Can Vitamins Save the World?

In a slum on the outskirts of Chennai, India’s fourth largest city and a hub of automobile and software manufacturing, life revolves around other people’s garbage. Dilapidated apartment complexes rise above the metropolis’s towering trash dump, which is constantly ablaze, sending noxious plumes of white and black smoke skyward and tainting the hot, muggy air with rank aromas and eye-irritating fumes. On the ground, amid the steady traffic of overflowing dump trucks, the buildings’ five-story trash chutes empty directly onto the sidewalks, where scrawny dogs rummage for scraps and naked children, wearing only a red string bracelet or belt to ward off evil, play. In the shadow of the apartments are one-room, half-story huts that house families of six or more who must fight a barrage of flies and filth while preparing meals.

Those living in this place called Kodungaiyur, who range from sex workers and daylong drunks to sawmill men, rickshaw drivers, and fish dealers, make the best of it: Mothers and daughters cobble together an income by sorting through scrap metal for recyclable goods, young men search out blankets and boards to construct the lean-tos that line the streets, and the poorest scour the mountains of waste to find anything that can keep their family alive another day. In a city approaching eight million people, this is a 24-hour reality for one million souls, or about 20 percent of Chennai’s population.

These “ragpickers,” as the bottom rung of society is known across the subcontinent, do their dirty, diligent work just a rickshaw-ride away from shiny technology parks that house Dell Computer, Samsung Electronics, and Motorola Cellular. While those multinational corporations symbolize India’s well-publicized and long-deserved, but relatively recent, rise to 21st-century prosperity, the ragpickers represent a much more global and generational story, a tale of the downtrodden everywhere who are locked into a seemingly unbreakable chain of poverty. They are born poor, hungry, and unhealthy; grow up unable to focus on school; wind up working dollar-a-day jobs, if they’re lucky, for their entire lives; and have children who are poor, hungry, and unhealthy.

There are signs, however, that the cycle can be derailed; during the last decade or so, global poverty policymakers have come to realize what may be the most crucial key in unlocking this chain: basic childhood nutrition. It’s not rocket science, but it’s taken the humanitarian world quite a while to figure out that it’s not just how much people put into their mouths, it’s what goes in that makes the difference. The focus is finally shifting from macronutrients-which are the foodstuffs needed to keep the body moving, such as carbohydrates, fats, and proteins-to micronutrients such as Vitamin A, iron, and iodine, the building blocks of lifelong health. For people who’ve been living for generations on simply rice and other grains, this is a significant shift.

Few are spreading this micronutrient gospel more widely and effectively than Vitamin Angels, a 14-year-old nonprofit based in a small warehouse on Santa Barbara’s Eastside. Run by the charismatic Howard Schiffer, the organization distributed vitamins to more than seven million children and pregnant mothers across 40 countries in 2007. Although other aid agencies incorporate vitamin dispersal in their repertoire, Vitamin Angels is one of the few nonprofits in the world solely focused on nutrition, and the only one that’s pledged to wipe out the world’s childhood Vitamin A deficiency by the year 2020.

The centerpiece of Vitamin Angels’ plight is India, a massive, disjointed country of 1.2 billion people where two million babies die every year from malnutrition. When it comes strictly to numbers of people, the subcontinent has the world’s biggest humanitarian crisis on its hands, even as business booms. “If your intention is to impact global health,” said Schiffer recently, “you really better have a presence in and a plan for India.” Last year alone, Vitamin Angels distributed vitamins to more than one million of India’s children. And as a trip through the subcontinent revealed last February, Vitamin Angels still has plenty of people to put under its wings.

Learning to Fly

When the Northridge earthquake struck in 1994, more than 20,000 people found themselves homeless, including poor populations of migrant workers in places such as Fillmore. As Howard Schiffer-then the 44-year-old president of a natural foods company in Santa Barbara-watched the aftermath unfold, he got a phone call from a friend at Direct Relief International (DRI), the Goleta-based nonprofit that responds to disasters across the globe. DRI, as usual, had sprung into action, but while it had the medicine and basic foods, the people were starting to get sick. They needed vitamins.

