(Water Source for Primeros Pasos)
According to the World Food Program (WFP), over 70% of people in Guatemala live in poverty. The country has the 4th highest rate of malnutrition in the world, and the highest rate of malnutrition in Latin America. The WFP says that 49.3% of children in Guatemala are undernourished. Most of these children live in the rural areas, and most are of indigenous descent. I can definitely vouch for having seen something of a geographically-based health disparity here. From what I have seen personally, and heard casually, there is little malnutrition in the city of Quetzaltenango (Xela) because of several outreach programs, and relatively clean and accessible water and sewage.
The United States once went through a period of time having malnourished children and adults as well. In 1946 the school lunch program was started to prevent and treat childhood malnutrition, after it was discovered that many young men were ineligible for combat when drafted in World War II. As a result, several measures have been put into place, and have virtually eliminated the issues of under-nutrition in the US. These days, aside from a few rare cases, most of the malnutrition we see in the US is actually obesity, and that’s a story for another day.
The area where Cody and I are working is only a few miles outside of the city, but those few miles make a huge difference. Those few miles mean that not all people have water in their homes; they have to collect it from a communal water supply. Some of our patients use latrines as bathrooms, since they have no indoor plumbing. The lack of clean water and adequate sewage systems is correlated with the presence of gastrointestinal infections, which can be not only uncomfortable, but even lethal. All of these factors contribute to the high levels of malnutrition, as well as sheer lack of food and nutrients, and the lack of consistent quality medical care.
One of the things I am working on at the clinic is the development of protocol for treating and screening for malnutrition. In a place where primary care falls by the wayside, because of lack of awareness and lack of financial resources, children do not get check-ups, and they often only go to the doctor when severely ill. That is not to say that we don’t deal with our fair share of coughs and colds, but people are definitely not seeking care often.
Severely malnourished children are given aggressive treatment in the hospital, or through some outpatient support programs. However, most of the children we see at the clinic are mildly or moderately malnourished. Despite the less severe name, these conditions are still quite problematic. They may not receive much attention here, but even a mild level of malnutrition would warrant a comprehensive medical work-up in the United States. These children easily fall through the cracks here because of the attitude of treating serious but not mild illnesses. The local doctors agree that it is sad, but their attention is often more desperately needed elsewhere, so these children are not treated aggressively. As a result, we see kids with growth stunting every day, and numerous other effects of malnutrition.
I have been working with the clinic on enhancing the screening process, and using every patient encounter as an opportunity for diagnosing and treating malnutrition. The hope is, that with this protocol, there will be a straightforward and regulated way to address these problems in each visit. This way, primary care can be given to a child, even though she is only coming in for an acute sick visit.
I am currently in the process of working with the clinic and the board to figure out exactly how to implement and fund the protocol. Hopefully this will help us see the levels of mild and moderate malnutrition decline in the near future for this community. It is my hope that with the implementation of such programs, we will be able to eliminate malnutrition in Guatemala, and in other parts of the world, just as we have done in the United States.