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MELISSA BLOCK, HOST:

This is ALL THINGS CONSIDERED from NPR News. I'm Melissa Block.

AUDIE CORNISH, HOST:

And I'm Audie Cornish.

We turn now to the decision we face every time we shop for groceries: The choice between food from local farmers and cheaper, mass produced alternatives, except, in this story, lives are at stake. The food we're talking about is a kind of fortified peanut butter that's saving the lives of malnourished children in dozens of countries around the world. And aid organizations are now thinking: If they could make this food locally, they could have an even bigger impact. They could create jobs, for instance, in Haiti where 80 percent of people don't have work.

NPR's Dan Charles has that story.

DAN CHARLES, BYLINE: On the northern coast of Haiti, in the city of Cap-Haitien, there's a shantytown called Shada where people live on almost nothing. The homes are jammed up against each other with barely space to walk between them. And in the middle of this slum, a powerhouse of a woman named Madame Bwa runs a free clinic. If your child is sick or weak, you go to Madame Bwa.

MADAME BWA: (Through Translator) This is the list of the kids that we provide services yesterday.

CHARLES: She pulls out a ragged piece of paper with 41 names scrawled on it. All of these children, she says, came in suffering from malnutrition.

BWA: (Through Translator) Some of them have big belly. They have yellow-red hair.

CHARLES: And these children all get the same medicine.

BWA: (Foreign language spoken)

CHARLES: We give them Medika Mamba, Madam Bwa says. That's Creole for peanut butter medicine. It's basically peanut butter with some added ingredients: milk powder, oil, sugar, and all the vitamins and minerals that a growing child needs. And it works, Madame Bwa says.

After three or four weeks, eating this daily package of energy and nutrients, the children will be fine.

BWA: (Foreign language spoken)

CHARLES: So 10 years ago, if these children showed up, what did you give them then?

UNIDENTIFIED MAN #1: (Foreign language spoken)

BWA: (Through Translator) Oh, they used to die. They used to die. They used to die.

CHARLES: Just over a decade ago, a French doctor came up with this peanut butter recipe and called it Plumpy'Nut. It was first tested in the African country of Malawi. Pediatrician Pat Wolff learned how to make it there. She is the person who first brought it to Haiti and called her version Medika Mamba.

PAT WOLFF: The previous 70 years, the recommendation from the World Health Organization had been liquid milk with a little sugar and oil in it, and sometimes extra vitamins and minerals if you could ever find them.

CHARLES: But that earlier treatment required refrigeration for the milk. Often, it took a feeding tube.

WOLFF: And it required the parents to be in the hospital with the child for a month.

CHARLES: This new peanut paste has turned out to be better in almost every way. Children like it. They can eat it at home, so it's easier on families. And more sick children survive by far.

All over the world, this so-called ready-to-use therapeutic food has become the gold standard for treating severely malnourished children. So that's the medical side of the story, an amazing success. But there's also a business story that's still being written.

WOLFF: Okay. Hi, guys. So...

CHARLES: I met Pat Wolff in a brand-new building a few miles outside Cap-Haitien. These are the new offices of the organization she founded: Meds and Food for Kids.

WOLFF: We're not really completely moved in yet.

CHARLES: Wolff set up Meds and Food for Kids in 2003 to bring ready-to-use therapeutic food to Haiti. They started in a small rented house grinding up peanuts in the kitchen, stirring all the ingredients together by hand, distributing their Medika Mamba to local clinics. But she felt like just passing out food wasn't enough.

WOLFF: We came here to rescue kids, right? But, you know, that doesn't go anywhere. It goes nowhere except to more rescue. Why do you suppose those children are malnourished? They're malnourished 'cause their parents have no money, and they have no money because they have no employment.

CHARLES: One day Pat Wolff had what she calls an epiphany. Medika Mamba, she realized, could provide employment if she made it on a much bigger scale because by this time - it was about five years ago - ready-to-use therapeutic food had become big business. UNICEF was buying millions of dollars worth of it every year for distribution in Haiti alone. But UNICEF was buying it from pristine, quality-controlled factories far away, mostly in France. The peanuts came from places like Argentina.

