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But he and his research partner, Andre Briend, saw immediate results. From the earliest trials, the peanut butter, known in the scientific community as ready-to-use therapeutic food (RUTF), showed an 85 percent success rate. By 2007, the World Health Organization declared RUTF the gold standard in treating childhood malnutrition.
Manary and Briend decided that if RUTF were to be of any use, it would have to move beyond research studies and into mass production. Briend established a partnership with a French company called Nutriset, which would manufacture the peanut butter, called Plumpy'nut, in its Rouen factory and export it around the world. Nutriset now controls 90 percent of the world RUTF market.
Manary, however, saw RUTF's potential for economic development, and by the time Wolff visited his clinic in Malawi in 2001 and again in 2002, he'd already started his own nongovernmental organization, Project Peanut Butter. The organization would buy peanuts from Malawian farmers and produce RUTF in a local factory. There was no way Project Peanut Butter would be able to compete with Plumpy'nut on a global scale, but it would provide jobs and pump money back into Malawi's economy.
Wolff liked what she saw, and with Manary's help, she started her own program. She got a grant from Rotary International, and she purchased a peanut grinder. She learned how to operate it, take it apart, and put it back together. "It was a little tricky," she says. "But now I was set. I could go to Haiti."
She set up the grinder in a church classroom in Cap Haitien and began making peanut butter.
Wolff alternates three weeks in Haiti with three weeks in St. Louis, where she tends to her pediatric practice. "My new patients know they'll only see me half the time," she explains. "The people who mind most are the ones who need me the least. If I died tomorrow, they'd say, 'It's a pity she's dead, but I need my medical records transferred immediately!' "
In Haiti, Wolff wakes up at dawn. She fills a French press with hot water and coffee grounds and, still in her nightgown, sits down with her laptop at the dining room table to answer the day's emails.
At 7 a.m., she leaves for the factory, a house in the Cap Haitien suburb of Mombin Lataille, and arrives in time for the daily morning meeting with the factory supervisor. "We talk about who's going to use the one car because the other car's been broken for a week," she says. "I talk to the quality control manager. I talk to the product supervisor, and we figure out how much medika mamba we need. We check to make sure we have the right kinds of bags and cups in storage.
"We talk about what's broken. There's always something broken — the car, electricity, water, the roaster — there's always something. Or someone didn't get their order of medika mamba. Or the head of nutrition for the entire country wants me in Port-au-Prince in two minutes. Or the missionary flights are coming in, and we talk about how customs is going to rip us off." She laughs. "That's how you spend all day, every day. You really have to like problem-solving. And you can't get flustered."
A problem that, in the United States, might be solved in a single afternoon can drag out into a monthlong saga in Haiti. MFK's broken Land Cruiser, for instance, needs a rubber seal for its engine. None of the Cap Haitien mechanics can afford to keep parts on hand; the seal had to be specially ordered from a dealer in Port-au-Prince. When the part arrived and didn't fit, a replacement had to be ordered from the Dominican Republic. When that part didn't work, the mechanic offered to use a lathe to make it fit.
That's the Haitian way, though: Improvise solutions with what little you have. It's very different from America, where, Wolff notes, "our ability to solve problems comes at our mother's knee. We have resources. In a land with nobody to ask and no stuff to buy, you can't solve the problem."
Most Haitians cook their meals in iron pots over a charcoal fire. Electricity is spotty. Natural disasters and political unrest regularly plague the country. There are few newspapers. Most of the roads were built during the American occupation in the 1920s and '30s and haven't been repaired since. And, adds Jamie Rhoads, MFK's agricultural development specialist, "the wonderful, corrupt government makes things even more tricky."
MFK has experienced its own share of disasters. For several years, Wolff has been working to bring the factory up to international food safety standards. It's a necessary measure so that MFK will be have credibility with UNICEF and USAID, who are accustomed to Plumpy'nut's First World facilities in France.
"We needed stainless steel," Wolff recalls. "There's no stainless steel in Haiti. It all had to be imported from the Dominican Republic. The Easter before our audit, there was a fire. The plumber had hooked up the propane fridge wrong, and there was a leak. On Sunday afternoon — kaboom! The whole place went up in flames. There was nothing left. Everything had disintegrated. That was two years ago. We had to replace everything in the lab and restore the house to its previous status. It cost $30,000, a huge amount of money for us."