This article first appeared in the St. Louis Beacon, March 5, 2013 - Women in wraps and headties as bright as the early morning sun emerge from “miomba” woodlands along narrow, well-worn paths into a clearing. Babies are securely nestled in slings against their backs. Many have walked for hours, some for days, to get to this place.
From a distance, it’s an exquisite sight.
A closer look reveals that many of the children so lovingly cradled are sick and dying. They are starving. The young mothers have brought their children to a mobile clinic in a remote African village in search of a miracle.
Dr. Mark Manary and his team are prepared to oblige them.
It’s a typical morning for Manary, who is equally at home in a makeshift clinic in Malawi as he is handling emergencies at St. Louis Children’s Hospital.
Here, he dispenses peanut butter, but in his hands the common snack has become a miracle drug.
Manary, a Washington University pediatrician and the director of Project Peanut Butter, is on a mission to eliminate severe malnutrition worldwide.
“Mark is very oriented to major societal challenges,” said Alan L. Schwartz, M.D., physician-in-chief at Children’s Hospital. “He takes on missions that would seem overwhelming to not just the average person, but 99.9 percent of people.”
Manary, readily admits he wants to “make the world a better place.”
He pioneered the use of a ready-to-use therapeutic food (RUTF). The nutritionally enhanced peanut butter has saved the lives of thousands of African children each year for more than a decade; with the recent addition of an antibiotic, it has the potential to save millions.
Saving the world
Mark John Manary was born in Bay City, Mich. He and his two younger sisters grew up in New York and Midland, Mich., headquarters for Dow Chemical Co.
His mother, who still lives in Midland, was a teacher. His late father worked at various jobs, including traveling auto-parts salesman.
Early on, it was clear Manary would blaze his own trail.
“As a kid I was a little bit quiet and not susceptible to peer pressure,” he said.
While attending Herbert Henry Dow High School, he started a club to promote recycling and established an Earth Day. He protested the Vietnam War.
In college, good students from Midland tended to major in chemistry; really good students majored in chemical engineering. In 1977, Manary earned a bachelor’s degree in both from the Massachusetts Institute of Technology in three years. While at MIT, he organized students to help impoverished Boston families wounded by drug abuse.
After college, he moved to St. Louis to begin work as an engineer at an aluminum manufacturing company. It was a brief career.
When Washington University saw his medical school admissions test scores, they came calling; he enrolled in 1978. He graduated in 1982, and completed his internship and residency at St. Louis Children’s Hospital in 1985.
He immediately began looking for a way to help save the world. His wife, Mardi, a registered nurse, suggested they start in Africa.
Man on a mission
“We wrote these Mennonites a long letter, they considered it, prayed about it and they sponsored us for two years in Tanzania,” Manary said.
Their mission had begun. He specialized in pediatrics, he said, because children usually get better. That seemed unlikely at the 150-bed hospital to which he was assigned. It usually had twice that number of patients and he was the only doctor.
Long odds did not deter him; a personal tragedy did.
“Our first child was born in Tanzania, but, sadly, he died there,” Manary said in a 2008 interview.
Their son, Matthew, was born in 1986. At just four-and-a-half months old, he died of sudden infant death syndrome.
At the urging of their families, they returned to the U.S., but Manary said he still “wanted to work in a really needy place.”
That place was the Cheyenne River Indian reservation in Eagle Butte, S.D., located in one of the poorest counties in the country.
In 1989, with an active toddler and a new baby needing medical care, the Manarys returned to St. Louis.
He began teaching pediatrics at Washington University’s medical school and resumed emergency unit duties at Children’s Hospital.
That’s a winner!
Africa still beckoned. In 1994, he returned as a Fulbright scholar to lecture at the Medical College of Malawi in Blantyre. His wife and their children, then 5 and 7, went too.
He was in charge of the pediatric malnutrition ward at Queen Elizabeth Central Hospital.
“There were kids lying around on wicker mats; a third of them died and only 25 percent fully recovered,” Manary said.
He ignored warnings from the pediatrics chief that little could be done.
“I gravitate toward the most important problems, not those based on my skills,” he said.
“We did our very best at implementing standard therapy, feeding them different kinds of milk,” Manary said.
Using the best malnutrition therapies known to the World Health Organization yielded modest results. He chose to commit “medical heresy”: He emptied the malnutrition ward.