Pat Wolff thought we can make it here, in a factory employing Haitian workers buying peanuts from Haitian farmers. She thought it could be an example that others could follow.

WOLFF: So that there would be more factories like this, more factories making other things, more people being employed instead of just always rescuing.

CHARLES: That's the dream and part of it is becoming reality.

Pat Wolff's group, Meds and Food for Kids, has a big new factory just a few miles from the slums of Cap-Haitien. MFK's Jamie Rhoads takes me on a tour.

JAMIE RHOADS: That noise you're hearing is the sound of money.

(LAUGHTER)

RHOADS: No, it's the - every time you hear that noise, it's 92 grams of hot peanut butter getting pushed into a little bag.

(SOUNDBITE OF MACHINERY)

CHARLES: Those little sealed packets will go to UNICEF or the World Food Program and then to hospitals and clinics all over Haiti. But potentially, an even bigger impact will be felt in the countryside, among Haitian farmers who grow the peanuts.

Jamie Rhoads is the person at MKF who works most closely with the farmers. He takes me out to meet some of them. The road there is terrible, unpaved and rocky. But Rhoads says look at this land. There's not much growing there now. But this northern plain of Haiti used to be one of the wealthiest agricultural areas in the world. And it could be again.

RHOADS: The soil fertility is really good. There's water everywhere. And it's just kind of like this gold mine of agricultural wealth waiting to happen, I think. I mean, look around you. It's totally green. Whatever they need, they can grow in this northern plain.

UNIDENTIFIED GROUP: (Singing in foreign language)

CHARLES: We get to the farm and walk right into the middle of a party, a peanut harvesting party. It's a small taste of that agricultural wealth that Jamie Rhoads is dreaming about. These farmers are growing peanuts for MFK's new peanut butter factory, and MFK is helping them do it more cheaply. The organization brought in a small tractor to help clear the fields and also sprayed the plants with a chemical that helps control fungal diseases.

UNIDENTIFIED MAN #2: (Foreign language spoken)

CHARLES: The farmers tell me, as a result, they're getting almost twice as many peanuts as in previous years. I see big piles of peanut plants just pulled from the earth. Men and women are sitting beside them, picking peanuts off the roots and dropping them into buckets.

RHOADS: This is a big step. I mean, this is the first time I've been around in a harvest where the peanuts look this good. And I think the excitement that you're hearing in the background is the people responding to that as well because everyone is telling me, in my whole life, I've never seen peanuts like this.

CHARLES: More farmers want to join the program, which should mean more peanuts for MFK's factory and more money in farmers' pockets.

It's all great, except for one thing: economics. These local peanuts still cost too much. It's mainly because small Haitian farmers have so little machinery. They have to pay people to plant by hand, weed by hand, harvest the peanuts by hand. Meds and Food for Kids actually pays more for these Haitian peanuts than peanuts that they import from the U.S. or Argentina. And that higher cost is tough to pass along to customers.

RHOADS: We sell to UNICEF, and UNICEF and others are very price sensitive. And we're competing with the international market.

CHARLES: Other organizations that try to make this food locally in other developing countries report the same thing. Local small-scale production turns out to be more expensive production. For now, at least, UNICEF has agreed to buy local even if it costs a little more, even 20 percent more.

But the big, long-term goal, Jamie Rhoads says, is to keep working with the peanut farmers, helping them grow more peanuts for less money. Rhoads thinks they can do it with some better peanut varieties that resist disease and a little more labor-saving equipment. And then, he says, those farmers won't even need MFK's factory anymore. They'll be able to sell their peanuts for a good price at any market in Haiti.

They'll make a lot of money. And in the end, he says that's the best way to make sure that their children won't go hungry.

Dan Charles, NPR News.

(SOUNDBITE OF MUSIC)

CORNISH: Tomorrow, on MORNING EDITION, Dan Charles looks into whether there can be too much life-saving peanut paste. Two humanitarian groups have built factories in Haiti to make it, but the country probably only needs one.

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