TWN Info Service on Health Issues (November 06/3)

6 November 2006

Guatemala: Devoured by malnutrition

The following article reports on malnutrition in Guatemala, which has the worst malnutrition problem in Latin America and is most acute among the indigenous population. The causes of this situation are many.

This news is reproduced with permission from South-North Development Monitor (SUNS) # 6125, 23 October 2006. 

With best wishes
Evelyne Hong

Guatemala: Devoured by malnutrition

By Alberto Mendoza, IPS, Guatemala, 19 October 2006

The ambulance pulls off the road, just where a steep rocky track leads up to the remote Guatemalan village of Shumpa. The health professionals' mission is to save the life of a malnourished two-year-old girl.

Celi Aldana is just one of many. Fully half of Guatemalan children under the age of five suffer from chronic malnutrition, which endangers their physical and mental growth and thus compromises the future of this country, which has the worst nutrition indicators in Latin America even though it is not the poorest country in the region.

The ambulance, which was donated by Japan, has driven out from the town of Camotan, where the majority of the population belongs to the Chorti indigenous community, in the eastern province of Chiquimula.

Maria Santos, a village resident who has been trained as an outreach worker by the National Women's Office in Camotan, gets out of the ambulance and heads towards the last house in the village, located at the top of the hill. She knows that Celi, one of the 11 children of 42-year-old Cornelia Gutierrez, has been showing signs of malnutrition.

A lethargic Celi and her three-year-old brother Bibiano, who is covered in mud, are outside. Their seven-year-old sister Elisa is watching over them. Two cows, several hens and a pig with her piglets, which are being raised for market, mingle with the children and a few skinny dogs in the yard.

Inside the adobe house, which has no electricity, Cornelia is taking care of her 11th child, just nine days old.

Cornelia, worried about Celi, says that this is the first time that one of her children has been in this condition. "She's been sick for three months. But the last time I went to the health clinic in Camotan, the doctor only said that we had a lot of kids, which is why they're undernourished."

Santos explains to the mother that the ambulance is waiting, and urges her to allow Celi to be taken to the nutritional recuperation centre in Jocotan, a town near Camotan. But Cornelia says that she needs to get permission from her husband, who is out harvesting corn.

After waiting for the husband until 5.00 pm, Santos has to go home to take care of her six children, but promises to return the following morning.

The ambulance heads back to Camotan, and returns the next day. However, Celi's father refuses permission to take her to the health centre.

Unfortunately, this is not atypical, says Juan Manuel Mejia, the only doctor at the Health Ministry's nutritional recuperation centre in Jocotan. He explains to IPS that the majority of the mothers are unable to leave their homes, their husbands and the rest of their children to accompany a sick child to the health centre.

Furthermore, the prevailing 'machismo' or male chauvinism does not allow women to make their own decisions, as was seen in Cornelia's case.

Mejia says machismo is clearly visible at mealtimes: "First, the father, who has come home tired from work, is served, and then the boys, and finally the girls and the mother eat."

Nevertheless, the state-run centre is not empty. By August it had treated 159 cases of acute malnutrition, which indicates that this year's total will surpass last year's 197 admissions.

And in the Belen children's hospital run by the parish church in Jocotan, 214 cases of acute malnutrition were treated last year, although three of the patients died, staff there told IPS.

The malnutrition in Chiquimula made international headlines in 2002, when serious food shortages aggravated a problem that already existed. In villages near Camotan and Jocotan, up to 25% of children were found to be malnourished.

The causes were various. As world coffee prices plummeted to historic lows, Guatemalan exports fell in 2001. That, combined with drought, the poor quality of soils and the already fragile peasant farmer economy, brought famine.

The severe drought that hit eastern Guatemala and the drop in coffee production led to the loss of nearly 190,000 jobs between 2000 and 2001, reported ANACAFE, Guatemala's National Coffee Association. Wages also took a nosedive.

From 2000 to 2001, coffee prices plunged from $90.60 per quintal to $56.80, and revenues from coffee exports - the country's main export commodity - in 2001 were 46.7% below the 2000 total.

The crisis accentuated the problem of malnutrition. The United Nations Development Programme's (UNDP) Human Development Index reports that 49% of Guatemalan children below the age of five are under-height for their age. And according to the UN Food and Agriculture Organisation (FAO), 22% of the population is undernourished.

The problem is at its most acute among indigenous people. Just under 70% of indigenous children are malnourished.

In Guatemala, indigenous people officially make up 40% of the population. However, non-governmental organisations like Refugees International put the proportion closer to 65%. The rest of the population is mainly of mixed-race (indigenous and European) heritage, with a small minority of European descent.

The United Nations children's agency, UNICEF, reports that Guatemala has the worst malnutrition problem in Latin America, even higher than the 35.2% average in Africa.

According to official statistics, 56% of the Guatemalan population of 13 million lives in poverty. But non-governmental organisations estimate that up to 80% of the population is poor.

UNICEF representative in Guatemala Manuel Manrique said the effects of malnutrition on child development are like "a life sentence," because it "compromises their health, their ability to learn, and their growth."

Referring to the causes of this situation, Manrique noted that more than 60% of families in Guatemala cannot afford an adequate diet, people living in rural areas have limited access to health services, clean water and sanitation, and parents in these areas have little-to-no formal schooling.

Malnutrition is also a result of "structural factors, such as limited social spending, extreme poverty and social marginalisation," he added.

Manrique said that some successful projects, such as the fortification of domestically-produced sugar with vitamin A, are currently threatened by the Central American free trade agreement signed with the United States, which will allow the entry of cheap non-fortified sugar from abroad.

However, in the last year, the government of the conservative Great National Alliance has begun to incorporate the problem of malnutrition in its public policy agenda.

The Secretariat of Food and Nutritional Security (SESAN) was created in 2005 to plan strategies to improve nutrition and coordinate actions among public institutions, non-governmental organisations and international donors.

Andres Botran, the head of SESAN, told IPS that malnutrition is "a challenge for the state" and that "in order for public policies to be successful, society must be involved."

To that end, the National Food and Nutritional Security Council was created, which includes seven representatives of civil society.

In July, SESAN presented a Programme for the Reduction of Chronic Malnutrition, which covers 41 municipalities, and focuses on questions of health and reproductive health education. Botran projects that the programme will cut malnutrition levels in half within the next 15 years.

A free fortified complementary food named Vitacereal is also currently distributed to more than 40,000 babies and toddlers between the ages of six and 36 months, and to 13,000 pregnant women and nursing mothers.

But Manrique said that to significantly reduce the rate of chronic malnutrition, these programmes should reach more than 170 municipalities and over one million children, for which more funds would be needed.