“An old Englishman accused us of killing the children,” Manary said, “but just being at home made them better.”
Home and a new super food that was a complete departure from the standard milk-based fare.
Manary discovered that a French pediatric nutritionist had developed a use for peanuts that would make George Washington Carver proud: life-saving peanut butter made of peanuts, powdered milk, oil, and sugar, fortified with vitamins and minerals. It was portable, calorie-dense, nutrient-rich and required no refrigeration or cooking. It was also tasty.
André Briend had created RUTF; Manary had a distribution channel.
Acutely malnourished children between the ages of 1 and 3 gobbled up what the Malawians call "Chiponde," or nut paste.
“Younger children are breast-fed,” Manary explains. “Older children can forage to get enough food.
“The results were clear,” he said of clinical trials. “We went from 25 percent (recovery) to more than 90 percent with mothers feeding their kids at home.
“André and I decided we had a winner.”
In 2001, he launched Project Peanut Butter to provide wider distribution. All of the peanut butter was imported from France the first year. That had to change; it needed to be manufactured locally.
Manary enlisted 3,000 farmers to plant the peanuts and recruited villagers to work in the factories.
He learned how to make the peanut butter in large quantities, employing his engineering skills to help build the factories.
“I don’t know anyone else who has been able to go to Africa and set this kind of operation up,” said Jeffrey B. Johnson of Birdsong Peanut Co. “He designed it, he built it and he made it operate.
“His whole life is dedicated to feeding people; he hasn’t made a dime on it.”
Despite more than 90 percent of the severely malnourished children thriving on the Chiponde regimen, Manary was not satisfied.
A landmark study
He and his research team determined that bacterial infections were contributing to kwashiorkor, an extreme form of malnutrition characterized by distended bellies, spindly limbs and edema.
They added a common antibiotic to the peanut butter. A colleague, Indi Trehan, monitored the clinical trials for three years while living in Malawi. The mortality rate dropped to less than five percent.
The results were published last month in the New England Journal of Medicine.
“This study is a landmark medical and scientific study that will change the lives of potentially millions of children and will never be repeated,” Schwartz said. “That’s how important it is. This is going to become the new standard of care for malnourished children worldwide. This is a man who is making a difference.”
Last year, the food factories made more than 900 tons of the life-saving peanut butter for children in Malawi and Sierra Leone. Some was shipped to Somalia and Zimbabwe. Manary estimates the enhanced therapy is saving in the neighborhood of 750,000 children annually. Others put the figure much higher.
He has spent approximately 10 of the past 27 years in Africa. His wife and children, Megan, 26, and Micah, 24, now with their spouses, accompany him sometimes. Soon, his 6-month-old granddaughter may join them.
“We’ll stand by (the African people) as long as needed,” Manary said. “But they are smart and resourceful; (one day they’ll) look and we won’t be there; we’ll be gone.”
Until that time, Manary plans to continue battling starvation wherever needed.
Serendipity
Some people question the wisdom of saving children who will likely remain in abject poverty.
“That’s one of the most maddening things,” Manary said, visibly irritated. “I don’t have time for those people. I’m just a stupid doctor and doctors are always voting for life.”
“He has a really simple goal: he wants to feed as many children as he can,” Johnson said. “Everything else is a distraction.”
Project Peanut Butter is “headquartered” in the Manary home in Maplewood. Mardi, until recently a parish nurse at Gethsemane Lutheran Church, now holds down the fort full-time while her husband makes frequent trips to Africa.
His work earns him numerous honors, including humanitarian awards from the city of Maplewood and the American Association of Medical Colleges, which named him Physician of the Year in 2004. He was featured in the Huffington Post’s July 2011 issue as the Greatest Person of the Day.
Bowling league on Tuesday nights provides a diversion and worship at a Mennonite church brings strength.
“My Christian faith has been a huge motivator in what I do,” Manary said.
He has no idea what’s next.
“Planning is overrated,” he laughs. “There are a lot of important things to do for the next six months. I don’t know what I’ll be doing in five years. We are individuals in a big world where we don’t control anything.”
This year, Manary hopes Project Peanut Butter will be expanded to Mali and Ghana, but he isn’t worried about how that will come about.
“We have never been in a situation where we couldn’t do this work; I think it’s providence,” he said. “I’m confident the help will always be there.”