Schiffer tapped his considerable connections in the nutritional supplements industry, the folks who’ve made household names out of omega-3 fatty acids, ginkgo biloba, and ginseng during the past 20 years. Three days later, a truck was unloading pallets of vitamins at DRI’s headquarters. “It was the most amazing thing,” remembered Schiffer, who suddenly realized how effective vitamins would be at combating disease and improving health in disaster zones. That same year, Vitamin Angels (VA) took flight.

For the next couple years, VA worked as an all-volunteer affiliate of DRI, adding to its disaster relief response. But Schiffer began thinking that the need for vitamins wasn’t just in disasters; they could be used to fight malnutrition in developing countries all over the world. “I realized that to reach the people,” said Schiffer, “we needed to work with more agencies.” So he moved VA into separate offices, and slowly separated from DRI. “It was a good thing in many ways,” he said, acknowledging it was scary to leave DRI’s support network, “because it got us on our own feet and got us out into the world to work with bigger agencies than Direct Relief, and reach a lot more kids.” By 1998, VA had officially incorporated as its own 501(c)(3) organization.

Schiffer remained a volunteer for the first 10 years of Vitamin Angels, but in 2004, after taking out two mortgages on his home and working odd jobs to feed his wife, son, and two daughters, Schiffer went to his board-a collection of mostly nutritional supplement entrepreneurs and natural food product industry executives-saying he had to find work again. But the board wouldn’t let him go. “We will find a way to make this work,” Schiffer remembered them saying. “There’s too much opportunity on the table.” So he became the full-time, salaried director of Vitamin Angels, and has since grown the nonprofit to employ 10 other people and a revolving team of interns. The growth has created more overhead, but Schiffer, who is 58 years old today, said that 95 percent of donations still go straight to the programs.

Using existing DRI partnerships and establishing new ones, VA grew quickly, jumping from 1994’s count of 100,000 vitamins distributed to a 2005 tally of 100 million. It sent vitamins into Indonesia after the 2004 tsunami and to New Orleans after Hurricane Katrina, but also began long-range efforts to stop mothers dying from childbirth in Bali with prenatal vitamins, to fight rickets in Tibet with calcium and Vitamin D, and to improve childhood health in the Dominican Republic with daily multivitamins and anti-parasitic tablets, among many other programs.

To do so, Schiffer connects with existing agencies in these countries-such as midwife organizations in Indonesia and the ministry of education in Honduras-and adds vitamin distribution to their repertoires. That ensures a reliable infrastructure, keeps overhead costs down, and leads to more in-country support and acceptance since the locals are still in charge. And childhood health, believes Schiffer, will make the rest of these peoples’ lives that much easier. “Our sense is that nutrition is a core strategy, a foundation piece,” he said. “If you deal with that foundation, then you can deal with education and all those other things. But you’ve got to put that one in place first.”

Vitamin Angels received a surge of support in 2001, when a wealthy, well-connected executive made a deal with God to help save the world as he awaited word of his World Trade Center-working daughter during the 9/11 attacks. (She survived.) The man contacted Schiffer, who informed him that he could save lives for literally 25 cents a head. Johnson & Johnson was brought on board, and VA had its first corporate sponsor, providing both products and cash.

Then, in 2003, the gauntlet was thrown down. At a meeting in Bangkok, Schiffer was presented with the chance to reach 35 million children throughout Southeast Asia. But Johnson & Johnson thought it was too much, too fast. “We had to leave it on the table,” recalled Schiffer, still dismayed by the missed chance. “I said, ‘That’s it. I am never going to walk away from that opportunity again.'” The next time, Schiffer promised to “write the check myself” if he had to. Since 2003, the organization has been preparing for that goal. Today, they’re ready operationally if not financially. “We could reach 50 million this year if we had the funding,” said Schiffer, who said that Vitamin Angels’ annual budget is now about $1.5 million, but bemoaned the constant fundraising required by the lack of an endowment. “The challenge we’re facing right now is that our funding is for three to five months, but our programs are three to five years.”

