When she arrived at the recovery center 3-month-old Daphne wasn’t in good shape. According to her caregiver, Daphnee was sick with diarrhea and a cough, evidently caught in the cycle of infection and malnutrition, where the presence of one, both causes and worsens the other.
At just over 5 lbs, she weighed 7 lbs less than a 3-month-old of average weight. She had all the signs of severe acute malnutrition. Her skin was dry and flaking. Her limbs, contracted. Her hair, thin. Her cry, weak and her body, cold. While somewhat different from it’s presentation in older children, this was malnutrition’s classic “look” for an infant under 6 months of age.
Without intervention, the baby’s health would continue to decline. Even with intervention, it was possible that Daphnee, like the 2.6 million children around the world who die each year because of malnutrition, wouldn’t make it.
But she did.
Two months and two weeks later, the child pictured above was no where to be found.
In the 10 weeks the pair spent at Second Mile Haiti’s malnutrition recovery center, Daphnee gained almost 5 lbs. Violenne, her second cousin and her primary caregiver, left the center with Daphnee in her arms, looking lighter and more confident--changed.
But how did they get here? What, exactly, changed between Day 1 and Day 70?
How did Daphnee beat the odds? And what made it possible for her cousin to assume care?
To put their situation in context, we must start with the baby’s mother.
Daphnee’s mother died within a month of giving birth. We don’t the know the details surrounding her death apart from what her cousin was able to impart: that she had a headache and abdominal pain, and was swollen. She left behind four children. Although she gave birth to six, two had passed even before she did.
At less than 4-weeks-of-age and without breastmilk to sustain her, Daphne’s chances of survival were slim. Still, the extended family did what they could to provide for the baby’s needs, because that's what families here do. Violenne, a cousin of Daphnee's mother, took the reigns. They bought formula when they could and gave the baby juice, tea, and porridge when they could not.
What the 3-month-old needed in the absence of breastmilk was a steady supply of infant formula. Introducing other foods before a child's digestive system can tolerate their foreign proteins, creates gastrointestinal permeability and is a sure-fire path to malnutrition, by way of infection and malabsorption.
In other words, this diet of flour-water and carrot juice, even with the occasional bottle of formula, had placed Daphnee squarely in the throes of malnutrition.
Although she didn’t describe herself as a “machann,” a term typically reserved for the most seasoned of market vendors, Violenne had, in recent years, been able to support her family through commerce. When she possessed a modest stock of sandals, charcoal, or food products to sell, Violenne could earn as much as $22 a month, the equivalent of $264 dollars a year.
Infant formula may have been what she needed, but it was neither practical nor accessible.
Assuming Violenne earned an average of $5.50 in one week and with the cost of formula at $8.50 for a 200 gram can, the baby wouldn’t have survived even two weeks on a diet of infant formula alone.
But Violenne wasn’t actually earning any money. She had four children of her own and had been without products to sell for the past 12 months.
Worried about Daphnee's health and unsure of her ability to meet the baby's needs, Violenne sought help at the nearest orphanage.
An orphanage worker recognized that Daphnee was malnourished.
And that's when we enter the story.
The orphanage worker referred Violenne to Second Mile Haiti.
As a malnutrition recovery center that specializes in equipping caregivers in ways that help them meet their families needs, we are, you could say, "in the business of" helping families like this one.
When they arrive at the center, Daphnee and Violenne are greeted at the gate by the manager of the recovery program. An assessment is made and because Daphnee meets the criteria for severe acute malnutrition, they are invited to stay. An introduction is given, a room (and roommate) are chosen and an assessment is made. Day 1.
Per the national protocol for treating malnutrition in Haiti, all children under 6 months of age must be referred to a regional hospital to evaluate for complications.
So to the hospital they will go, together.
The nurses prepare Violenne for the trip by teaching her the correct way to prepare a bottle of infant formula. They show her how much formula to give and how often. Since she will spend anywhere between 5 and 10 hours at the hospital, Violenne is given some money for lunch, but the baby's expenses will be covered through a dedicated account in Second Mile's name.
When no acute medical complications are found, Daphnee returns to the center where her rehabilitation begins. Day 2
On their third day, Violenne and Daphnee wake early alongside two dozen other mothers and children. They wash and bathe and assist Center staff with a few morning chores. Then they meet the nurses for the morning assessment. Violenne complies as the nurses instruct her to place the baby on the scale. She steps away as they move closer. The numbers flicker and flash until they settle. And the nurses seem happy as they read them.
