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First Things First: Prioritizing Efforts to End Deadly Hunger

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My father had a passion for proverbs -- he used a lot of them in his everyday conversations. As a child, I regularly heard him say such things as "ignorance is bliss," "laughter is the best medicine" and "first things first," and swore I would never use such trite and overused expressions.

But the fact of the matter is, when it comes to humanitarian work, one of these aphorisms takes on renewed and profound meaning -- and perfectly describes what we do at Action Against Hunger. That phrase: "First things first."

Given my position as the head of this international humanitarian organization, people often ask me what the best way is to end poverty and despair in the world. They also frequently want to debate the pros and cons of investing in struggling countries: Should they invest in education, they ask, or health care; economic development or infrastructure?

As I listen, the words "first things first" come bubbling up from my childhood. Because no child can learn in school on 100 calories a day; no health system can properly prevent disease if their patients return to contaminated water sources; and no markets will thrive if people can't nourish themselves enough to lead productive lives.

The populations that Action Against Hunger works with are just beginning to recover from the cruelties of man or nature: civil war, earthquakes, floods, famines and drought. It's easy to feel overwhelmed by their needs as the struggle to survive in the wake of such horrific events -- where people have lost everything, including their homes, their families, their livelihoods, their savings and their security.

Therefore, "first things first" is not just an expression; it has become a commitment -- a promise to provide the essential building blocks of life to people everywhere so they have a chance at changing their lives.

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But, even when we pare our mission down to this basic need, there are priorities. Acting to save the most vulnerable -- the young children on the brink of death due to acute malnutrition -- is our top priority, our raison d'etre. Our teams saved the lives of over 225,000 young children last year with a 90 percent cure rate.

At the same time, Action Against Hunger works to prevent acute malnutrition with a range of services, from helping new mothers understand the importance of breast feeding to providing specially formulated food to children who are at high risk of malnutrition. We halted hunger 972,000 times last year through high-impact nutrition interventions, using fortified peanut- and soy-based products designed for moderately malnourished children.

To break the cycle of hunger and ensure long-term food security, we rely on an array of new and sophisticated tools to assess what is needed village by village. This could involve testing new drought resistant seeds; bringing in an ichthyologist to help assess the reasons behind fishermen's empty nets on Lake Tanganyika; or, as we recently did in drought-stricken central Kenya, helping the pastoralists of yesterday become the farmers of tomorrow.

And, finally, to prevent recurring nutritional crises and the outbreak of diseases like cholera, we also partner with local leaders and national governments to ensure access to clean water for drinking, planting and sanitation. Where needed, we help build wells, drill boreholes, construct water towers, repair pipes, build latrines and promote hygiene practices. Last year, we met the water and sanitation needs of 2.9 million people around the world.

There is no better way to illustrate the importance of the life- and livelihood-saving work our organization carries out than to tell the story of konzo, a debilitating condition found in the developing world that can arise during food crises. In 1979, Dr. Hans Rosling -- recipient of the 2011 Action Against Hunger Humanitarian Award -- was working as a district medical officer in Mozambique, managing health and hospital services for 360,000 villagers, when he noticed people coming in from a drought-stricken rural area with irreversible paralysis of the legs.

When he investigated the outbreak, he found it derived from the combination of low protein intake, poor soil conditions, and a lack of sufficient water resources for the thorough processing of bitter cassava roots that, due to hunger, people were consuming as their only source of food -- without proper treatment, the bitter cassava becomes laced with naturally occurring cyanide.

Therefore, the only source of nutrients for these malnourished people was actually hurting -- and even killing -- them. He named the disease "konzo" and for the last 20 years Rosling, now an acclaimed professor of International Health at Karolinska Institutet in Stockholm, a global health advocate and a TED Talk luminary, has researched it across remote rural areas in five African countries, while advocating its eradication.

In November 2009, Action Against Hunger launched a 22-month intervention in a region of the Democratic Republic of Congo to address the factors underlying a konzo epidemic. Our eradication efforts took a cross-sectoral approach, as we always do, leveraging ACF's three technical areas: Food Security & Livelihoods (FS&L), Nutrition/Health, and Water, Sanitation & Hygiene (WASH). Specifically, our strategy pursued several tactics at once: we distributed sweet varieties of cassava cuttings (which contain far less cyanide than bitter cassava) and cereal seeds to 12,500 households over two agricultural seasons and helped build 13 community-based mills to process the cassava and cereals.

We worked with community groups and leaders to raise awareness on the causes of konzo and conducted nutritional trainings on the proper retting methods (i.e., soaking) for preparing konzo-causing varieties of cassava. Finally, we rehabilitated eight defunct boreholes to increase access to water during the dry season and constructed 51 cassava retting tanks in key cities.

The changes we've made with the community is reducing the rates of konzo -- from the hundreds per month to dozens. But, sadly, we still have a long way to go. More than one quarter of the konzo cases we diagnosed (in children under 18 years of age) were also suffering from acute malnutrition.

Our teams discovered that 56 percent of adults diagnosed with konzo were also severely malnourished. All too many people still don't have the time to allow the bitter cassava soak before they go hungry. And not enough of them have the alternative supplies of food to consume instead of the cassava. Konzo is but a single side-effect of global malnutrition. There are thousands more.

As Nicholas Kristof has said, in the lottery of life, we are the lucky ones. You and I get to live in a country with ample economic opportunity, with an abundance of food and clean water to sustain us -- and fuel our dreams. If the rich countries of the world were to act collectively -- if we were to put first thing first -- we could, no doubt about it, end deadly hunger in the world.

Join us for Action Against Hunger's 12th Annual Benefit Gala on Monday, November 14, 2011 at New York City's Guastavinos, featuring the contemporary Lebanese cuisine of Chef Philippe Massoud and his Flatiron flagship ilili Restaurant. Tickets start at $1,000, www.actionagainsthunger.org.

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