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At 9 a.m., PJ, Luis and I crammed into a a dusty red pick-up truck. An hour and a half later, we arrived in Galte Yaguachi, an indigenous community swallowed by hills and clouds in the Chimborazo region where MEDLIFE Ecuador is expanding the community's one-room schoolhouse. Over 90 children receive their primary education here, from first through sixth grade. When we arrived, a crowd of small children in red wool ponchos were giggling and tumbling over one another, precariously balancing metal mugs of a nutritional, sweet, light gray-colored drink made of quinoa. But the community seemed emptier than usual. Apparently an indigenous festival drew many of the adults to another side of Guamote.
That's where Maria Antonia Yasaca Ortiz's husband, Carlos Puculpala Pucuha, was. She is a 27-year-old mother of three young children (above) who attend gradeschool in their community. Her family works in agriculture, like the majority of those living in Yaguachi. She spoke softly and tended to look at her feet when interviewed, but wrangled her children into a line for a photograph like an expert sheep herder. Maria spoke to us in the local language, Quichua, about how the school is terribly overcrowded. She said she would love to see all of the children be able to learn in the schoolhouse.
Manuel Yasaea Ortiz, 36, expressed similar concerns, though not for his own three children, who are teen-aged and attending school further away at the Unidad Educativa Nacion Puruhua. Manuel has three small cousins who attend school in Galte Yaguachi, and he worries for them, loudly and eloquently in Spanish. He said that the schooling opportunities there were seriously lacking, especially for any child who wants to enter into a profession outside of agriculture. Manuel excitedly talked about how grateful the community was for the new construction. In fact, he was so elated, he heartily volunteered to repeat exactly what he said in Spanish in Quichua as well, with the same enthusiasm and booming voice.
School construction in Galte Yaguachi is set to begin in about two weeks, on November 26th, 2012. The community has two months to complete the project, which will be a large, one room school situated next to a line of three new bathroom stalls also made possible by MEDLIFE Ecuador. Once built, the school will more than double the amount of space for students in the community.
Rachel Hoffman is a MEDLIFE year-long media intern working out of Riobamba, Ecuador
Savannah King, a MEDLIFE Summer 2012 Intern in Lima, Peru, writes about her recent work using preventitive nutrition education to combat some of the root causes of malnutrition:
Nutrition. A commonly used word. A commonly found problem. MEDLIFE has already written about it a few times, with good reason. According to UNICEF, of the twenty five regions of Peru, nine have a chronic malnutrition rate in children aged 0-5 of over 30 percent. Preventative and educational programs seem to be the leading campaigns for addressing the nutrition problems in areas like periurban and rural Peru and other South American countries, and many of these programs have seen measurable success.
Of the programs I have reviewed, education is always at the forefront of the battle against malnutrition, stunting and deficiencies. Rather than handing out bottles of supplements, the programs aim to make changes starting at the base: teaching a new mentality about food and providing lessons on basic health and diet knowledge.
For instance, one program stressed three main messages in the populations where they worked. The first message was that serving babies a thick puree at mealtimes will satisfy and nourish the child. The second suggestion was to add a small portion of liver, egg or fish to babies’ plates. These three food options are all inexpensive but bring large health benefits when added to a diet. It is not unreasonable budget-wise to suggest adding these items regularly into meals, and the extra protein and iron contribute largely to the children’s intake of nutrients. Lastly, the third message was umbrella advice about how to eat. The program urged the population to think about meals as a time to eat slowly, enjoy the food and spend time as a family. This simple change in mentality likely also encourages a more happy and positive household environment. Also utilizing tools like food preparation demonstrations and group educational sessions, this program saw a significant (⅔) decrease in the rate of stunting, increases in knowledge and preventative behavior and improved feeding practices and growth rates.
Another program focused specifically on pre-natal and newborn care by addressing not only nutrition, but hygiene and proper stimulation of newborns as well. After a four year implementation, the program saw measurable decreases in stunting, vitamin A and iron deficiencies and malnutrition.
