According to the World Food Programme, almost 15,000 children living in Guinea-Bissau are plagued by acute malnutrition. As of 2013, a mere seven percent of the country’s population is food-secure. Rural communities suffer especially—as many as 93 percent of Guinea-Bissau’s rural population is living with food insecurity and the consequential threat of malnutrition.

So, what is malnutrition, and what impact does it actually have? According to the World Health Organization, malnutrition is “a deficiency of nutrition” caused by factors related to poor diet and disease. Malnutrition hinders physical development, leading to stunted growth and underweight children.

Malnutrition also negatively impacts brain anatomy, physiology and biochemistry, potentially leading to irreversible brain damage. Additionally, an analysis of child mortality data from 10 countries, including Guinea-Bissau, found that due to “the vicious cycle between malnutrition and infection,” children who suffer growth restriction due to malnutrition are more likely to become ill and have a higher rate of severe illness, leading in turn, to further developmental stunting.

The World Factbook, a publication by the U.S. Central Intelligence Agency, identifies Guinea-Bissau as having the fifth greatest death rate out of 225 countries. Life expectancy at birth, a mere 49.87 years, is also the third shortest, ranking above only South Africa and Chad.

With 18 percent of children less than five years of age underweight and the high risk of disease, Guinea-Bissau is certainly impacted by that “vicious cycle” of malnutrition and illness.

The same analysis that notes this cycle also observes the importance of the “context of poverty” that malnutrition and its ill effects occur within. This poverty, the authors assert, “leads to diminished access to health care, exposure to contaminated environments, poor child care practices, and food insecurity that ultimately affects patterns of intake and illness.”

Poverty rates in Guinea-Bissau have increased notably over the past few years. Now, 75 percent of the country’s population experiences poverty.

Several contributing factors, including socio-political fluctuations and the declining market value of cashews, the country’s primary cash crop, have caused the increased poverty and subsequent malnutrition in Guinea-Bissau. The country’s economy is predominately supported by agriculture with more than 80 percent of the labor force employed in farming. This portion of the population is also the most vulnerable when it comes to food-insecurity.

Experts estimate that in order to end world hunger, alleviating food-insecurity in places like Guinea-Bissau, $30 billion per year is needed over the course of a decade. While it seems like a staggering sum, when compared to U.S. military spending, $30 billion is a drop in the foreign policy bucket.

The U.S. Department of Defense base budget for 2015 is $495.6 billion, nearly 17 times the $30 billion needed to alleviate world hunger. However, the U.S. spends less than one percent of its foreign policy budget on international aid.

An increased contribution to the fight against global poverty and hunger need not be drastic. In fact, by fulfilling their 1970 promise to give 0.7 percent of gross national income as official international development aid, the U.S. and other wealthy member countries of The Organisation for Economic Co-operation and Development could end global poverty.

This foreign aid investment would help people struggling with food insecurity in places like Guinea-Bissau, preventing malnutrition and all its ill effects.

– Emma-Claire LaSaine

Sources: World Food Programme, MDGIF, The American Journal of Clinical Nutrition, CIA, Nutrition Reviews, WHO, Los Angeles Times, U.S. Department of Defense, OECD
Photo: World Food Progamme


Like many countries in Africa, Lesotho faces a multifaceted humanitarian crisis in which issues are intertwined and often exacerbated by each other’s presence. The Lesotho government estimates that around 725,000 people, or about a third of the population, are in need of some form of humanitarian aid. Lesotho has the third highest prevalence of HIV/AIDS with almost a full quarter of adults ages 15-49 infected with the virus.

Furthermore, the United Nations estimates that almost 9,000 children under the age of 5 are severely malnourished in Lesotho. In 2009, a study conducted by the World Food Program (WFP) estimated that 39 percent of children under 5 years old exhibited signs of stunted growth resulting from malnutrition. UN research shows that school attendance for young boys and girls has been decreasing in recent years as well. This is likely due to families reliance on children to assist with increasing agricultural responsibilities.

Unpredictable weather conditions such as floods and droughts have burdened the production and availability of food in addition to other necessary resources. These factors have also contributed to increases in soil erosion and infertile lands. Minimal access to secure, high yielding seeds has also been an obstacle. These fluctuations of climate, coupled with the constant demand for staples such as maize, oil and sugar have caused prices to increase. All of these factors have contributed to malnutrition in Lesotho.

