It was raining in Addis Ababa when I left, but would it be raining in Wolayita? The spring rains had failed, bringing awful consequences for the people in this remote, beautiful and harsh area. Wolayita is in the far south of Ethiopia, seven hours drive from the capital. It is a part of Ethiopia where people live on the edge at the best of times, and this is one of the worst of times. The energy and ingenuity required to survive in these dry lands is extraordinary, and the courage and endurance of the people who survive here is impressive; but now, they are desperate and overwhelmed.
Despite the early-warning systems put in place by government and NGOs (with support from the one I represent, Concern); despite better reserves of grains; despite the resilience of the farmers and their families - despite all this, the twin evils of drought and soaring food prices have engulfed the people here.
Their reserves of food, resources and energy are exhausted. It is a terrible sight to see a mother who you know has such deep reservoirs of courage - the kind that you or I can only dream of - bow her head and quietly weep, exhausted by her efforts and her despair.
She was sitting on the bed, tenderly holding her small baby close to her under a cotton wrap. I asked if could see the baby; she gently drew back the cover and I saw the wizened infant, his body overwhelmed by malnutrition, his immune system shut down - the consequences of starvation. This tiny, pale baby coughed a dreadful, wheezy, wracking cough - a cough that belonged to a very old man.
I wondered if the baby would last the week, and I am sure his mother also questioned if her loving care and the determined but limited help from the health centre and Concern would pull him though. Pneumonia had attacked him as his body, in desperate survival mode, shut down his immune system.
Lyndall Stein is executive director of Concern, an International NGO headquartered in Dublin. To learn more of Concern's work on Ethiopia and its current emergency appeal, click here
Also by Lyndall Stein in openDemocracy:
"Darfur journal" (18 November 2004)
A saving system
That is what happens when you are malnourished, starved of vital nutrients. Your body closes down unnecessary functions, desperately saving your vital resources to keep your heart and brain going. You will go though many agonising stages, until your body will even begin to digest its own tissues. Starvation will reduce you to a shell, and will reduce a small child very quickly to a silent, limp, passive, sad memory of all that a child should be - laughing, crying, yelling and quietly, happily burbling.
All the children who are acutely malnourished are dreadfully quiet. The nutritionists, nurses and helpers are always cheered by a screaming child - it means they still have some strength, resilience and vital life-force left.
In the next bed was Misrach Shiburu, also deathly quiet. Tending him was his sister, a tiny 15-year-old, who gently brushed the flies away from his face as he lay listlessly on the bed. She was in charge of him; his mother had to stay at home to look after her youngest and could not be with her 5-year-old little boy. Though acutely malnourished, he was getting better and sat up gingerly while we were there, not well enough to cry or smile, but at least able to look around. The team at Duyango Fango felt he would be alright. He was being fed "plumpy-nut", a vitamin-enriched peanut paste which - dense with vitamins, minerals and calories - quickly builds up small children suffering from the effects of food shortages.
In 2004, Concern introduced a new and innovative technique to tackle malnutrition across Ethiopia and other parts of Africa, where food shortages take such a dreadful toll on the health and life-chances of children and mothers. It requires the involvement of the community, the local health system and a remarkable supply-chain and logistics operation, bringing the specialised food for the under-fives and also a special mix of flour, vitamins, sugar and oil which helps feed the other children in the family. This helps to ensure that the plumpy-nut is kept for the little children who are unwell and the most vulnerable, the ones who so desperately need the special paste.
After the pain of seeing Bizunesh Sisay's silent tears, it was a welcome sight watching another baby, not yet so malnourished, grasp the silver packet of plumpy-nut and eagerly lick the nutritious paste. The health workers explained that this baby would improve very quickly.
It had been a complex and difficult job
working with the local government to bring this system into their local health
systems. It took tough negotiations to convince them it would work, and then to
ensure the logistics would be consistent. But now it has made it possible for
us to scale up and, working in collaboration with local structures, treat the
thousands of seriously malnourished people who have began to queue up across
Wolayita - one of the most affected areas in this current food crisis.
