Cecilia Amanya’s home is a small hut made of earth in the tiny village of Nasewa, Kenya. It’s dark and dank, with wasps’ nests hanging from the grass ceiling and a chicken strutting across the dirt floor. Sitting inside, I listen as she says that, during her earlier pregnancies, she would eat chunks of soil from her bedroom walls.
And I was no longer surprised to hear it.
I was traveling with the Santa Barbara–based nonprofit Vitamin Angels to the remote villages of western Kenya, to meet the women who, like Amanya, were recipients of the prenatal vitamins the organization distributes. “I used to eat soil” was a refrain I heard over and over again when the women described what life was like before taking the vitamins.
It’s an epidemic, in fact, among the pregnant women in this area and places like it — poor, remote, rural corners of the world. The burden pregnancy takes on a body that’s already undernourished is simply too great. A growing fetus hungrily takes what it needs from the precious little that’s available, and, in the case of these women, whose diets often consist of ugali (a staple here made of mashed, boiled corn and water) and little else, there’s nothing to spare. Pregnancy pushes them over the edge, leaving them perilously malnourished — so much so that, in a particularly sinister side effect of starvation, they become sickened by food. Their bodies desperate for nutrients, they begin to crave — and eat — soil.
But it’s a dangerous replacement. Parasites and bacteria can cause illness. Babies born of such conditions are often premature, underweight, and vulnerable to a number of birth defects; and a malnourished mother can’t produce the milk a baby needs.
The (well, a) fix is simple: prenatal vitamins. But getting vitamins to these women is not easy. Basic infrastructure is all but nonexistent — the only roads are unpaved; electricity is sparse. In remote villages like Nasewa, women must walk miles just to collect water from a well. If they make it to a clinic to give birth at all, they either walk or are carted in a wheelbarrow.
The Stacked Deck
These are the unreachable. Globally, around 30 percent of people in need are not attended to by the world’s largest organizations, because getting to them is just too difficult — the logistics too complicated, the bureaucracy too thick, the cost-benefit analysis too unfavorable. (For me to reach Amanya’s home involved a flight to Johannesburg, South Africa; one to Nairobi, Kenya; another to Eldoret, a city in western Kenya; a two-hour drive along narrow dirt roads; and a 20-minute hike through the bush.)
It is precisely this 30 percent that Vitamin Angels targets — in 49 countries throughout the world. Traveling with the small group, what I saw was astonishing: a miracle of logistics, a triumph of possibility, with joy — and heartbreak — lurking around every corner.
The women we met, recipients of the vitamins, were vibrant, strong, full of life, and eager to tell their stories. In the villages, women would gather to greet us with song and dance. Then they’d testify about Vitamin Angels (never “vitamins,” always “Vitamin Angels,” as in: “I took the Vitamin Angels, and no longer ate the soil.” There are, after all, no other vitamins here.)
“Before Vitamin Angels,” said Caroline Odela, “I did not even want chapatti [unleavened flatbread]; I put it aside for the soil!”
“Now I am very healthy. I eat like a pig!” said Walkista Akoit. “I used to eat a lot of soil. Now I don’t want to look at it even.”
Eunice Amcaga said, “Even when we walk around, we are shining! People from the village are asking, ‘What are you eating?’”
“I was so tired. All I could do was lie there,” Rose Okoit said. “I couldn’t even do my housework.”
One day in the car, between sites, I asked our translator, Evelyn Mulunji, a PhD candidate from the town of Kakamega, who works in Eldoret with Global Network, Vitamin Angels’ in-country partner in Kenya, what, exactly, these women mean when they use the word “housework.”
“Fetching the water. Fetching the firewood. Working in the garden. Digging for food. Building the fire. Boiling the water. Cooking the food,” she said — not to mention taking care of four, six, 10 children apiece.
“And the men?” I asked.
“They stand on the side of the road,” she said, rolling the “r” along with her eyes, a mix of resignation and bemusement on her face. If the men worked, it was generally in “odd jobs,” or as a driver, one of the guys gathered on a dusty intersection with a moped, waiting for a fare.