In an effort to combat the drastic price increases, UNICEF, WFP and the Lesotho government are working to implement relief measures. Efforts to adapt to irregular climate conditions are also in place. The Food & Agriculture Organization of the UN has created the Emergency & Resilience Program along with the Lesotho government to implement long term procedures such as subsistence farming and agro-conservation tactics. So far, the program has aided almost 20,000 farmers in Lesotho.

In 2007, UNICEF helped create the Lesotho Child Grants Program that affords impoverished families 40 U.S. dollars each quarter to purchase basic necessities. The program helps over 10,000 families and is being expanded to provide assistance to over 15,000. In addition, the dollar amount allocated to each family will be increased by 94 U.S. dollars.

Puseletso Tsiu is a recipient of the child grant who has greatly benefited from the program’s assistance. Tsiu’s two daughters died of AIDS and she has assumed responsibility for their childrens’ care. As a result of the extra support, she has been able to buy pairs of shoes for her orphaned grandchildren to wear to school. A commonplace purchase in the first world, such as the purchase of shoes, is viewed as a crucial investment in countries like Lesotho.

The National School Feeding Policy, sponsored by the WFP, provides two meals per day for students who can meet attendance requirements. For many families, the program provides an added educational and economic incentive to send young children to school. Families like Tsiu’s rely heavily upon the meals provided in schools so they can save money by not feeding them at home. In total, this program provides meals for over 400,000 students in Lesotho.

In the case of Lesotho, it has been demonstrated that international unity between organizations and governments can make a positive difference. “Kopano ke matla” is an old saying in Lesotho that roughly translates to “unity is power.” When faced with such adverse conditions, the meaning and power of this phrase must not be underestimated.

– The Borgen Project

Photo: World Food Programme

Malnutrition in ArmeniaSituated between Georgia, Turkey, Azerbaijan and Iran, Armenia is a lower-middle-income country with a population of 2.977 million people. According to the most recent data, 32 percent of the population lives below the national poverty line. While poverty levels have gradually decreased in recent years, malnutrition is still widespread, especially among children. Below are some fast facts to get you up to date on malnutrition in Armenia.

1. Based on World Bank studies, 5.3 percent of Armenian children under the age of 5 are underweight.

This number comes from 2010 World Bank studies that defined a child as ‘malnourished’ if his or her weight was more than two standard deviations below the median for the international reference population in the same age bracket.

2. Stunting affects about one in five Armenian children.

Stunting, also known as chronic malnutrition, is caused by long-term undernutrition. A stunted child looks averagely proportioned, but is shorter than normal for his or her age. Stunting can also affect a child’s cognitive abilities and increase his or her vulnerability to disease. After a certain age, the effects of stunting are irreversible.

3. Children from both poor and wealthy families are malnourished.

The 2010 Armenian Health and Demographic Survey, or ADHS, found that while stunting is more prevalent among children whose mothers have less education, there is no clear correlation between income and stunting.

The occurrence of stunting across income brackets highlights the importance of education in combating malnutrition in Armenia. Kim Hekimian, lecturer at the Institute of Human Nutrition at Columbia University, argues that educational initiatives for families could have a huge impact on lowering rates of undernutrition in children. “We want to measure the knowledge of caregivers—mothers and grandmothers—because they probably don’t know about the importance of iron and protein for little ones, [they think] that bread and potatoes are filling, nutritious, and relatively cheap.”

4. Malnutrition is a threat to Armenian national security.

In recent decades many factors have contributed to Armenia’s diminishing population of which 28.2 percent has emigrated and fertility rates are below replacement level. Now, experts fear that the prevalence of malnutrition in Armenia will only make matters worse. “For the small population we have left, we have essentially a situation where one in five children is not going to reach his/her potential,” Hekimian explains.

5. According to the World Bank, 16.8 percent of Armenian children under the age of 5 are overweight.

For comparison, in 2012 the World Bank found that six percent of children in the U.S. under the age of 5 are overweight.

While many people believe that overweight and obesity are problems found only in high-income countries, childhood overweight and obesity cases are increasing at a 30 percent higher rate in lower- and middle-income countries.

In many cases, families choose processed foods that are high in fat, sugar and salt because they cost less than fresh fruits and vegetables. However, these processed foods are low in nutrients. It is not uncommon in developing countries to find children who are both undernourished and overweight or obese.