Daphnee gained weight.
And that's when Violenne gets it.
She understands now that by following the nurses recommendations, and the instructions she received at the hospital, Daphnee will improve. From the other mothers, who’ve been at the center longer than she has, she understands that in time Daphnee will even start to look like a healthy baby. “Mine was worse than yours, and look at him now,” they say. She sees, in the faces of program graduates who can be spotted waddling around the center on Tuesdays and Thursdays, that this is possible.
She learns that it might take 6 weeks, or even twice that, for this transformation to occur.
But she commits.
Every day during Daphnee’s recovery, Violenne attends lectures in nutrition and health, and participates in gardening and business classes. She learns about normal childhood development and how to help Daphnee reach the milestones she'd missed because of malnutrition.
She tells the staff that she hopes Daphnee has a long life, and that one day she’ll be able to send her to school to become a nurse.
While she reached only the second grade herself, Violenne receives one-on-one support from program staff and learns to write her name. They make learning about business easy, and family planning, fun.
Just as she stepped in to care for Daphne when her cousin died--because that's what families here do--Violenne’s family members step in to look after her older children during the weekdays. On weekends, she and Daphnee join the family at their home, and everyone is excited by the baby’s progress.
By the end of 10 weeks Violenne seems confident in her ability to care for Daphnee. She thanks the educators, the motorcycle drivers, the cooks, and the gardening staff for the role they played in Daphnee's recovery. "I didn't think she would live, but thanks to you, she is all-the-way well" she says.
She tells the nurses that their guidance helped her fall more in love with Daphnee every day.
She takes the program post-test and scores a perfect score, an improvement of 71% from her pre-test score. On her last Friday at the center, she is generous with her kisses and looks so happy she might cry.
Within a few weeks of leaving the center Violenne is ready to begin the next phase of the recovery program. Daphnee has continued to gain weight in her care. She is a 6-month-old now and solid foods have been re-introduced with success. Violenne is ready for her business package.
The story could end here. Afterall, Daphnee received the medical care and infant formula she needed to beat malnutrition. And Violenne now has a means to support her as she continues to grow.
But that would be leaving out the best part.
You may be wondering: How is Daphnee now? Was Violenne successful with her new business? Has anything changed?
And to this I would answer: Excellent. Very. And Yes.
In the six months that have passed since Daphnee and Violenne left the center, Daphnee has changed. Her progress is evident in the photos taken during her follow-up visits.
Daphnee has grown physically, and she has also grown more a part of Violenne's life and family. Using some of the profits of her business Violenne paid to have a birth certificate made for Daphnee and chose to have her baptized. She bought Daphnee a special dress and held a celebration for the family.
Daphnee is 9 months old now and is doing things that 9-month-old's do. She may have found her smile at Second Mile Haiti, but in Violenne's care she found her family.
She was headed to an orphanage, but her path was redirected. She was headed to a place known for the negative impact it has on the very people it claims to protect.
Orphanages, in Haiti and around the world, have been associated with child-trafficking, sexual abuse, and gross child neglect. Yet we continue to send money to these institutions and to build new ones even though we know that institutions are bad for children's health and development. Why?
In our own families we strive for nothing but the best. Generally, we believe that "the best" for our own children is to grow in and out of the shadows of our love. We are desperate to do right by our children, so we create the family we want for them, or we find a suitable alternate, a grand-parent or an adoptive family. But when it comes to children somewhere else, why do we simply settle for the shadows?
Most children in orphanages aren't there because their parents don't love them. They are there because unemployment is high, and life is hard, and poverty is complicated. Poverty is a problem everywhere but orphanages are a problem in Haiti.
At Second Mile Haiti, we feel privileged to do the work we do, working to create alternatives for Haitian families desperate to do right by the children in their care.
It was Violenne that stood up to help an orphaned baby in her moment of greatest need. It was her love and care that allowed Daphnee to live for two months without her mother's milk. And it was her love that led her to an orphanage door. In this case, the story ends the way it should, with Daphnee continuing to grow in the shadow of that love.
But what about the others?
An orphanage shouldn't be the first place a family thinks of when they need a little help. We have to do better.
Will you help us?
A monthly donation to Second Mile Haiti is a great way to help ensure that every child gets a chance to beat malnutrition, that children like Daphnee can remain with their families, and that women like Violenne can continue to pursue empowering opportunities for themselves and their families. If you've ever wondered what it what it looks like to Support a Family, this is it.
To help support families like Daphnee's donate here.