Also in openDemocracy on food crises in Africa and beyond:
Simon Roughneen, "Hard to believe your eyes: drought in Kenya and Ethiopia" (15 May 2006),
Carlos Reyes-Manzo, "Ethiopia: digging for blue gold" (2 October 2006),
Anna Husarska, "Water problems in Somalia: a photo-essay" (9 October 2007),
Anna Husarska, "Kenya's displaced people: a photo-essay" (5 February 2008),
Heidi Fritschel "The price of food: ingredients of a global crisis" (9 April 2008),
Amélie Gauthier, "Haiti: empty stomachs, stormy politics" (21 April 2008),
Paul Rogers, "The world's food insecurity" (29 April 2008),
Tony Curzon Price, "The food economy's missing link" (2 May 2008),
Stephan Haggard, Marcus Noland & Eric Weeks, "North Korea: the next famine" (20 May 2008),
Simon Maxwell, "Rome's food summit: a torch passed" (6 June 2008),
Sue Branford, "The world food summit: a lost opportunity" (10 June 2008)
The price of delay
In Shashago I saw a beautiful young woman with huge, limpid dark eyes. She was sitting waiting with her old mother (a rare sight in Ethiopia where life expectancy for women is in the mid-40s). The health worker approached the young woman, gently lifted her sleeve and measured her too slender upper arm. Yes, she was underweight and needed supplementary food, but it would not arrive till the following Wednesday - and today was Friday. He touched her head and said that she had a fever. They had no treatment; antibiotics had to be saved for the smallest and sickest.
I asked to see her twins, their tiny heads topped with brightly coloured home- knitted bonnets. I guessed that they were a few weeks old; she explained that they were five months old. Her old mother was feeding one with a battered old bottle. I asked why, and she explained that she had been unable to feed them as her milk had dried up; this, like her stunted babies, was a consequence of malnutrition. There was no alternative to the borrowed bottle and a feed of sugared water - the luxury of formula-and-clean-water was an impossibility. She desperately pleaded for something, some of the plumpy-nut, but it cannot be used for such young babies. The only hope for her babies would be the delivery of the vitamin-enriched cornmeal, due to be delivered more than half a week away. She was reluctant to leave the modest health centre, despite the workers there explaining that they could not do any more for her now; so this sick, hungry, and desperate woman just stayed seated, summoning up her strength for the long journey home.
She gestured us over when she saw us taking photographs, and pointed at her twins, their still pale and delicate faces wrinkled and yellowish. It was an invitation to photograph them, perhaps knowing how fragile their future was. She had the strength to smile when she saw her twins' image on the digital camera.
She should start to produce breast milk when the supplementary food arrives. It should be there by Wednesday: hopefully the twins will hold on; hopefully the supply chain will hold up; hopefully we can find the money to keep buying the essential life-giving supplies; hopefully we can keep more babies and children alive. But every day is a race to match our budgets to the ferocious daily rises in food prices.
Aine, our warm and experienced country director, a nurse by training and a development expert for over twenty years, has worked in Ethiopia many times since the 1980s. She explained to us the consequence of these price rises. The week before we arrived the price of Famix, the vitamin-enriched supplementary mix, had gone up from $775 on Friday to $915 per metric ton by Tuesday. How do you plan or budget in those circumstances? How do you ensure a steady supply of food supplements when it is a race to get the order down the line from Addis to Wolayita before the next price rise?
Berket Kebele, who is 28, was waiting at our food-distribution centre. His handsome face is drawn and thin. He explained to me his daily regimen: a handful of roasted beans for breakfast; no lunch - despite a four-hour walk each day to get to his field to farm; and for dinner, some corn, washed down with coffee which lessens the hunger-pangs. His small son, Barakal, had the swollen feet and face that are the dreadful signifiers of oedema in kwashiorkor, extreme malnutrition. Others are eating just one "meal" a day: some cornmeal - and nothing else.
"Every life we can"
Why is Wolayita suffering so much? The government is trying. It has introduced a safety-net system - with beans and other basics bring made available to the neediest - but they are overwhelmed. The amounts are not enough, the numbers are out of control, and the failed spring belg rains have done their cruel work. So is the "real" answer: a natural disaster, or climate change; the price rises; the cost of fuel; the spread of bio-fuels; reckless financial gamblers taking a "punt' on basic foodstuffs; or the determination of those in the rich world to protect the cosseted lives and cars which "eat" food as fuel, whilst those small children, who need fuelling, suffer, starve, die?
Whatever the reasons, the responsibility is ours now too. Mulangetti, our passionate and determined programme manager, says to me in Wolayita: "we must save every life we can". From his tiny rented room in the servants' quarters behind the landlord's house in Bedesa, he is working early, staying late, uncomplaining as generators fail, fuel supplies falter, food prices escalate, queues of hungry and desperate people get longer. He, his team, the local health workers and the communities themselves, work so hard, racing against the clock as prices race ahead, to get vital, lifesaving food into the mouths of those hungry babies, those who most desperately need nourishing - and need it now.