– Caitlin Harrison

Sources: UNICEF, World Bank 1, World Bank 2, World Bank 3, World Health Organization, Armenian Weekly 1, Armenian Weekly 2
Photo: Flickr

Since 1990, hunger in Lao People’s Democratic Republic, or PDR, has dropped from 34.5 percent to 20.1 percent in 2014. Though this decline of over 14 percent is promising, Lao PDR remains one of the world’s hardest hit countries by poverty. Citizens, mostly in northern and rural provinces, suffer from malnutrition, stunting and what the International Food Policy Research Institute, or IFPRI, calls “hidden hunger.”

Child nutrition is significantly lacking in Lao PDR. Forty-four percent of children are stunted due to poor diets that are lacking in key nutrients, including vitamin A, iodine, healthy fats and protein. As a result, over 40 percent of children in Lao PDR are anemic. The problem of “hidden hunger,” or a pronounced deficiency of key nutrients in childhood, has long term effects on the brain and the physical development of a child.

Lao PDR has the second highest rate of poverty in Southeast Asia, after Timor-Leste and continues to deal with gaps in its economics and wealth distribution. According to the IFPRI, Lao PDR ranks 61 out of 76 countries facing extreme hunger, with the country ranking at 76 being the most affected. Poverty and extreme hunger remains alarming in rural regions of the country, where access to healthcare and adequate nutrition remains scarce.

For example, in the province of Houaphan, 50.5 percent of the population faces extreme poverty. Those who live in this province often depend on agriculture to work and eat; however, the region is susceptible to natural disasters and wavering weather conditions, causing productivity to be low.

Recognizing the impact of climate and environmental factors on the nutrition of individuals, the government of Lao PDR launched the National Nutrition Strategy, aimed at addressing the causes of malnutrition, hunger and economic disparity. In conjunction with the U.N.’s Food and Agriculture Administration, this strategy will tackle hunger at its most basic causes.

The FAO said, “To address the immediate causes (at the individual level), the focus will be on improving nutrient intake and reducing infectious diseases that affect the biological utilization of food.”

As the completion of the Millennium Development Goals quickly approaches, Lao PDR is still not quite on track when it comes to meeting them. Resources are needed to complete these goals and not enough are being provided to Lao PDR that will improve overall development.

Lao PDR depends largely on agriculture and farming, yet those regions are affected by poverty and lack the resources to contribute to the nation’s economic stability. It is in the nation’s best interest that the government develop those programs that focus on educating rural families on sustainable farming practices and how to effectively maintain agriculture and livestock in the face of climate change, so that poverty will give way to sustainability.

– Candice Hughes

Sources: FAO, International Food Policy Research Institute, UNDP, WFP
Photo: Flickr

Cairo Slums

The population in Egypt is 96 million people. Currently in Egypt,there are 26.2 million people that are unemployed. Between 20 and 30 percent of people in Egypt live in poverty. The government and the World Bank suspect that the amount of poverty is grossly underestimated. The rate of urbanization has increased from 50 million, and it estimated to grow to 57 million by the year 2025. Cairo is an urban area that is expanding.

There are three major catalysts for poverty rates to be increasing in urban areas. The government does not have a standard definition of urban areas that is restrictive. In the absence of restrictiveness, boundary expansion of areas is not taken into account. Population evaluation methods are not able to be taken in order to have a needs assessment. This further translates into miscalculation of slum dwelling research on imperative items such as the cost of food, and public services to allot for proper government assistance.

Education is poor in slums in Cairo and food is scarce. Poverty restricts dietary supplements. Carbohydrates and grains are the most common types of food eaten. Vegetables, fruits and protein are hard to come by due to the price and lack of resources for the unemployed. Due to the scarcity of food that is available, children commonly suffer from iron deficiency.

Research indicates that the rate of malnutrition among children in Cairo is high. Sixteen percent of the children are underweight. A lack of basic health care services contribute to the poor health of the residents. It is estimated that 40 percent of Egyptians live on two dollars a day or less. Due to unemployment is rife among the young, forcing many to put off marriage and children until well into their 30s.

