Mark Manary, MD
If you want to round in the pediatric nutrition ward at Queen Elizabeth Central Hospital in Blantyre, the largest city in Malawi, you must get used to the constant wailing of children with kwashiorkor, a severe, often fatal form of malnutrition. For St. Louis pediatrician Mark Manary, the din is a cry for help he can't refuse.
Since 1994, Manary has worked for months at a time with the malnourished children of this country in southeast Africa, whose 10 million people are among the world's poorest. "The average person here spends most of his day preoccupied with getting enough to eat," says Manary. Manary spends his days treating wasted bodies at the bedside, researching ways to improve nutrition, and persuading villagers to feed their children peanuts.
He launched his peanut project during a five-month sojourn in early 2001 to address a heartbreaking problem. Of every five malnourished children discharged from the hospital, one dies and another is readmitted because the corn-based diet at home remains inadequate. Peanuts are richer in protein and fat, but they're cultivated more as a snack food than a staple.
"We sent mothers home with a white peanut paste and asked them to feed it to their children," says Manary, who returned to Malawi for another six weeks last fall. "The preliminary results are good. The fatality rate after discharge is now less than 5 percent, and the readmission rate is about as low."
Over the years, Manary has attacked malnutrition from other anglespotassium supplements, intensive nursing techniques, a new way of preparing porridge to boost absorption of zinc. The results have been mixed, testifying to the intractable nature of the problem, but Manary persists in his search for answers.
Medical missions like the one in Malawi are a key part of his evangelical Christian lifestyle. He's also doctored in Tanzania, The Gambia, Papua New Guinea, and in South Dakota as part of the Indian Health Service.
His family works alongside him. His wife, Mardi, a registered nurse, managed the first phase of the peanut program in Malawi; Daughter Megan, 14, and son Micah, 12, weighed and measured patients. Back home, the children speak to schools about Malawi and raise money to buy egg-laying hens for villagers. "What we do together centers the kids in our faith," says Mardi.
Manary, who works in an ED and is associate professor of pediatrics at Washington University School of Medicine, finances his war against malnutrition with grants from the National Institutes of Health and major foundations and the largesse of anyone else who wants to help out. "Airlines sometimes transport our supplies for free," he says.
"It's easy to get discouraged, but Mark is remarkably undiscouraged," says St. Louis pediatrician and friend Sarah Legett, who worked at Queen Elizabeth Central Hospital in Malawi for seven years before Mark arrived. "His research is clearly his passion. I think he has the potential to change the way we rehabilitate malnourished children all over the world."
For now, Manary is treating them one at a time in Malawi. When you ask him what motivates him, he quotes Jesus from the gospel of Matthew: "I was hungry and you gave me something to eat. Whatever you did for one of the least of these brothers of mine, you did for me."
Says Manary: "You can't look at the suffering in Malawi and say it's too big, I'll do nothing.
Robert Lowes. Doctors Who Go the Extra Mile: Fighting hunger and death half a world away. Medical Economics 2002;3:43.