Can cheap, nutritional food be invented?

by Steuart Pennington 

Nutrition is key to everything, we all know that. Good nutrition is key to health, to learning, to well-being, to strength and to both psychological and physical functionality.

The basis of sustainable development is nutrient replete physiological functional human beings that can participate in finding solutions to their own health and poverty challenges.

Eight years ago when I adopted the Doornkop Needy Children’s Centre, a crèche in Soweto, the first thing I wanted to do was to build a sturdier building "how can children learn in a corrugated iron shack?" I thought.

I was dissuaded of that.

"The first thing we need to do is ensure that our children are properly nourished with three healthy meals a day" the parent in charge advised.

Money was a problem.

That’s how I came across e’Pap and its founder industrial chemist Basil Kransdorff who has been at the cutting-edge of new processes. He is father of the revolutionary, micronutrient-fortified e’Pap porridge, which earned him an Ashoka social entrepreneur award in April last year.

This drive for social change, he comments, is a feature of Ashoka’s 3 000 Ashoka fellows around the world, half of whom have been responsible for policy changes in their home countries. The Washington-based NGO describes its fellows as being the "one in 10 million" real change makers in society.

"The development of e’Pap arose curiously," he says. "It was at the start of the Aids pandemic in 2000. CARE (Community Aids Response) founder Jenny Marcus, for whom my wife Rose was a volunteer, successfully raised donations from former South African anti-apartheid legal activist-turned UK insurance businessman Joel Joffe, and the Elton John Foundation.

"Jenny asked me ‘to apply some science’ to food packs for HIV/Aids patients queuing outside the hospitals. Most had lost their jobs and been alienated by their families. "As a social responsibility project, we accessed the best brains in the world on food fortification. We understood that nutrient form, nutrient interactions and bioavailability (absorption by the body) to achieve nutrient repleteness, were key." The formulation objective was to deliver an affordable single meal portion that contained many of the important nutrients found in a healthy well balanced diet. In this way even the poor could also comply with the medical advise at that time when there were no ARV’s available and which was to go home and eat a healthy well balanced diet.

And the rest, as they say, is history. e’Pap hit the ground running and is now in over 15 countries across Africa . Over the past 12 years we have been able to get over 130 million food portions into the mouths of malnourished people and now it is being globalized across the World.

But the proof of the pudding is always in the eating (pun intended!). Below is a letter to Basil, which is worth reading.

(In all the work that I have done in disadvantaged rural schools nutrition is a priority challenge. Children walk to school, arrive hungry and very often have nothing to eat until midday (State feeding scheme or not) and when they do its nutritional value is questionable in relation to addressing the "hidden hunger" (micro nutrient deficiencies). In many urban schools children eat junk food, like Niknaks or Cheezecurls as a daily diet. If the nutrition is not right so that children become nutrient replete , learning will not happen, there is exhaustive empirical evidence to prove this. e’Pap made a significant difference to the children at the Doornkop Needy Children’s Centre.)

Dear Basil Kransdorff!

In the following I would like to give some anecdotal evidence about the efficacy of "e-Pap" which we are using for some time now in our wellness clinic for people living with HIV/AIDS as a nutritional supplement for selected patients.

I wanted to find out if e’Pap can be of additional benefit to patients who are either:

1. already on treatment for HIV and/or TB, or
2. who are not yet eligible for treatment according to the South African guidelines for the initiation of ARVs. And I also wanted to find out if the supplement can
3. improve the testing of new TB-cases by enhancing the sputum quality.

Since we are a small clinic, the numbers are low and cannot satisfy the requirements of a scientific study, but I am quite amazed about the findings.

In all three groups of patients e’Pap shows astonishing positive effects regarding the Body Mass Index and especially the general condition and satisfaction of individuals.

Let me give you three examples:

A 31-year old lady presented to me in June this year with a body weight of only 34 kg (BMI 13.8), having to be supported by two helpers since she was too weak to stand on her own legs (see picture right).

At that point she was on TB-tx for 3 months and was told to let her CD4- count be determined in our clinic. It was surprisingly high with 561 (normal range 500-1400). She also didn’t show clinical signs of other opportunistic infections so I treated symptomatically and decided to refer her to a hospice (Rivoningo hospice in Pretoria CBD) and to start her on e-Pap (4 table spoons – 50 grams) twice daily.

In other words: I didn’t change her medication and in fact only added the nutritional supplement! After only 4 weeks she had a normal BMI of 20 and was leaving the hospice because she was feeling fit and strong now. The picture on the left was taken after 9 weeks (BMI 22).

Another lady (33 yrs) also presented in a desolate condition, with a BMI of 17.6 and a CD4-count of 71 (indicating a very low immune status) and she was clinically suffering from pneumonia. I started e’Pap and treated with oral antibiotics. The sputum showed Acid Fast Bacilli. Within 2 weeks she already improved her BMI to 25.4 and was feeling a lot better!

Note: that was before starting the TB- and ARV-treatment!

The case of the third patient was also astonishing for me: It was a 43 yr. old male from another ART-clinic who came to us because he was not well (loosing appetite and moderate weight loss of 6 kg) and was seeking health in our clinic by chance. He was on ARV-treatment for 6 years but started to feel weak over the last couple of weeks. In his case this could not be explained by a treatment failure (neither virologically nor by non-adherence).

Since I didn’t want to interfere with the colleague’s treatment I only added e’Pap (not expecting a major effect, to be honest, I was rather expecting a condition like a kidney failure as cause for his condition). After 4 weeks he was presented to me by the nurse who told me, she couldn’t trust her eyes when seeing the man, who just came in to get more e’Pap! He regained the 6

kg of his body weight but more importantly felt a lot better! His treatment wasn’t changed at his ARV-clinic so his condition must have improved through e’Pap only!

Our Sediba Hope Centre is functioning as a so called wellness clinic for people living with HIV/AIDS.

We are a Non Profit Organization (NPO) being funded mainly by the Foundation for Professional Development (FPD) and by the United States Agency International Development (USAID). Unfortunately the funds we get are barely sufficient for the essential medication. There is no extra money in the clinic for nutritional supplements that have proofed to play a major role in preventing further deterioration of the health of many patients. From my understanding antiretroviral and anti tuberculosis medication and nutritional supplements should be used hand in hand in the fight against HIV/AIDS and TB. Therefore it’s hard for me to understand that lots of money is readily spent for the still rather expensive ARV-medication and that nutritional supplements like e’Pap are not supported in the same way until today.

Hope this can change in near future!

Our journey over the past 12 years has given us insights to some significant learning’s.

e’Pap’s success in the field of nutrition is in part due to our social entrepreneur business model. As social entrepreneurs, we were able, at no cost, to facilitate access to International technical experts. They shared their expertise with the same passion that thousands of individuals and organizations have helped get e’Pap to communities to alleviate the suffering caused by malnutrition and disease.

As social entrepreneurs, we are able to develop, without restraint, technical solutions from outside traditional organizational structures. Ashoka refers to these often-immovable, suffocating structures as silos - that they suggest are the impediment to developing solutions to challenges in a fast changing world.

Our most important learning – all interventions are destined to fail unless we first prioritize nutrient repleteness of the people we are trying to help. Our education systems will continue to fail until we focus on making children nutrient replete. Nutrient replete children can still learn from under a tree. Nutrient deficient children can never learn to become responsible, successful citizens even in brand new classrooms filled with well-trained teachers with all the available support of pencils, delivered books and learning materials.

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