On a residential street in Maplewood, in a two-story house with grey siding and white shutters, resides a global charity.
Project Peanut Butter, a non-profit corporation, helps produce and distribute a peanut-butter paste that is saving malnourished children in Africa and other parts of the world.
The vitamin-fortified and sweet-tasting concoction—really a therapeutic or ‘medical’ food—allows mothers from impoverished and rural villages to treat their ill children at home. Its success rate is nothing short of astonishing: 90 percent of children treated with the paste recover. That’s more than twice the rate as the old standard—a milk-based therapy administered in a hospital.
Project Peanut Butter operates out of the Flora Avenue home of its founders, Mark and Mardi Manary.
Mark is a professor of pediatrics at Washington University School of Medicine. Mardi is a part-time nurse with Lutheran Senior Services in Brentwood. Married for 31 years, they have lived in Maplewood since 1997, and have two grown children.
Patch initially met the middle-aged couple at their house before Dr. Mark Manary left for a flight to Geneva. “I have to leave in 45 minutes,” he said apologetically.
A decade ago, Manary battled a hostile international medical community that considered his home-based therapy as reckless. Now he sits on a panel that sets standards for treating malnutrition for the Switzerland-based World Health Organization.
They didn’t plan to start a charity
The Manarys didn’t plan to start a charity but they did want to perform some sort of humanitarian work after Mark completed his residency in pediatrics from St. Louis Children’s Hospital.
At Mardi’s suggestion, the couple worked at a hospital in Tanzania as Mennonite missionaries from 1985 to 1987.
“It was an all-purpose, general hospital,” Mark said. He was the only physician.
He delivered babies, treated the ill and tended to injuries. “Injuries, like people who were gored by an ox,” he said. Mardi taught nursing students.
Although the couple fell in love with Africa, they also experienced heartbreak: their firstborn, Matthew, died there. They returned stateside but never forgot Africa or their passion for international work.
In 1990, the couple was asked to take a short-term position in The Gambia in Africa. “This reawakened our desire to do service,” said Mardi. Soon they began to seek out work in Africa.
In 1994, Mark took a leave of absence as a pediatrics instructor at Washington University School of Medicine and emergency room physician at Saint Louis Children’s Hospital and traveled with Mardi and their two young children to the southern African country of Malawi, one of the poorest countries in the world.
He went as a Fulbright Scholar at the University of Malawi’s College of Medicine, and worked at a local hospital. Upon arrival, Mark was advised to avoid the wards treating the malnourished: it was too depressing.
“You could hear the wails of mothers every single day,” Mardi said.
Undaunted, Manary decided to tackle childhood malnutrition head-on. He said malnourished children are so fragile, the outcome of treatment is unpredictable.
“You could do everything you could possibly think of, bring any kind of resources to bear on the matter and leave them overnight, and two of them would die.”
“Twenty-five percent would die in the hospital, 25 percent would go back home and die slowly or become mentally retarded. Only 25 percent used to do well,” Mardi said.
Trips of a lifetime
On his own time and dime, Dr. Manary returned to Malawi several more times over the next decade, tweaking approaches to the milk-based therapy. He added vitamins to diets and explored recipes based on local food resources.
When Washington University began to see survival rates of malnourished Malawian children improve they kept him on salary while abroad.
Mardi stayed home with the children, and when possible, returned with Mark and their children, Megan and Micah.
“We reared the children between two worlds,” Mardi said. “We took them with us if the time was going to be more than a few weeks. If it was not possible to take them, I remained here with them.”
To fight malnutrition, Manary realized he needed something to sustain young children after mother’s milk no longer sufficed, during the lean months of the year when the rains came to Malawi, and until the children were able to forage on their own for berries and such.
About the same time (2001) French research scientist Andre Briend was looking for someone to test a nutrient-enriched peanut butter—a ready-to-eat therapeutic food (RUTF)—he developed for a company called Nutriset. A colleague of Briend’s gave him Mark Manary’s email.
Manary tested the pre-packaged medical food at a Malawian hospital. It worked! Three subsequent studies conducted by Washington University School of Medicine researchers confirmed the product’s efficacy in treating childhood malnutrition.
But to reach the masses, Manary knew they needed to keep things simple.
It also needed to be something that didn’t have to be cooked or refrigerated, had a long shelf life, and could be prepared in a mud hut.
Manary’s group investigated several formulas of the paste from 2001-2004 and came upon their own variation of Briend’s recipe. The ingredients are simple: peanuts, sugar, oil, powdered milk and extra nutrients.
Hope in a jar, or foil packet
“In terms of making the food, this can be done in somebody’s kitchen, in somebody’s bowl,” Dr. Manary said. They have shared the recipe with others, including an orphanage in Uganda and a tuberculosis clinic in the Philippines.
But to make a real impact, Manary needed a factory to mass-produce the product that international relief organizations, like Physicians Without Borders and UNICEF, would buy and distribute.
The factory would have to meet stringent, production and quality control issues—and be located in Malawi.
In 2005, after raising sufficient funds, Project Peanut Butter–Malawi was established.
The factory site employed local people, and received international certification in 2007 thereby allowing large relief agencies to buy and distribute the medical peanut butter paste.
“One of the tenets of Project Peanut Butter is that it is absolutely free,” Manary said.
There are 150 locations that treat malnourished children in Malawi. Project Peanut Butter manages the feeding at 18 of those sites, but its factory makes the food for all of them.
“It is huge, massive—like an American factory,” Mardi said.
Project Peanut Butter-Malawi produced 900 tons of the ready-to-use therapeutic food in 2011.
Children enrolled in the program are fed the food three times a day, for four to eight weeks. They are fed by jar or from pre-measured foil packets at home.
Besides the Malawi operation, there is Project Peanut Butter-Sierra Leone with its own factory. Another is planned for Mali, in western Africa.
All are locally incorporated, not-for-profit entities that own the machinery and the facilities. The project helps them import milk powder, keep the machinery running and with quality control.
Consider their challenges: impoverished countries, foreign governments and raising money. It takes about $1million over two-years to start up a factory.
“As the person who handles the finances, it’s scary,” Mardi said.
“There have times when we thought we would have to re-mortgage our house. We’re not afraid of that. But the people who donate, many of them are one-time. We often get (donations) in lieu of wedding presents for someone, or a memorial,” she said. Often these come in $10 or $20 denominations. A treatment for one child costs $25 to $30.
But the charity has benefitted from grants and donations from larger groups.
“We can think of a 100 different organizations or people who have come to help us at one time, and most of them have then gone away,” Mark said. However a few, like a peanut company in Virginia, continue to give. On a couple of occasions, they donated $40,000 to Project Peanut Butter.
The couple has also hit the speakers’ circuit to raise funds. “We do a couple of speaking engagements a week,” Mardi said.
Clearly their mission to save the lives of malnourished children has become their passion. “The time is right,” Mark said. “We actually have the technology and a solution.”
"And we each have the ability to save the life of a child," Mardi said.