When dealing with vulnerable individuals, having a singular approach is often not that successful. Whilst one program intervention may work for one child, others will need a different approach or many different approaches in order to work. 

This was the case for Joseph. Joseph has been a patient at TTF for over 5  years - he came to the clinic when he was only 12 years old.  Joseph has always been a skinny kid but during 2015 was diagnosed with having TB and lost quite a lot of weight to only 32kgs. So when the opportunity to include him in our nutritional support program came up he was one of the first individuals who was suggested. Starting the nutrition program in February Joseph weighed 39kgs and measured as significantly malnourished. We initially saw slow but steady gains in weight but then he would get sick and drop weight again. Progress wasn't as quick as we had planned. 

We began to wonder what was happening and therefore went to his home to understand his living situation. When he had enrolled in the program Joseph's care giver had told us that there were 8 people in the home but when we got to the house it appeared there were 17 individuals living there. With only the Grandmother providing an income through selling vegetables on the road side it was clear that one of the reasons Joseph wasn't gaining any weight is because the food was being shared to thinly and not being of benefit to Joseph. 

Families in Zambia share everything so requesting that food only go to Joseph would have been very difficult. Instead we want to ensure that we can support him in a controlled environment, through hospice or out of home nutritional support. 

This is where we need your help. Joseph needs nutritional support outside of the home. We need to pay for a placement for Joseph and other children like him, where individuals are so malnourished they need food packages  dedicated just to them, to bring their weight up pas the 1st percentile on the BMI index. We have found that individuals who start off malnourished than others gain weight much quicker. Therefore once their initial weight is boosted gaining more weight should be quicker and bringing them out of the danger area in terms of health risks. 

Pledge to donate to our Crowd funding campaign and help us to bring about significant change for vulnerable children like Joseph. 
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By Jac Connell, Acting Country Director, Tiny Tim & Friends: 
A few weeks ago one of the social work team came to my office with a small child, Rachel (aged 2), who had been identified at the Clinic that day as HIV+ and at risk of TB. Weighing only 7.1kgs (15lbs), our counselor, Mwenda, was concerned about malnutrition and wanted to include Rachel on the list of patients who would benefit from our crowd funding campaign, should we be successful. 

She was incredibly tiny and I could tell from holding her that she had breathing problems and a persistent cough, a symptom we see often at the clinic and a primary indicator of TB. 

As with all of the patients we are considering supporting with nutrition the team usually sit with the family or undertake a home visit to assess what the household is like, how many people the individual lives with and what the income for the household is. 

As soon as we asked Elina, Rachel's mother, about food for the family she broke down in tears. She admitted that there was no food at home, as her husband was bedridden with TB and therefore had lost his job. They were totally reliant on her mother in law to provide food and often would survive on only one meal a day. 

Sadly, their story isn't particularly unique to us. They live in a two room house, sharing a pit latrine with their neighbors (17 people in total). Elina had never been to school as a child because her family couldn't afford it and therefore had never been able to get a job herself. Rachel's father is unable to work so they pay their rentals (approx $30 per month) through support from other family members.

Rachel has an older sister, who is 7 and in good health, but who has had to stop going to school after they could no longer pay the school fees. 

Rachel has been diagnosed with TB, but without food, both her and her father will struggle to take their medicine, recover and risk passing the disease to her mother. Having only recently started on HIV treatment, Rachel is in a vulnerable situation. Being underweight puts her at risk of picking up any number of illnesses which could prove to be fatal. 

We need all of our donors and supporters around the world to come together to support children like Rachel through our crowd funding campaign - by donating you will change a child's life: 

 Sadly, sometimes patients come to TTF and from their appearance you immediately you know there is a major health problem. This was the case for 19 year old Panji when he was brought to the TTF Clinic earlier this year. Panji is 1.73m (5ft 8) and weighs only 42Kgs (92lbs). He is significantly malnourished and currently undergoing tests to see if he is suffering from Tuberculosis. 

His malnutrition, alongside HIV and suspected TB puts his health at significant risk, and without boosting his immune system just a small infection could prove fatal. 

Panji's parents died when he was just a child and he now lives in a one room house with 6 other people (his sister (pictured below), brother in law, and four nieces and nephews),  sharing a pit latrine with 20 other people. Whilst food in the home is provided by Panji's brother in law, there isn't enough to support Panji in his current state and he is in desperate need of nutritional support. He needs your help to ensure he can go on to finish his education and lead a healthy, successful life. 