Controversy exists regarding the poverty alleviation methods that the government is taking in Egypt. Changes have been suggested to improve the poverty by way of comprehensive studies performed in Cairo. These efforts would increase the definition of poverty beyond income and introduce dimensions of well-being as additional indicators. The additional indicators would include, housing conditions, access to services and the quality of employment. These changes would allow proper assessments to be made.

Underestimating the rapid increase of poverty in urban areas is problematic because it does not allow for proper assessment of the populations needs. The value of poverty lines needs to be increased to determine the true rates of poverty in Cairo. In doing so, the government can make appropriate allowances and funding for an increase of access to nutritious food, quality of housing conditions including water, sanitation and electricity, education and health care.

Erika Wright

Sources: Al Arabiya News, Connected in Cairo, Environment and Urbanization, IRIN, Encyclopedia of the Nations
Photo: Flickr

Guatemala has one of the highest rates of child malnutrition in the Western Hemisphere and the sixth highest in the world. Half of all children under five are considered severely malnourished. Malnutrition is highest among the indigenous population and nearly two-thirds of indigenous children do not get enough to eat. In some of the poorest villages that number rises to 90 percent.

This is significantly higher than nearby Honduras and Nicaragua, both of which are significantly poorer than Guatemala. Haiti is the poorest country in the Western Hemisphere and the average Guatemalan earns four times more than the average Haitian, but Guatemala’s childhood malnutrition rates are twice as high as Haiti’s.

The reason child malnutrition rates are so high is largely the result of high levels of income inequality, some of the greatest in the world. Another primary factor is  neglect toward indigenous communities on the part of the central government.

In recent years the situation has become worse due to a prolonged drought in many parts of the country resulting in lower crop outputs. This has led to food shortages and higher prices for those who are already too poor to put enough food on their tables.

Child malnutrition is both the result of and a primary cause of extreme poverty, it creates a sort of poverty trap. When children grow up malnourished, their education suffers and they are more likely to drop out of school and have trouble finding employment. They are also more likely to suffer from psychological and physical health defects.

Studies show that high levels of child malnutrition have stunted the growth of Guatemala’s indigenous population. Indigenous Guatemalans are on average several inches shorter than indigenous people in southern Mexico who belong to the same indigenous group and share similar physical and genetic features. The difference is that Mexico has much lower levels of malnutrition.

Due to low rates of tax collection and entrenched corruption, it has been difficult for the Guatemalan government to come up with the resources to tackle the problem. But it has begun to address it and work towards a solution.

Partnering with foreign donors, the Guatemalan government has instituted a program aimed at providing food supplements to some of the country’s poorest villages. The EU has provided 186 million euros (about $200 million) in development aid to Guatemala. Progress is being made and several villages are benefitting, but corruption is hampering the program. Many Guatemalans accuse the government of embezzling much of the money for personal use.

USAID is funding farming cooperatives aimed at boosting income and food security. Several villages that have benefitted from the programs report better crop yields, higher levels of income and reduced levels of malnutrition.

But despite these important victories, there is still a long way to go. Most villages continue to struggle and have yet to benefit from any assistance. But progress is being made and things are moving in the right direction.

Matt Lesso

Sources: DW, The Economist, USAID
Photo: Flickr

poverty_in_bangladeshThe World Bank has pledged to deliver two billion dollars in aid to help Bangladesh fight poverty. The aid will focus on improving education, public health and responses to natural disasters. The last part is particularly important as Bangladesh’s climate, dense population and low-lying coastal location make it particularly prone to natural disasters. This in turn hampers its efforts to fight poverty.

Bangladesh is a striking success story in the fight against global poverty. The World Bank has called it a role model for the rest of the world. Between 2000 and 2010, Bangladesh lifted 16 million people out of poverty, a 26 percent reduction. It has also done a remarkable job at lowering its birth rate and slowing its rate of population growth, though its population is still growing and overpopulation and overcrowding remain serious problems.

The aid finances three new development projects. One of the new projects being financed will build 552 new public shelters to house storm victims. Another aims to raise primary school enrollment to 98 percent and raise graduation rates to 80 percent. The third provides income assistance to several million poor families and aims at improving child nutrition. Bangladesh still has one of the ten highest rates of child malnutrition in the world.

The government of Bangladesh aims for it to become a middle-income country by the end of the decade. The World Bank has played an important role in providing aid to help make this goal a reality. Since independence it has provided $19 billion to Bangladesh and is currently spending $7.5 billion to finance 32 development projects. The World Bank says that Bangladesh is “key” to the fight against global poverty because of its large population.

