at least 2 years old. Some younger children are carried to the program on an older sister’s back. At this point, the child already has HIV and is already stunted.
USAID and PEPFAR have done a massive amount of good in supplying Zambia with ART treatment for the majority of people with HIV. The greatest reduction in infection has been seen in monther-to-fetus transmission. But work still remains to be done, as numbers still hover around 25% with over 1.1 million people living with HIV.
But another great tragedy faces the future of Zambia. 45.4% of all children are considered stunted. While malnutrition is a global concern, stunting is a hidden and dangerous aspect that is often forgotten. Kwashiorkor and Marasmus are the common forms of wasting malnutrition, and are the children you see who are skin and bones or swollen with protein deficiency. These diseases afflict only about 5% of all children in Zambia. Stunting, however, will determine the future of nearly half the population.
Simply put, stunting is inadequate nutrition even with adequate caloric intake. Vitamin, protein, and mineral deficiencies cause irreversible damage to children, especially in the first years. Modern nutritionists and agronomists now refer to this as the “First 1,000 Days,” or the time from conception to the age of 2, when the window on opportunity to properly nourish a body and brain exists. A lack of micronutrients during this time will result in increased morbidity (the likelihood of dying young), decreased cognitive ability (measurable loss of intelligence and learning ability), short stature, and impaired immunological ability (getting more sick more often and taking longer to recover from illnesses). Stunting is easily measured physically, but ‘stunts’ the brain just as much, if not more, than the body.
A nation with a stunting rate as high as Zambia’s can expect to loose at least 11% of its GNP every year due to “low labor productivity, high health-care expenditures, and more”. A family with parents who are stunted will likely have stunted children, lower wage-earning potential, more illnesses, and less education. It is the very definition of cyclical poverty.
And it is overwhelming. Do we give up? Most feeding programs are targeted to children. And they are important! And ours is important (if not just to halt the progress of stunting, than to assure that the child’s body can handle the added stress of ART treatment, for which adequate nutrition is essential)! Unfortunately, all current research shows that, despite the plasticity of the brain, added nutrition after the age of 2 does not reverse stunting. Our program struggles with seeing children who are obviously short in stature, constantly ill, and cognitively impaired.
Programs throughout the world are trying to address these issues (none directly in Zambia that we have found), but they are complex. Hygiene, income, food scarcity, health-care access, and more all factor into the stunting rate of a nation. But what about the individual child?
One of the little girls who come regularly to the feeding program is Queen. She is 4 years older than my daughter and yet shorter and smaller. She usually has her baby sister on her back and two other sisters with her. They are all stunted according to the international growth chart. The older two attend the local community school but are each 3-4 years behind the traditional grade for their age. Lately, they have had runny noses, crusty eyes, and fevers. While we address the problems we can, they happen again and again.
Every week, I argue with children about their age, having to determine their estimated age by their teeth. Most children have no idea of their birthday or even how old they are! Kids who say they are 14 are as small as my 6-year-old, and I can’t argue with them. These same 14-year-olds are also in grade 8 but don’t understand basic math skills and their English (although their education from grade 5 and up is all in English) is extremely limited.
When the problem is so pervasive, it is demoralizing and overwhelming. Even when I focus on just one child. But I will keep on looking. And working. And praying. “May YOUR kingdom come”!
“You may choose to look the other way but you can never again say that you did not know.” -William Wilberforce