Decreasing Malnourishment Rates in the Highlands of Southwestern Guatemala

Recently the Global Health Portal spoke to Maya Krasnow (Psychology/Global Health Studies, WCAS 2015), who spent her summer introducing a tablet app to help health promoters decrease malnutrition in children in a small village in the highlands of southwestern Guatemala.

Tell us about your project.  What inspired your work?

IMG_6335Guatemala suffers the sixth-worst malnutrition in the world. Half the children under age five are chronically undernourished, and up to 90% of children in some rural areas. In San Lucas Toliman, a small community in the highlands of southwestern Guatemala, the Health Promoter program has begun to take action against this devastating problem. Part of their work involves monitoring children under age five for signs of malnutrition. The hope is that if growth impairment is caught early, health promoters can more effectively intervene by providing nutritional supplements and education to the parents. While this program is a great asset to the San Lucas region and has improved nutritional health among children, we believe the use of mobile technology could further enhance the Health Promoter program. The Global Health Research Foundation has developed an application for handheld tablet computers to systematize and expedite the work of the health promoters. Currently, the health promoters keep paper records for each of their patients (1380 children and counting are enrolled in the program). One feature of the application is that it digitizes the patients’ information, making it accessible and easier to identify children that are becoming more severely malnourished. My role, along with several other students, was to introduce the new technology to the health promoters, have them test it in the field with their patients, and get their feedback to see how it can best be used to enhance their already impressive program.

How did your experience on the ground vary from your expectations?

IMG_6119My experiences greatly surpassed my expectations. The student interns I worked with brought varied skill sets, viewpoints and experiences to create a cohesive, diverse and effective team. We were devastated to part ways after being together 24 hours a day for nearly four weeks, but have already started planning return trips to Guatemala. More importantly, the health promoters responded enthusiastically to the new technology, validating our hope that the tablet application will provide important benefits to their work and the health of the community. On a personal level, I particularly enjoyed the friendly and welcoming Guatemalan people. The interactions with strangers in the small pueblo of San Lucas were a striking contrast to my experiences at home. I will miss greeting everyone I pass on the street with ¡Buenas!, random conversations with the souvenir store owner Jorge, the middle aged town gossip Marta befriending us and inviting us into her home after realizing we were with Dr. Pablo, and the little boy who came over to join us in a game of cards and talk about his obsession with Real Madrid F.C. (he was outfitted completely in his favorite team’s apparel, socks and all).

What was your most meaningful experience abroad, and what did it teach you?

IMG_6322This experience allowed me to work closely with Community Health Workers and to rapidly pierce so many cultural barriers to experience firsthand the strength, courage, dedication and complete selflessness of these men and women. As volunteers, they donate their time while sacrificing income and, in many cases, the care of their own young children, to care for the sick children of others for many hours each day. But the health workers continue to serve their community because they believe in the importance and necessity of their work. By listening to their stories, sharing laughs (mainly over my all-too-frequent grammatical errors), and getting a snapshot into their daily lives, I quickly became immersed in their rich and vibrant culture and developed lifelong friendships. There was Cesia, a charismatic and intelligent mother of two who worked with us everyday, and who I grew to look up to as an older sister. She provided invaluable insight to the project and taught me everything I know about the promoter program and Guatemala’s healthcare system. Then there was Magali, whose strength and dedication to the promoter program is pure inspiration. Magali was married 35 years to the love of her life. As we walked to her modest home one rainy afternoon, she recounted all of the good times they had spent together raising their five children. Before she unlatched the door she stopped to tell us about the devastating morning she woke up to find her husband lying next to her, dead of a heart attack. For weeks she couldn’t bear to get out of bed, but just two months after this horrific tragedy, Magali was back to work. The sick children needed her.

IMG_6299What was your most challenging moment, and how did you cope?

As successful as the trip was, it was impossible to look past the extreme suffering of the people of San Lucas. They live on less than $1000 a year and die of diseases of poverty such as malaria, diarrhea, and tuberculosis; diseases that are completely preventable with access to quality healthcare. They deal with hardships unimaginable to most: loss of loved ones, finding a tortilla or piece of fruit to tide them over for the day, obtaining enough money to send their children to school. Everyday I was surrounded by people facing extreme adversity. I heard their stories and felt their pain, but I also saw their strength and courage. Nonetheless, it took an emotional toll to witness the magnitude of the problem and to feel powerless to change it. One example of this is a small old woman named Maria. Her entire family had perished in Guatemala’s 36-year civil war and she was found lying in the woods with her throat slit and on the brink of death. Now she struggles to survive, barely able to speak because of the war injury, living just with a stray puppy and with no source of income or food for either of them. The Parish allows her to come during mealtimes, so every night she hobbles over with a plastic container to collect her dinner, remarkably always with a smile on her face. At first, it was unbearable to see Maria everyday because I was reminded of her painful past. But this is only one example of the numerous hardships that stem from poverty. The reality is that many of the people have suffered similar plights so I had to just do my small part: ask Maria how her day was, help her fill her container with food, invite her to sit down next to me and make her feel welcome – just be her friend.  I saw up close for the first time true suffering in the world and learned we can’t stop it all.  But if each of us does everything in our power to alleviate suffering, there is hope that lives such as Maria’s can be bettered in some way.

IMG_1475Did you encounter any cultural differences that required getting used to?

I ended up loving the Guatemalan culture. It is entirely community and family oriented, with extended families (usually between 10-15 people) living together under one roof. I lived in a home with three families consisting of three generations, and I‘ve never met a more fun-loving group. The tías loved to take us dancing, to cook and feed us (their guacamole is the best ever), and tell us their stories. The young cousins were an endless source of entertainment, always up for a game of cards or to make use of us gringos as human jungle gyms. The hardest thing I had to get used to was feasting on black beans for breakfast each morning.

Has your summer experience impacted your future goals and interests at Northwestern?

I have known for a long time that I wanted to do something involving global health after college but wasn’t sure exactly what. After going to Guatemala and working side by side with the doctors and Community Health Workers there, I committed to becoming a doctor to combat the diseases of poverty.

Do you have any advice for students wishing to conduct research in an unfamiliar location?

My main piece of advice is to be patient and open with the entire process, beginning with grant applications. Conducting research in an unfamiliar location will be challenging at times and unpredictable situations will undoubtedly arise. It is important to remember to be flexible and persistent, and to keep your end goal in mind. Be open to all experiences and take advantage of every opportunity you have. Learn how to make tortillas from scratch, go dancing with the tías, hitch a ride on the back of a pickup truck through winding mountainous roads with spectacular views.  Most importantly, be kind to everyone you meet along the way.

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