Despite all the progress and praise, there is still a long way to go. Bangladesh still has an estimated 47 million people living in poverty and raising their living standards remains a daunting task.

Bangladesh has a lot of work to do in terms of raising living standards and developing its economy before it can be called a middle-income country, but its government and aid donors are ready to rise to the challenge.

– Matt Lesso

Sources: World Bank 1,  BBC 1,  BBC 2,  Finchannel,  Reuters,  World Bank 2
Photo: Water Aid

Malnutrition can originate from all sorts of sources: lack of funds, lack of access to food or even negligence. According to the World Health Organization, 45 percent of infant deaths are caused by a lack of nutrition. And malnutrition may not always be the direct cause of death in these children. Often they may pass from things like malaria, pneumonia and diarrhea, all of which stem from a lack of nutrition.

In areas like South Africa, malnutrition is an issue affecting 64 percent of infants. UNICEF has made significant efforts to pervade the country and educate mothers on the benefits of breastfeeding. It seems the primary source of a lack of nutrition has been mixed-feeding practices. In these cases, supplemental food is certainly less than enough from a nutritional standpoint. Nevertheless, 53 percent of infants in South Africa under six months of age are mix-fed.

UNICEF has taken initiative by directly corresponding with the Department of Health in South Africa in order to improve policies and education. They have also taken the approach to focus malnutrition on HIV transmission. With babies more severely undernourished, they are much more apt to receive HIV from their mothers because they are weak and unable to grow.

Deaths under the age of five occur in very specific regions, precisely sub-Saharan Africa and Southern India. The good news is that the rest of the world has seen a drop from 1990 from 32 percent to 18 percent in the percentage of infant deaths under the age of five.

While infants in certain parts of the world suffer from malnutrition due to a lack of finance or education, it seems almost everywhere in the world malnutrition can happen as a result of negligence. For example in 2010 a baby died in South Korea after only a three months of life at a mere 5.5 pounds. CNN reported that the couple was too engaged in online gaming to have paid attention to their newborn. Ironically the game they were playing involved raising a virtual child.

In northern France this year, an infant died of malnourishment at 11 months of age. Parents magazine reported that the vegan couple was only breastfeeding the infant. At this age babies should be introduced to more solid foods, and especially in the case of a vegan couple. Because the infant’s mother was not receiving enough protein, she died with both a Vitamin A and B12 deficiency.

Regardless of what may cause malnutrition in infants, it is something that clearly needs to be monitored. It gives us hope that certain statistics are falling, but the world needs to send its focus more so to the problem areas. We can give our donations, but best of all we can give our wisdom and our health knowledge to prevent more infants from unnecessarily leaving this earth.

Kathleen Lee

Sources: WHO, Parenting, CNN, UNICEF 
Photo: Flickr

south sudan
South Sudanese children are suffering the effects of mass malnutrition, and foreign aid agencies are struggling to keep up. On July 14, Medecins Sans Frontieres (MSF) announced “shocking” levels of child starvation in South Sudan, reporting that at least 13,500 children have been admitted to the organization’s feeding programs.

South Sudan’s mounting civil crises have erupted into violence in recent months, which interferes with farmers’ ability to grow crops and provide food for communities. Agricultural infrastructure has been destroyed and crop planting has been widely disrupted or halted. These factors exacerbate the already-present food shortages and force displaced residents to share scarce resources.

Yet even in this time of dire need, seven major international food aid organizations–all of which focus primarily on South Sudan–are at risk of shutting down due to lack of funding. And the UN’s most recent request for food aid in South Sudan is less than half-funded. The UN requires at least $1.8 billion to make an impact on the malnutrition epidemic, but the seven agencies are short in funds by $89 million. If funding and food aid for South Sudan doesn’t increase soon, the UN warns that as many as 50,000 children could die by the year’s end.

“We will be staring into the abyss and failing to avert famine if funds do not start arriving soon,” said Mark Goldring, chief executive of Oxfam, in a report conducted by CARE International. “This is not a crisis caused by drought or flood. It is a political crisis turned violent… Mainly we are calling on governments to fund the aid effort before it is too late.”

