Feeding Afghan children a formula for peace
January 26, 2009
Heading into a 10-month deployment to Afghanistan a year ago, Capt. Tim Harrelson wanted to do something about malnutrition and infant mortality, but figured he would spend most of his time treating trauma and running sick call inside the wire.
By the time he returned to Misawa Air Base in Japan around Christmas, the physician assistant had helped develop a nutritional paste that saved many Afghan children from starving to death. The knowledge was left for local doctors and other provincial reconstruction teams.
"You get involved with a mission that can sometimes seem overwhelming in scope," said Harrelson, 38, of Indian Land, S.C., who was recently awarded a Bronze Star for his deployment efforts.
"It was greatly satisfying. In that situation, you hope you can leave a positive legacy. It doesn’t matter if your name is attached to it or not. What matters is it works and someone else can use it — and you get to where people can be happy and they can be healthy.
"I think that’s what helps establish peace in the region."
Striking the right formula for the nutritional supplement and persuading villagers to accept it became the task of Harrelson and Capt. James Arnold, a family medicine physician at Andersen Air Force Base, Guam, who also played a key role on the team in Zabul.
Arnold and Harrelson took a cue from Dr. Zamarai Sultan, the Qalat city public health administrator, who told them about a product he knew of that had been used in Africa. Last July, they found a recipe online they thought could be successfully copied and introduced locally.
"We had a very difficult time developing that," Harrelson said. "We experimented with several mixtures and ratios until we got something kids could easily digest, with all the nutrients."
Called "Ready to Use Therapeutic Food," the paste consists of only five ingredients — sugar, oil, powered milk, almonds and liquid vitamins, all of which were available in village markets.
Harrelson said no cooking is required, and it’s not water-based, so it can stay on a shelf without refrigeration for four months. It also won’t go bad and doesn’t cause sickness, he added.
In August, they tested the supplement at Qalat Provincial Hospital, and it met with "significant and immediate success," he said. From there, it was exported throughout the city, north to Shajoy and then into the small village of Surri.
"When we got [there], all we could see is what we could not do," Arnold said in an Air Force news release. "We had to learn and accept what we could do and do it to the best of our ability. Once we got to that phase, we took off like a runaway train.
"You can’t solve all of these children’s individual medical problems, but you can tackle very simple things. That is going to impact a lot of people."
The paste was designed specifically for children between 6 months and 5 years old. Harrelson said the reconstruction team could feed about 30 kids a month for $5.
A child receives a 600-calorie serving for a day. The routine ultimately will put a child on the path to a normal diet.
"You can put it on a spoon or the end of your finger. The children don’t have to chew it; they can suck on it. It’s actually very sweet," Harrelson said.
"Being able to teach the Afghan doctors how to make the paste was a tremendous success."
Arnold and Harrelson also tagged along with a 101st Airborne Division company on an 18-day combat mission aimed at carving up Taliban strongholds. Harrelson became the first Air Force physician assistant ever inserted into an Army infantry unit during Operation Enduring Freedom.
"We traveled separately, lived out of the Humvee and slept on the ground. The only shelter we had was the truck," Harrelson said.
The duo didn’t fire any weapons. Medical support and civil affairs were their main missions, and they managed to penetrate a dozen cities.
"All the villages had experienced periods when the Taliban would come through and take their food or occupy their homes," Harrelson said. "Most of these villagers would go their whole lives without seeing a doctor once.
"The true medical impact was limited to addressing acute issues on one day, but the goodwill it established set a foundation of trust between the village elders or leaders and our mission leaders."
The outing with the 101st didn’t yield any close calls with the enemy, Harrelson said. On other missions, however, convoys were fired on, and he heard bullets ping off his Humvee. He also saw trucks in front get hit by rocket-propelled grenades.
But he never worried about the dangers and said he felt safe with the Air Force and Army security details.
"The men and women I worked with … were amazing. They all knew their job and we all supported each other," he said."They knew if they went down with an injury, I would take care of them and they would make it out. And I felt the same about their protection of me."
In major Taliban offensives, Harrelson stabilized more than 30 coalition casualties.
He also treated more than 800 Afghans during other medical missions. During a public health project, he provided clean water to 300 families, leading to a 25 percent drop in pediatric mortality.
"Strange, but while I was there, I always felt like I had a purpose to fulfill, and I believed without a doubt that I would fulfill it and not be harmed."