"Rewriting the Myths, Redefining the Realities"
by Margi Ness
As in most countries, the disenfranchised are primarily the poor elderly, single mothers with children, and people with disabilities. When the going gets tough, these people get left behind. When a government deteriorates, the people are not just left behind, they are stomped on and promptly forgotten.
Nearly every day on my recent two-month visit to Ecuador, I had a hearty almuerzo (lunch with a set menu and price) for 60 cents. While the price was right for me, it was far out of reach for the majority of the population. I felt guilty grumbling about the cheap, but tasteless, almuerzos. Typically, the almuerzo, most of which was unidentifiable, consisted of a soup with rice or potatoes, an entrée that included rice and potatoes, a green vegetable, and a lettuce and tomato salad that gringos shouldn’t eat. It also included a water-based juice, also off limits to most gringos; and often a piece of fruit for dessert. The similarity of the menu and the taste got old, but nutritionally the meal seemed sound. I alleviated some of my guilt by putting my left-overs in a bag (not the neat doggie bags we have, but a bag in which everything gets mixed together) to give to the grateful street people waiting outside the restaurants. I knew my meager offering really wasn’t doing anything to alleviate the children’s distended bellies, and I wondered if any kind of assistance was available for them.
A week into my journey, I met Laurel Zaks at an unofficial “get-away” apartment for Peace Corps Volunteers. Over a few beers, I learned of her work at the Centro de Recuperacion Nutricional, a feeding center for malnourished children. She learned of my interest in the field and of my desire to find out about services for people with disabilities. As luck would have it, the Catholic Dioceses of Germany and New Zealand and Gurgrunethal, a chemical company based in Germany, fund both the feeding center where Laurel works and a new center for people with disabilities. Though the Ecuadorian government provided no assistance, one town provided some help. I was invited to visit both programs.
A few weeks later, I hopped a bus to Santa Domingo de Los Colorados, a poor community in the sierra, the highlands of the Andes Mountains. A dilapidated building houses the feeding center. Laurel, a nutritionist with a Master of Arts in Public Health, was in her element. Unlike many other Peace Corps Volunteers who were having trouble finding or developing meaningful projects in the chaos of the country, Laurel knew exactly what she was doing. She was saving children’s lives. Laurel explained the Centro’s program as we walked through the facility.
Our first stop was the playroom, packed with 15 kids, five moms, two assistants, and an assortment of toys. “Only five of these kids are officially in the program. We take malnourished children under five years old,” Laurel explained. “A mom or dad is required to participate. So far, it’s always been the mom. When the moms come, their other children often must come too. The mothers learn nutrition and hygiene, and must help with the cleaning and play program.” I was struck by how young many of the mothers were. “Yes,” Laurel continued, nodding toward a young girl. “That mother is a child herself. She’s 13, but she has the mental ability of an eight-year-old. She was raped. She’s luckier than some. Her parents are allowing her to remain at home, which is more than most families in similar circumstances. Her parents aren’t helping with expenses or childcare, but at least she and her
baby have a roof over their heads.” Laurel paused and went on. “That woman over there is 19. She already has four kids and she’s pregnant again. We try to teach family planning, but people can’t afford pills or shots so it doesn’t do much good.”
I learned that the major forms of malnutrition are marasmus, kwashiorkor, and marasmatic kwashiorkor (easy for her to say!). Marasmus is primarily a deficiency of energy-providing foods. It is a chronic condition of semi-starvation, to which a child can adjust to some extent by reduced growth. In advanced stages, it is characterized by muscular wasting and absence of subcutaneous fat. It is found in children of all ages and often results from failure of breastfeeding and the use of over diluted formula. It is associated increasingly with the food shortages that typically occur with wars, droughts, and extreme poverty. It may also occur in the elderly. At the Centro, a typical presentation of marasmus was a 25 month old child I observed who had the development of a 13-month-old. Her belly was distended, like many of the children begging on the street, either from parasites or because her muscles were not developed enough to hold her stomach. Her small buttocks and extremely thin limbs were typical of the condition. Loving, but uneducated, parents may point to their child’s big belly with pride, not realizing that what they think symbolizes the health of their child is actually showing the child’s slow starvation. The parents know their children are eating, but they don’t understand that the food they are giving their children doesn’t have enough calories for their child to thrive.
Mothers generally don’t breast feed because they don’t want to, don’t know how to, don’t have enough milk, or they have breast infections. “Because there is no birth spacing, moms are often pregnant while they should still be nursing. Add to this the poor nutrition of the mother, and breast feeding becomes nearly impossible,“ Laurel explained. “The moms turn to formula feeding which is not only over diluted, it is diluted with bad water. We give demonstrations at the Centro on how to make soy milk because it is cheaper and more nutritious.”
Kwashiorkor, the more serious form of malnutrition, is characterized by extreme protein deficiency. It appears among infants and young children in the late breastfeeding, weaning, and post-weaning phases, usually between the ages of one and four years. Subcutaneous fat is usually preserved, but muscle wasting is often masked by edema. Children are swollen, their hair is sparse, and they have bands of blonde or orange hair in their normally black hair.
Marasmic kwashiorkor combines the symptoms of both deficiency states. The loss of subcutaneous fat becomes very apparent when edema is reduced in the early stages of treatment.
Most of the kids at the Centro come in weighing 37 percent of their healthy weight. The Centro provides three high caloric, high protein meals and two snacks a day. The Centro is open Monday through Friday and the malnourished children spend the night. If the mother lives a long distance from the Centro, they, and their older children, are invited to spend the night in the one big, shared bedroom. Getting the children to their normal weight is a long process because the kids go home every weekend and have little or no food and bad water once again.
The general population believes that if a person has a physical disability, they can’t think, so no attention is paid to them. Despite this ignorance, a few children with disabilities have been brought to the Centro. The Centro has no special accommodations for them and the staff has no specific training, though good food and medical care are provided. According to Laurel, there are a disproportionate number of children with Down syndrome. These children have a particularly difficult time thriving. One two year old with Down’s syndrome, brought to the Centro too late, died a few weeks before my visit, weighing only seven pounds.
While the staff does the best they can, the facility is too small and seriously lacking in many areas. There is no hot water. There is only one bedroom for all the mothers and their children. While fathers rarely come to the Centro, for those who might, there is no place to sleep. The list of needs goes on.
However, a light shines at the end of the tunnel. A new center was being planned, funded mainly through the German company Gurgrunethal, that was to be completed this past spring. The new center will serve 150-180 people. It will have a consultation area (clinic) for pediatrics, dental work, lab work, psychology, social work, nutrition and a place for a midwife. It will have 21 adult beds with an expectation that two to three children, in addition to the malnourished child, will accompany each mother. Although fathers rarely come, the new facility will have a separate room to accommodate fathers wishing to stay. As this article is written, it is unknown if the new center has been completed. Totally dependent on funding outside the country, hang-ups are inevitable, and unfortunately, it always takes longer than expected.
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Copyright 2002 A&H Publishing Corporation