The malnutrition crisis in South Sudan is a product of civil strife and contentious domestic politics. Since fighting began, 1.5 million South Sudanese have been displaced from their homes, thereby interfering with dependable access to food and water. Both of the parties fighting have also refused to respect a ceasefire agreement signed in January, leading authorities to report that nearly four million South Sudanese remain at risk of famine this year.

But while solving South Sudan’s political problems will help avert further violence, the most pressing priority for aid workers is now the nutritional needs of South Sudanese children. Many of these children are starving, and travel for days to reach MSF facilities. Others remain hiding in the bush, surviving off swamp water and roots.

Malnutrition is of course a threat in itself. But the three leading causes of death in South Sudan–malaria, diarrhea and respiratory infections–are also much more easily contracted by malnourished people. This compounds the dangers of the massive shortage of aid in the region.

“The United States’ monetary aid to the region is complicated because they don’t trust the South Sudanese government,” said Dr. Jenny Bell, a medical worker with a focus on South Sudan. “Because of this, they’ve shifted everything to humanitarian aid, and all the development efforts have been wiped out.”

Although humanitarian aid is always welcome, monetary aid is crucial to obtaining necessary medicines and nutritional requirements for malnourished children. Hopefully the global community will be able to meet the UN’s funding appeals before the situation in South Sudan plummets any further.

– Mari LeGagnoux

Sources: IPS News, All Africa
Photo: Unocha

1,000 days
The fact remains that undernutrition is completely and indisputably preventable.

Yet this condition continues to claim the lives of 2.6 million children each year. This is more than any other disease, making malnutrition the leading cause of death among young children.

In September of 2010, U.S Secretary of State Hillary Clinton, and then-Irish Minister for Foreign Affairs Micheál Martin, took a stand to fight this deadly disease.

The two diplomats, along with a community of global leaders, launched the 1,000 Days Partnership. This movement promotes action and investment in nutrition during the 1,000 days from the start of a woman’s pregnancy until a child’s 2nd birthday.

Why 1,000 days? Leading scientists, economists and health experts all agree that the proper nutrition in the first 1,000 days of pregnancy and the life of an infant “have a profound impact on a child’s ability to grow, learn and rise out of poverty.”

When a woman is undernourished during pregnancy, her baby has a higher risk of dying in infancy and is more likely to face lifelong cognitive and physical deficits and chronic health problems.

Once the child is born, the first two years are critical to their chance at a healthy and productive life. Undernutrition weakens the immune system, and children not receiving nutritious foods are more susceptible to dying from common illnesses such as pneumonia, diarrhea and malaria.

According to The U.S. Agency for International Development (USAID), a nutrient deficiency is not only dangerous to early childhood health, but also to the long-term success of a child. Lower levels of educational attainment, reduced productivity later in life and lower lifetime earnings are all consequences of a lack of early-nutrition.

In a recent release, USAID reports that “undernutition robs the developing world of critical human capital and capacity, and undermines other development investments in health, education and economic growth.”

According to the 1,000 Days movement, the answer to improving nutrition lies in three strategic, affordable, cost-effect solutions: “ensuring that mothers and young children get the necessary vitamins and minerals they need; promoting good nutrition practices, including breastfeeding and appropriate healthy foods for infants; and treating malnourished children with special, therapeutic foods.”

Evidence shows that providing the proper nutrition to a mother and her newborn has extensive benefits. These advantages include significantly reducing the burden of diseases such as tuberculosis, malaria and HIV/AIDS, increasing a country’s GDP by at least 2-3 percent annually, and, most importantly, saving more than 1 million lives each year.

Since it was created in 2010, over 80 international relief and development organizations have partnered with the 1,000 Movement. Along with its efforts to encourage new actors to invest in maternal and child nutrition, 1,000 Days also encourages support for the Scaling Up Nutrition (SUN) movement. The two organizations work in tandem at a U.S.-based hub formed in June 2011 by InterAction, a coalition of U.S.-based international relief and development organizations and the Global Alliance for Improved Nutrition (GAIN) in collaboration with the U.S Department of State.

1,000 Days founder, Hillary Clinton, appropriately asserted, “Improving nutrition for mothers and children is one of the most cost-effective and impactful tools we have for poverty alleviation and sustainable development.”

— Grace Flaherty

Sources: Daily Times NG, 1,000 Days
Photo: Care