The women in the village of Kaujakito welcomed us with song, dance, and a play, reenacting how they learned about Vitamin Angels. Performed in Swahili, it began with a registry worker coming to the door and explaining about the vitamins and culminated in a wild birth scene. There was a sudden roar of laughter from the crowd, loud and knowing. Mulunji let us in on the joke: “She is saying, ‘Oh, my husband is always drunk.’”
Alcohol is a common problem. But it’s not the only thing that complicates the already tough circumstances. Here, men may marry again and again: Often they do, and once that happens, the prior wife is left on her own. Despite the fact that, almost always, the women I spoke with said how much they loved going to school, nearly every one had to drop out young. In Kenya, primary school is free, but secondary is not. Uniforms must be purchased, fees paid. Though costs amount to somewhere around $30 a year, it might as well be $3 million. If a family has money to keep any children in school, boys get priority.
These women are clearly smart, capable, and resourceful. They have to be. But the deck is stacked. As Howard Schiffer, founder and president of Vitamin Angels, told me one evening at the Western Ambience Hotel in Bumala, there’s only so much you can do, and basic nutrition is fundamental.
Angels Among Us
Vitamin Angels grew out of need and happenstance. After the 1994 Northridge earthquake, Schiffer, then president of a natural products company who’d spent many years in that industry after working as a midwife during the home-birth movement of the ’70s, got a call from someone at Direct Relief International (DRI). The quake had left many homeless and living in unsanitary conditions, and DRI feared for their health. Could he help get some vitamins to these people?
Schiffer reached out to various industry contacts and secured some donations. A couple of weeks later, Schiffer and DRI’s Ellen Engleman met at Esau’s to talk, and Vitamin Angels (VA) was born. For some time, it operated as an affiliate of DRI, but in 1998, it grew into its own organization. And, despite some scary days early on — Schiffer took out a second and third mortgage on his home to keep it going — Vitamin Angels has established a recession-proof, completely scalable business model. Its funding is marketing-based, collaborating with companies in the health and nutrition sector; its overhead is minimal, partnering with organizations that are already working in the field. It has grown 30 percent a year since 2008. Last year, Vitamin Angels aided 27 million women and children.
At the start, VA took whatever was donated (usually vitamins or supplements that were mislabeled, misbranded, or just weren’t selling) and then scrambled to get them to whoever was in the greatest need. “But we started realizing that wasn’t creating the long-term relationships we needed, because we’d go with one product, and then six months later, we might not have it anymore,” Schiffer told me recently. “So we started really looking at what the biggest needs were.” Today, VA focuses on prenatal vitamins, children’s multiples, and vitamin A. (Two high-dose doses of vitamin A a year, which runs about 25¢ per child, are enough to prevent deficiency-caused blindness.)
In the time he’s spent in the field, Schiffer came to an interesting realization: When it comes to practical, on-the-ground health care, particularly at the village level, it is more often than not the women who are running the show: sometimes in an official capacity as with a health promoter or advocate — someone who works with one of Vitamin Angels’ partner organizations or indigenous agencies, as Mulunji does. Beyond that, often, the point person in a village is a mom or auntie, a doula (“They’re called traditional birth attendants now,” Schiffer said with a grin), or grandma.
“The women are the ones who know who’s sick, who’s having an affair, whose kids are doing some kind of risky behavior,” Schiffer said. “They really understand and know what’s going on. So when you want to address a problem, if you have those women enlisted, your success rate goes way, way up.”
His anecdotal experience echoes findings across disciplines from agriculture to microfinance; in terms of return-on-investment and long-term success, investing in women yields greater results. According to the U.S. Agency for International Development, “When women have the same amount of land as men, there is over a 10 percent increase in crop yields.” In terms of microfinance, studies show that women pay their loans back faster and are more inclined to stay and invest in their own communities; as a result, the communities do better.
The implications of that are huge. At the World Economic Forum in Davos, Switzerland, this past January, the International Monetary Fund’s Christine Lagarde said, “The evidence is clear, as is the message: When women do better, economies do better.”