Pre-natal nutrition education has both been proven effective by studies and specifically mentioned to me by local women as the type of education they see as most important to changing the health of their communities. During an interview with two women in Villa El Salvador about their families’ typical diets, the women informed me that pre-natal and newborn nutrition education in their community was significantly lacking. We discussed the young age of many mothers in their area and the vicious cycle of poor diets that is often the result. When a mother raises her children with poor eating habits, those children grow up lacking the understanding of what it means to eat balanced, healthy meals, thus increasing the likelihood that they will raise their children with poor dietary habits as well. The women were very insistent that nutrition education, especially for young mothers, would be a welcome and much needed help to their communities.
Along with other topics including the importance of cervical cancer screening and the risks factors of hypertension, infant nutrition has its own informational pamphlet that MEDLIFE hands out at sites during our weeks of Mobile Clinics. Recently, we went one step further and held a workshop on obesity, breast and cervical cancer and family nutrition. Carolyn, Maureen and I (three of MEDLIFE's Summer Interns in Lima) presented on the components of a balanced diet, suggested nutritional boosters to the daily diet and explained why each of the food groups is important to one’s body. We finished with a sampling of a fresh, colorful vegetable salad in the hopes of introducing all those present, including mostly mothers and a few children and men, to how tasty and economical a nutritious snack or side dish can be!
Nutrition is an issue not only in Peru, but all over the world. For the most part, though, it is not going unnoticed and, however slowly, non-profits and governments are addressing the problem through various programs and interventions. From the programs I’ve reviewed and the affected people with whom I’ve discussed the topic, it seems education -- starting at the pre-born stage -- is one of the most important battles that we can fight, and I believe that positive results are inevitable.
Villa El Salvador, one of the many districts in Lima, Peru where MEDLIFE operates, is characterized by a long history of diligence and self-sufficiency. The area was awarded the Price of Asturias Award for Concord in 1987 and was nomiated for a Nobel Peace Prize for excellence in social work and community growth in 1986. Even in the face of numerous challenges affecting all aspects of daily life, the people of Villa El Salvador have proven themselves to be stalwart and community minded.
MEDLIFE's relationship with the former shantytown over the past year and a half has grown significantly in the form of reoccuring Mobile Clinics, workshops and patient follow-up care.
This past May, MEDLIFE held another successful health workshop in the town's civic center with nearly 180 residents in attendance. MEDLIFE staff handed out pamphlets covering an array of health topics, including breast cancer, cervical cancer, diabetes, malnutrition, hypertension and cholosterol, fungal infections, and sexually transmitted diseases.
After discussing the risks of breast cancer, Dr. Jenifer Soto led an exercise in self breast examination which received enthusiastic participation from everyone -- even a small number of men. Dr. José Luis Rodriguez explained how to detect and treat malnutrition among children and senior citizens.
Workshops like these are a crucial component of our ever-expanding education program as we strive to teach patients about the importance of preventative care.
MEDLIFE Intern Amara Channell writes about a new facet of our educational programs -- health and nutritional workshops for the poor in Latin America:
“What can I do to make my child eat more?”
If you have ever attended one our Mobile Clinics, chances are you have heard at least one mother ask why her child is not eating and what medicine the doctors can give her to fix it. Each time the doctors patiently explain that picky eaters are not sick -- they just have a behavioral or taste issue.
Through our expanding educational programs, we have found that one of the biggest problems is that patients lack or misconstrue basic nutritional knowledge. Very few Peruvian schools offer health education, and even if they did, many of our patients have not completed school. The mothers we work with sincerely believe that the more they can make their children eat, the healthier they will be. Their goal is to have chubby children because to them it is a sign of health. Unfortunately, this means that these children are eating fattening diets, not balanced ones, with large amounts of white rice and potatoes, but not much else. Along the way they are developing greater risk of diabetes.
Although very few of our patients show signs of traditional malnutrition, Kwashiorkor or Marasmus, many of them do suffer from micronutrient deficiencies (or “hidden hunger”) which are harder to spot. Worldwide, over one billion children suffer from micronutrient deficiencies. Even though these children may seem perfectly healthy, they have depressed immune function, smaller attention spans, decreased muscle development, height stunting, and poor teeth. They are less likely to complete school because of increased illnesses and decreased brain development. As adults they continue to have issues because the lack of nutrients causes them to be more susceptible to obesity, illness, and muscle weakness. A recent Economist article states that these adults will end up with lower paying jobs, die sooner, and have poorer partners.