Last year, VA launched its most ambitious initiative yet, with the support again of Johnson & Johnson and on-the-ground agencies in the selected countries. Fittingly called Operation 20/20, the goal is to eradicate childhood blindness caused by Vitamin A deficiency throughout the world by 2020. That requires distributions of Vitamin A-which is needed for healthy eyesight, not to mention strong skin and good immune systems-every six months for kids between the ages of two and five. Combined with an anti-parasitic tablet that rids children’s stomach of the worms so prevalent in areas without clean water or basic hygiene, the program costs $1 per child for four years of treatment. It reached 4.5 million children in 2007 and will reach seven million this year. Though 17 countries across the world are already benefiting from Operation 20/20, the country likely to benefit the most is India.

The Subcontinent’s Sickness

“In India,” explained one of Vitamin Angels’ contacts in Mumbai (formerly Bombay) as our car weaved through the city of 20 million’s treacherous traffic and suffocating smog, “everything is plenty.” Plenty of people: 1.2 billion and counting; plenty of languages: 415 distinguishable languages and more than 1,500 dialects; plenty of ethnicities: six ancient bloodlines spilling into nearly three dozen distinct tribes; plenty of castes: thousands of “forward,” “scheduled,” and “backward” groups dictating social order; and plenty of religions: Hinduism, Islam, Christianity, Sikkism, Buddhism, Jainism, Judaism, Zoroastrianism, Bah¡’i, tribal animism.

But most of all, India has plenty of problems. Corruption is endemic at all levels of government. Catastrophic poverty is prevalent in both urban slums and rural villages. Separatist groups in nearly every geographic region threaten to tear the nation to pieces, from the Naxalite-Maoist uprisings in central and northern India to the freedom-fighters in northeast Nagaland to the persistent problem of Kashmir. (Worries of all-out war with Pakistan make headlines so often that the word “nuclear” is simply abbreviated to “n,” as in “N-Bomb.”) Xenophobic politicians inspire violent hatred of “immigrants” from state to state. Hindus hate “preferential” treatment given to Muslims, thereby fueling jihadist uprisings in response and making terrorist bombings a very real daily concern. Monsoons make lowlands unlivable three months a year, forcing people to move to higher ground and wait out the annual floods. Droughts, meanwhile, are pushing farmers to kill themselves by the hundreds per month due to crop failure. Pollution is ridiculous. Basic sanitation is lacking. Clean water is a joke. Disease is rampant.

“India is the white elephant,” said Schiffer one afternoon last February on the way back from a vitamin distribution in Pune, a city of 2.5 million where more than half the population lives in slums. “Anybody who’s dealing in humanitarian relief has to come to a point where they realize they’re going to interface with India.” Sub-Saharan Africa attracts more attention because of its higher per capita rates of malnourishment and extreme poverty, “but in sheer numbers,” said Schiffer, “South Asia eclipses everywhere, and India is the biggest part.” And in a world moving fast toward overpopulation and witnessing an ever-widening gap between the haves and have-nots, as India goes, so go the rest of us.

Over breakfast at a hotel near Calcutta in early March, Schiffer pulled out the morning newspaper and pointed to an editorial about how Bangladesh and Nepal-two South Asian countries far behind India in terms of modernization and commerce-are significantly reducing child mortality. Meanwhile, two million kids die every year in India, mainly due to malnutrition-related reasons. “Bangladesh and Nepal have made reducing infant and child mortality a priority,” said Schiffer. “India has not.” He’s at a loss to determine why the subcontinent’s rulers have not done so, but admitted, “These are the people who have the least political clout, the least money, the least power.” And in India, where political connections are sometimes needed just to get your plumbing fixed, it’s easy to see why slum dwellers and farmers might get overlooked.