Schiffer, just back from Davos himself, nods at the parallel. “It’s the same thing that’s been shown; when you increase women’s income, the income levels at the family go up. When you get women involved [in health care], the health of the kids in the community is paramount, and that’s what gets addressed. And at the most fundamental level, that’s how critical women are to being part of the solution.”
Information is spread. Friends and family members tell each other about the vitamins, why they need them, whom to talk to to get them. When a woman picks up the vitamins from a volunteer or clinic worker, often she’ll learn about other services, too. (For example, there’s the Depo-Provera birth control shot, which many women we met knew about — and wanted — sometimes, without telling their husbands. Several asked if we could get it for them.)
While focusing investments on women has become a data-driven strategy for some organizations, for Schiffer and Vitamin Angels, working directly with women was less strategy, more an organic function of how they operate. “We had chosen this model, to piggyback on groups already working at the village level, providing some service, operating a school or maternity clinic or doing some kind of community organizing,” he said, “so immediately we were in the villages. And it was just observation, just like, oh, [the women are] who we’re working with. … This little region in western Kenya, 500 or 600 little villages, who’s going to get out there? The only people who are going to get out there are the people who are living there. And the people who are living there are going to be the most concerned because it’s their babies or their kids who are dying or getting sick or not growing.”
When Schiffer goes into the field, his intention is manifold. He wants to make sure the vitamins are getting where they’re needed; he wants to get to know the in-country partners. But so much is about simply bearing witness, hearing the stories, and giving the people he’s reached a forum in which to tell them. And that’s something he didn’t expect.
A trip into the field with Vitamin Angels involves taking oral histories from the recipients, something that was originally done as a way to deepen donors’ engagement. But, Schiffer soon realized, that doesn’t begin to scratch the surface of what goes on when you ask people about their lives. There’s something transformative in telling one’s story.
“It was one of those things that, after the fact, I’d look around and say, oh, there’s something else going on here that I never even realized,” said Schiffer. “We’re telling people that what you have to say is important; we want to know your story. So many times, we go into the villages, and the people who are traveling with us, we’ll say, part of your job is to be interviewers. And they go, I don’t want to pry, and I go, no, you don’t understand; if you don’t take the story, it won’t get heard.”
And listening offers its own rewards. It doesn’t take a lot of conversation to realize that, no matter the circumstances, no one person is really very different from any other. I took to asking the women what their hopes for their children were. To be healthy, get an education, and have a good life was the near-universal answer.
Sometimes, I even found a friend.
Our first day in the field, to reach our third stop, we veered off the main dirt road onto another dirt road, at one point asking directions from women carrying plastic jugs of water on their head. Finally we arrived at a small clearing, the vegetation surrounding it so lush that when the sky split apart in the thunderstorm it was clearly thinking about, hardly a drop would hit the ground. Mary Omubek, due to deliver her fourth child any day, looked into my eyes when I asked how this pregnancy was going and said she’d been feeling really strong, despite several bouts of malaria (which she spoke of the way I might a hangnail). I asked if she’d thought about baby names; she laughed, said no. Piling into our car, just minutes before that lovely, electric sky exploded, Omubek caught me and said, “Shannon, if my baby is a girl, I name it you!”
It was harder when the women said that the vitamins were great and they had their appetites back but that now there wasn’t enough food.
Near the end of our trip, we visited Matayos and were seated with the village elders, while the women sat on the ground, in a grassy clearing just feet from an open sewer. Mulunji stood to introduce us. But this time, she decided on a little call and repeat. In Swahili, she spoke, the women repeated, some looking sheepish, some looking proud. She translated for us: “I am sooo strong” was first. “I am verrrry beautiful” was next. “And there is no one like me!” was last, and by that time, everyone was yelling.
“Just this one piece,” said Schiffer, “when they get the vitamins, and all of a sudden they’re healthy, and it’s, like, big smiles, and you see the equation totally change. And what I see is incredible competence, incredible commitment, and incredible potential. And it doesn’t take a lot.”