In the past few weeks, MEDLIFE has started trying to counter these problems with nutritional “talleres,” or seminars, for local Peruvian women. The seminars last about an hour and give women the absolute basics about nutrition as well as a chance to ask individual questions.
The presentations start by suggesting affordable changes that the women can make, such as eating eggs instead of bread for breakfast, and emphasizing how important variety is. There is an incredible abundance of affordable fruits and vegetables here, but it is not a cultural norm to include them in most meals. By adapting the new MyPlate program (developed by USDA), we can show them a healthy and balanced way to think about preparing their plates.
Last week the President of Ecuador, Rafael Correa, announced that the country will eradicate malnutrition within the next four years. The government will focus on pregnant and breastfeeding women, as well as young children. The pledge is a response to the fact that Ecuador has the fourth highest rate of malnutrition in Latin America, hovering around 19 percent of the country's population. Yet, according to UNICEF, the Chimborazo region of Ecuador -- where MEDLIFE conducts most of its Mobile Clinics and patient follow-up work -- has an even higher malnutrition rate of 44 percent. The Chimborazo region is home to many poor, rural communities, as well as indigenous groups.
“Aliméntate, Ecuador" is a new program that provides pregnant women and mothers of infants with a small stipend to get regular checkups. The program also helps teach mothers about exclusive breastfeeding (when an infant only receives breast milk without any additional food or drink) as well as complementary foods (when additional foods are introduced into a child's diet). According to the program's website, "Aliméntate" has already been successful in reducing rates of anemia by 12 percent during the past year in the community of Manta.
On a cold and misty Thursday afternoon, after an exhausting day of stair-building during our engineering brigade, I headed down the muddy slopes of Pamplona Alta alongside a few other MEDLIFE staff members towards a surprisingly clean green building, just a few minutes from our work site.
This was one of the nearly half-dozen Wawa Wasi centers in Pamplona Alta – low cost daycare programs where children under four years of age from low-income families can spend the day while their mothers are studying or working outside the home. Wawa wasi is a Quechua phrase meaning "home for infants." The program was founded in 1993 as a collaborative effort between the Peruvian government and UNICEF to alleviate the dire needs of the increasing number of families living in poverty. For a nominal cost, children are provided with two full meals a day and are instructed in a number of subjects such as basic hygiene and early education.
We were visiting this particular Wawa Wasi in the community of Mirador Dos to give a presentation to local mothers on basic hygiene and prevention of parasites. Stomach and intestinal parasites are rampant in Pamplona Alta due to exposure to contaminated water, food, and even the dirt in which children frequently play. Although we had expected to have somewhat of a larger audience, we were pleased with the ten or so parents who turned up. I began by asking the mothers how many of their kids had ever had diarrhea (although children worldwide frequently get diarrhea, it is a common cause of death in developing countries). Seeing an overwhelming number of hands go up, I clarified some of the common causes of diarrhea in developing countries, such as ingesting contaminated food and water. We then covered several essential points concerning hygiene, such as hand-washing and how to prevent transmission of contagious diseases.
This week, the Save the Children Federation (SCF) – an international organization that enforces children’s rights in developing countries – released a report on so-called ‘healthcare deserts.’ The term is akin to others used in the development world to describe areas devoid of resources (e.g ‘food desert’); SCF defines a ‘healthcare desert’ as an area where a child “has not received any of the six routine immunizations, including diphtheria, whooping cough and tetanus, or received medical treatment or advice for diarrhea.”
According to the report, at least 40 million children live in such healthcare deserts, lacking access to health care workers and medications for easily preventable (but often fatal) diseases such as diarrhea, pneumonia and malaria. SCF's study focused on 25 countries throughout Asia and Africa, naming India as the country with the most children in need. Yet, curiously, India’s economy has grown in recent years. What’s more, the child mortality rate has decreased globally. We look, on paper, like we are generally on target to meet the Millennium Development Goal of reducing -- by two thirds -- the under-five mortality rate.