A doctor who comes to Shada holds office hours for two hours a week. It's not nearly enough. Usually there are more than a hundred patients waiting to see him.

"It's hard to see kids die of malnutrition after getting called in the middle of the night to bring them into the world," Bwa says in Kreyol, with Rhoads translating.

The Shada clinic rarely receives medika mamba. A 1.1-pound bag currently costs $2.50. Few residents can afford to pay for it, and MFK can't afford — at least, not yet — to donate it. In addition to the $2 million for the new factory, the organization requires $66,000 a month just to stay afloat.

"We need to keep growing," says Steve Taviner, MFK's director of development, who works in the St. Louis office. "This is what makes the new factory imperative. We've hit the wall for how much we can make. With the new factory, we can make four or five times as much more cheaply and efficiently. In five years, we want to be the primary supplier of RUTF in Haiti."

Though MFK's sales have been steadily increasing, Taviner says they account for only one-third of the organization's overall revenue. Most of the funding still comes from donations, from places such as Google, Nestlé, Christian World Relief, the Macaulay Foundation, Novus International, Scottrade, and Emerson Electric. Inmates and employees at three federal prisons in Illinois read about MFK and raised $2,200.

"In many ways, ironically, the earthquake was a remarkable opportunity," Taviner says. "It raised lots of interest and funds. The phone was going nonstop. We've raised $1 million since January 12."

Wolff is still looking for donors.

"I almost got on Oprah," she wisecracks, "but they went for star power and went with Wyclef Jean instead. God knows why." She continues more seriously: "The development business is very complicated. It's not filled with altruistic people. But there are people within it who are altruistic. We need to find those people and have them pull the levers."

Six weeks ago, though, Wolff decided she needed to take a more radical step. The day after the land purchase was delayed, she boarded a plane to Rouen, France, to meet with executives from Nutriset, the parent company of Plumpy'nut, MFK's chief competitor in Haiti. Working with Nutriset would give Wolff access to UNICEF and USAID. To do that, Wolff is willing to compromise. MFK will begin using Nutriset's peanut butter recipe, which contains slightly different ingredients, including special stabilizers. "It's a trade secret," Wolff says. "We'll never find out what they are." The size of the peanut butter packets will also shrink. Instead of 1.1 pounds, they'll be one-fifth of a pound, the same size as Plumpy'nut's.

"Nurses prefer the bigger packets," Wolff says. "That way, your neighbors won't ask you for [an extra packet]. You're not supposed to share."

More significantly, MFK will have to alter its plans for the new factory to meet Nutriset's production demands, which means more equipment and more training for the workers.

"It's the way to a sustainable future," Wolff says. "We're having growing pains, but we need to make it happen. It's a bigger and more complex vision than we had before. It's kind of exhausting, but it's never boring. Boring could be worse."

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