That the Indian authorities seem more intent on building fancy superhighways and improving their international airports than addressing their shockingly poor citizens is tragic to Schiffer, especially since his organization has been able to improve the welfare of more than one million Indian children at the cost of 25 cents per child. By fighting childhood malnutrition-a problem affecting more in India than anywhere in the world-Schiffer believes the poor people of the world could start throwing off the chains that lock them to society’s lower class, in part because they would no longer need to have such large families with so many mouths to feed. “When nutrition levels go up and child survival rates go up, population density goes down,” Schiffer explained, when asked why he’s trying to save lives in an already overpopulated place. “It’s a lot easier to raise yourself out of poverty with three healthy kids than with nine sick ones.”

It’s a message that Schiffer takes with him wherever he goes. “There are many problems in the world today that require billions of dollars and decades to solve,” he said one warm afternoon in the squalid suburbs of Calcutta, while teaching a group of Indian educators the benefits of growing and eating Vitamin A-rich foods such as papaya, carrots, and bell peppers. “This isn’t one of them. We can solve this now.”

Walking the Nonprofit Walk

Vitamin Angels is just one of countless aid providers working in every developing country on Earth, and its day-to-day operations are much like what international nonprofits must endure everywhere: a harmonious blend of aid-dispersing, deal-arranging, headline-generating, problem-solving, promise-making, fundraising, trust-building, speech-giving, staff-educating, and ceremony-enduring. In India, where political allegiances mean everything and the overwhelming flood of humanity never ceases, this humanitarian dance must be performed with utmost care.

The most time-consuming aspect of a VA tour of duty is also the easiest and most pleasurable: sitting through the ceremonies that each in-country organization throws for Schiffer and crew. These feature, with occasional variation, presentations of flowers and scarves, traditional songs and dances, modern songs and dances, poetry, skits, anthems, and, at least in the village of Paddapai outside Chennai, energetic puppet shows. Following the revelry and announcements in the local dialect, Schiffer then stands to deliver his message, which goes, “You’re all very important and you each have a very special gift to give to India and to give to the world. And to give that gift, you have to be healthy.”

Next comes an outline of the importance of the golden Vitamin A droplets in red or green capsules and the chewable, pink anti-parasitic tablet (because stomach worms that come from drinking dirty water or playing in feces-tainted soil can consume a third of a child’s food, vitamins included). Invariably, the kids slowly realize they are about to take medicine, and some start to shuffle nervously. The vitamins are then distributed, usually accompanied by the cries of some of the younger children. “That’s it,” said Schiffer after a morning distribution in Pune, where the government ministers have supported the Operation 20/20 program. “It’s that easy. It’s that simple.”

This largely symbolic process happened as many as three times per day in the February-March India mission, and occurred from the slums of Mumbai, where raw sewage trickled down the dirt walkways through piles of trash, to the rural island villages on the backwaters of the Bay of Bengal, where emaciated cows wandered through idyllic rice paddies. “It means a lot to them that we actually come out here,” said Schiffer.

As vitamins get dispersed, Schiffer entertains the children, experiencing much joy in the process. “What I see all over the world is that they’re just kids,” he explained. “They’re no different than our kids. They were just born in untenable circumstances.” He looks for particularly sick children, and then gives their parents multivitamins with the instruction to provide one a day. He also tries to connect with the teachers and elder females of the community, explaining, “What we’ve found is that women control the healthcare system when it gets down to the village level. If you can get the mothers and the grandmothers and the aunties involved, you will be successful.”

In addition to attending the pomp and circumstance, Schiffer also uses the vitamin distribution trips to disperse cash donations to in-country nonprofits, get media coverage in regional newspapers and television programs, film videos that will be used to bolster fundraising efforts in the United States, and evaluate the organizations with which VA partners. In India, where Vitamin Angels works with church groups, eye hospitals, and health clinics as well government agencies, Schiffer was tremendously satisfied with the people he met. “Fortunately, we’ve been led to the right people,” Schiffer said.