Panji, was identified in the community by one of our teen mentors. He had previously been tested for HIV but wasn't yet ready to accept his status. Our staff have been working closely with him to provide him with medical advice and emotional counselling to prepare him to start on medication. But because of his late access to treatment he is incredibly sick and because of his poor health, he has been unable to attend school for the past 6 months. He desperately wants to complete his education so he can make something of his life and help others. 

With the right medical, social and nutritional support Panji can go onto lead a healthy life, but we need your donations to support him and 49 other children and adolescents like him to reach our crowdfunding goal. So please consider pledging today and changing Panjis life around for the better!
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Esther is a single mother to three small children, living in one of the most urbanely dense compounds in Lusaka. Having not finished school, her employment prospects are limited. She came to our attention when her youngest child, 3 year old Samson, was brought into the clinic suffering with various health issues, he was incredibly underweight for his age. Without a job or a source of income Esther was struggling to feed her children this is her story: 

Last week we successfully graduated 8 children out of our nutrition programme after just 3 months. All 8 of these children had gained such a great amount of weight and grown in height that they are now well within the healthy weight range on the BMI index.

Through our nutrition programme, not only have we been able to support these vulnerable children to gain weight and become healthy, but we have also provided their families and caregivers with nutritional support and education needed to ensure that can help their children to have a well balanced diet. The weekly food packages have also allowed families to make small savings in their weekly outgoings to support several of them in investing into their small businesses or paying for school fees. 

Thanks to the support of 34 donors who funded our CARINGCROWD CrowdFunding programe at the end of last year. Please stay posted for individual stories on each of these children. 

For more information about our nutrition programme and how you can get involved in us helping even more malnourished, vulnerable children to get healthy and get the education they need check out our programme page: Nutrition programme. 

As Tiny Tim & Friends grows in terms of patients, and the number activities we undertake to provide additional layers of support to those patients, we must also grow our support networks around the world. In Lusaka our community volunteers provide an essential part of our work in: helping us access individuals who would have been previously unknown to us; in allowing us to provide home based support to our patients across Lusaka; and in ensuring we can provide follow ups to everyone we test as HIV+ in order to ensure they are getting the right medical care and treatment they need to lead a healthy life.
 
We specifically work with HIV+ women in the community to help support our work and to provide HIV awareness and sensitisation. Their personal insight into living with HIV and their understanding of the issues the communities are facing enables us to have a much greater impact on the lives of the children, adolescents and pregnant women we work everyday to support.
 
One of our community volunteers is Margaret, 45, who after her diagnosis of being HIV+ decided she wanted to help others: 

 We want to share with you the story of just one of the children, whose life has been changed thanks to everyone who donated, through CARINGCROWD, to our Nutrition programme. Gladys is 6 years old and was brought to the Tiny Tim & Friends Clinic last year by her grandmother who was concerned with a persistent cough and considerable weight loss. Upon testing it was discovered she was HIV+. Gladys weighed just 12kgs (26lbs) putting her below the 1st percentile on the BMI index and classifying her as considerably underweight.

Thanks to the donations of 34 people through CARINGCROWD, we were able to enroll Gladys into our Nutrition programme. After only one month on the programme Gladys had gained 4kgs (almost 9lbs) and now is considered as a very healthy weight (at the 78th percentile on the BMI index).

We spoke to her Grandmother, Janet, about the impact the food support and nutritional advice is having for her family: 

"I have cared for Gladys for most of her life, as both of her parents have died. I own the family home but we live there with 15 other family members, selling vegetables to make money for food - usually making about 300 kwacha a week to feed the entire family (less than $30). 

I took Gladys to the TTF clinic as I was worried about her weight and after speaking to a woman in the community thought she may be HIV+. The food we have been getting from TTF helps so much. Before we could only feed Gladys at breakfast and in the evening and now she has 3 meals a day and snacks. The food is also helping with her taking her medication which was previously making her sick when she took it without eating. 

We have always tried to make her go to school but since she has become sicker she was missing more and more. Now she has gained weight and is managing on her medication better so is going back to school. 

The nutritional talks are also helping me in thinking about how to care for Gladys and prepare her meals - I have also been sharing this with my daughters and supporting my other grandchildren with this knowledge. 

I am too thankful to this support and I try and encourage the younger mothers in the programme to think about how they are using the food to help their children gain weight and become more healthy like Gladys."

Gladys is just one of the children we are seeing significant changes in due to the nutritional support and education their families are receiving. Without your donations this would not have been possible. So thank you and please watch out for more updates on the children you are helping.
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