My two-month Masters of Public Health practicum placement with Primeros Pasos in Quetzaltenango, Guatemala started off on a dramatic and tragic note. Upon exiting Guatemala City’s La Aurora Airport, I immediately noticed an odd-textured rain falling down on me while I waited for a taxi to transport me to one of the city’s many bus terminals. Also noticeable was an intense smoky smell and texture of the air, which I at first attributed to air pollution. Once I arrived at the bus terminal, the bus driver urgently shepherded everyone waiting around onto the bus, informing us that the nearby volcano named “Fuego”, Spanish for “fire”, had had a major eruption. In order for the bus to get to its final destination of Quetzaltenango, it was necessary to first drive towards the volcano before passing it for higher ground in the Guatemalan highlands. Traffic, sirens, and noticeably thick and discolored air were a constant until we had traveled for about two hours north. It was at this point that my fellow passengers and I overcame our initial panic enough to realize that we all had what we now knew was volcanic ash coating our hair and clothes. After the strange “rain” had settled and dried, it had a sand-like consistency and a dark-black appearance. 

As most are now aware, the Volcán de Fuego (the most active volcano in Central America) on Sunday June 3rd, 2018 had its most violent eruption in decades, with over 100 people confirmed dead, thousands displaced, and hundreds still missing. Smaller eruptions have continued through the time of writing (06/21/2018). Additionally, on Sunday June 17th, a 5.6 magnitude earthquake struck the same region most affected by the eruption. Though Quetzaltenango (referred to by its nickname, “Xela”, from here forward) is about four hours northwest of the volcano, there was a palpable sadness felt throughout the city. As early as Monday, however, local students and organizations in Xela could be seen set up throughout the city with donation boxes and information about agencies directly involved in continued rescue and recovery operations. 

With keeping the people directly impacted in my heart and on my mind, I got to work on Tuesday, June 5that the Primeros Pasos community clinic located just outside of Xela. My first day was filled with orientation to the day-to-day operations of the clinic, which serves the majority rural population of Guatemala’s Palajunoj Valley. The main ailments seen here are chronic malnutrition, respiratory infections, skin diseases, and gastrointestinal parasites. The clinic also offers dental care. 

Over the past week, I’ve developed surveys investigating current trends in family planning, breastfeeding, diabetes management, and hygienic practices as well as dietary diversity amongst the mothers of children enrolled in the Nutrition Recuperation Program. After translation and revision, I created REDCap versions of the tools which are now ready to be administered at the Nutrition Recuperation Program meetings beginning next week.

In addition to programmatic work, I’ve also made a couple of visits to the communities which Primeros Pasos serves. During the first community visit of each month, children are weighed and measured. Back at the clinic, the nutrition team inputs the data for each child into the WHO Anthro software, which produces z-scores that indicate whether the child is overweight, normal, underweight, or stunted for their age and/or height. For children who register scores that fall in any area other than “normal”, the clinic’s nutrition outreach coordinator addresses letters to the children’s mothers to invite them to attend nutrition recuperation meetings. Additionally, children with z-scores falling within the “severely malnourished” range are set up to receive nutritional supplements from the Guatemalan government.

Moving forward, I will be engaged with redesigning Primeros Pasos’ education program. Earlier this week, I was lucky enough to be able to visit a community school and give brief nutrition lessons to the school’s kindergarten and first grade students. Meeting the kids for whom I will be creating curriculum for was informative, inspirational, and last but not least, incredibly enjoyable! 

Ready to talk to kindergarten and first-grade students about nutrition! 

See you in a couple of weeks,


One morning, we were lucky enough to catch a ride in a “camioneta” (pickup truck) to the rural community where we were working for the day. 

A typical (delicious!) Guatemalan breakfast.

Nutrition team meeting with Monica, Primeros Pasos’ Nutrition Outreach Coordinator. 

One of Primeros Pasos’ “pets”, Frijol, posing outside of the clinic. 

Beautiful vista from one of the rural communities, La Candelaria.