In many cases, that means partnering with missionary groups such as Believers Church, which works throughout India and brings Operation 20/20 to more than 12,000 schoolchildren in West Bengal and beyond. That leads to the potential for abuse (such as giving vitamins only to those who come to church), so Schiffer must remain vigilant in making sure it doesn’t happen. “I don’t mind being exploited if the work is being done,” said Schiffer, “but we have to make sure the work is being done right.” With Believers, one of the most organized Vitamin Angels partners anywhere, vitamins are given to all Christians and non-Christians, and Indian traditions are respected. “They really do walk their talk, and they are really committed to helping the poor,” said Schiffer, describing all the church groups he’s partnered with around the world.

It’s not just church groups that have the chance to misuse the aid: Corrupt politicians or favor-currying bureaucrats can also misdirect the vitamins or de-worming tablets, which fetch as much as $8 each on the black market. “In 14 years now, that hasn’t happened,” confirmed Schiffer, “but it’s always a concern.”

More common than abuses, however, are the delays imposed by customs officials wanting kickbacks. It happened in Indonesia a few years ago when perishable prenatal vitamins were held without reason for nine months. And it happened this winter in Calcutta, where a shipment was waylaid by the city’s communist government as officials awaited a bribe. To head off such problems, Schiffer must play the geopolitical game. “There’s always this part of forming strategic alliances with the press, with government officials, with people in private enterprise who are powerful enough so that, if needed, we can make a phone call,” he said. “We’re always looking at cultivating these relationships.” In the case of Calcutta, a powerful Vitamin Angels supporter from South India made some calls, and the vitamins were released.

Meanwhile, Schiffer is also laying plans for the future over meals and in car rides between the distributions. Everyone wants more support, it seems, and Schiffer is willing to ramp it up every year. He’s also looking into forming a separate wing of Vitamin Angels in India, which would wipe out many administrative headaches, and is considering ways to incorporate the vitamins into a sort of microloan program. Most of all, he’s hoping to find a pharmaceutical corporation in India that’s willing to support Vitamin Angels, and is surprised that no one has stepped up to the plate yet.

Beyond Vitamins

These days, the world’s downtrodden depend on nonprofits to survive. Schiffer sees this everywhere he goes-from Kenya and Malawi to Guatemala and the Dominican Republic. This reality was driven home while touring a slum in west Mumbai, where a line spilled out of one hut with mothers holding their babies in hopes of seeing a doctor inside. The doctor, part of the Child Eyecare Charitable Trust, was relying on records that had been kept meticulously for the past few years, the only medical history for the slums’ 20,000 or so residents. After a brief consultation, medicines were given out to each patient. This happens once or twice a week, and the line is always too long. Nearby, feces floated in an open sewer and the mounds of garbage reeked of urine.

“The fact that they’re not seeing any epidemic break out is because there’s a [VA-sponsored] team coming here every week,” said Schiffer. “This entire slum costs just $2,500 to provide Vitamin A and de-worming medicine. That’s not a lot of money.” And, as one program manager said in his public acknowledgement of Vitamin Angels’ dedication to his village, “We are not only strengthening the children. We are strengthening the country also.”

Over time, Schiffer plans to start getting vitamins to younger and younger children, bolstered by a recent study that shows a drastic decrease in child mortality for kids who get a dose of Vitamin A within a few days of being born. Then the focus will shift to women, pre-conception. Meanwhile, community education programs must grow and gardens rich in nutrients must be planted. “We don’t want to be handing out vitamins forever,” admitted Schiffer. “That doesn’t make any sense. : I’d be happiest if I came back to see gardens being planted.”

So as the 21st century rolls onward, with the Earth’s population surging and the poor getting poorer, the Vitamin Angels of the world are keeping their heads down and working diligently to do their part. “The day that kids are born who have a full chance of meeting their intellectual and structural capacity,” said Schiffer, “that would be the end goal. Every person has a right to basic nutrition.”

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For more information on Vitamin Angels, including a video report from this recent India trip, see vitaminangels.org. For more reporting on this subject and photographs from India, see independent.com/india.