1. Inadequate Nutrition in Guatemala Madison Calhoun

2. Patanatic, Guatemala Objectives: 1. Identify the influences of the determinants of health (environmental, social, political, legal- ethical, economic, behavioral, and cultural) on delivery of care to the people of Guatemala. 2. Assess the health status, health care access, and emergency preparedness needs in Patanatic and the surrounding communities. 3. Participate with healthcare providers and community leaders to gain further insight into the health of the community. 4. Interact professionally and appropriately with the community to facilitate a successful working relationship. Image retrieved from http://www.weather-forecast.com/place_maps/pa/Patanatic.8.gif

3. Background Guatemala has the fourth highest rate of chronic malnutrition in the World, and the current rate of malnutrition for children under five is 49.8% (World Food Programme, 2016) According to the Millennium Development Goals, Guatemala’s target was to halve the proportion of children 5 and under, who suffer from hunger in 16 years. Unfortunately, there has only been a 6% decrease recorded (Children under 5, n.d.) The Food and Agriculture Organization states that, “food availability in Guatemala is poor mainly due to vulnerability to environmental factors like droughts and floods, deforestation and soil erosion and to inadequate agricultural and economic policies” (2007).

4. Background According to the World Food Programme, “The most vulnerable groups are indigenous women, girls and boys living in the highlands and the “dry corridor” (a semi-arid zone with periods of droughts, degraded soils and low agricultural yields)” (Guatemala, n.d.). Guatemala has access to a lot of freshly farmed fruits and vegetables, but unfortunately, these fruits and vegetables are exported instead of being consumed locally. Proper nutrition is critically important in children because, “it is directly linked to all aspects of their growth and development” (Children’s Heart Center,2007)

5. Centro Educativo y Salud Patanatic Built by the community with the help of Woodland Public Charities 2 full time nurses that are from the community on call 24/7 do not have a form of transportation for home visits

6. Centro Educativo y Salud Patanatic Has instituted many programs in the community, including: water filters, smokeless stoves, multivitamins in schools Has an agreement with the community members for a small yearly fee for using the clinic. There is no payment at the time of services. If a family cannot pay the yearly fee, the nurses will ask them to help with tasks that need done around the clinic. ie: washing the windows

7. Inadequate Nutrition While performing check-ups on the elementary school-age children in the communities around Patanatic, we noticed that most of the children charted below average for both height and weight Also during our experience in Guatemala, we noticed the interaction of a multitude of variables related to the problem of inadequate nutrition. We learned about the expense of healthier foods versus unhealthy or non- nutritious foods and the differences in availability of unhealthy snacks and sodas in comparison to healthier options. The first millennium goal from the United Nations is related to eradicating extreme poverty and hunger (2015). The problem of inadequate nutrition directly relates to hunger in the country and can also be associated with the extreme poverty in the country.

8. Individual Level Interventions Families using the water filter provided in their home to get adequate water intake and maintain good health by using the clean water to wash fruits and vegetables. Families using the smokeless stoves provided by the community to cook their food. These stoves use less wood than traditional cooking methods, so save families money that can be put towards healthier food choices, or other necessities. Choosing to eat more nutrient rich foods like fruits and vegetables instead of snacks sold at little convenience shops.

9. Community Level Interventions Water filters and smokeless stoves The community has worked very hard to provide families in the community with these items. The community does not hand these items out without first discussing the terms with the family receiving the filter or stove, such as payment and/or care instructions.

10. Community Level Interventions Multivitamin program in the elementary schools The clinic in Patanatic has started a new program that provides multivitamins to children attending elementary and now some secondary schools in the area. Teachers receive a month supply at a time and hand out vitamins daily to the children. Regular check ups from the nurses The clinic provides check ups to all members of the community and the nurses also sporadically visit elementary schools for check ups. Having record of these check ups provides a better understanding of the health status of the community and also gives the nurses opportunities to teach about appropriate nutrition habits.

11. Systems Level Interventions New government The previous leadership in Guatemala was very corrupt and many members of the government even went to jail for corruption. This severely inhibited systems-level programs from the government that address the problem of inadequate nutrition. A new government has now been elected, so there is hope for improvement in the near future.

12. Systems Level Interventions International Campaigns There is a campaign in Guatemala and Costa Rica called “Yo como verde” or “I eat green.” This is an international organization using several means of advertisement. This initiative attempts to educate people on why they should eat sustainable, nutritious and healthy foods. A campaign advertised through Borgen Magazine advertised a non-profit organization called The Thousand Days. It is a campaign to target adequate nutrition for the first 1,000 days of a child’s life. Image retreived from https://www.hivos.org/news/i-eat-green-campaign-healthy- eating

13. Conclusions/Suggestions I learned an immense amount during my experience abroad and highly recommend an international experience to everyone. Some of the most interesting things I learned: Community is quite important in Guatemala and there are even community leaders that meet and make decisions in the community. The process of helping a community/country from abroad must be done carefully and thoughtfully and community buy-in is incredibly important. One suggestion I have is for future clinical groups going to Guatemala to have a better understanding of the culture before going and take a cheat sheet with basic and medical Spanish phrases.

14. Most Profound Clinical Experience The most profound clinical experience I had was interacting with the individual patients while doing assessments. Using what limited Spanish I knew and lots of body language, I was able to communicate relatively well with both children and adults in Guatemala. There were many times that both the patient and I just had to laugh because we were not understanding each other and ask for help from a translator, but I truly enjoyed every moment of those interactions. I believe those interactions will further my ability to provide culturally competent care to my patients in the future.

15. Most Profound Cultural Experience The most profound cultural experience I had was while interacting with the community. One of the very first things I noticed when we arrived in Guatemala was the friendliness of the community. Everyone we passed greeted us and smiled. A second very profound experience I had was while doing home visits to do check ups on the elderly. I remember one woman in particular who was 75 years old. She warmly welcomed us into her home and would not rest until she had given each of us a chair to sit in. That act of such respect and kindness truly stood out and is something I will not forget.

16. References Children under 5 moderately or severely underweight, percentage - Guatemala. (n.d.). Retrieved February 24, 2016, from http://www.indexmundi.com/guatemala/children-under-5-moderately-or-severely-underweight,-percentage.html http://www.indexmundi.com/guatemala/children-under-5-moderately-or-severely-underweight,-percentage.html Guatemala | WFP | United Nations World Food Programme - Fighting Hunger Worldwide. (n.d.). Retrieved February 24, 2016, from http://www.wfp.org/countries/guatemala http://www.wfp.org/countries/guatemala (n.d.). Retrieved February 25, 2016, from https://www.cia.gov/library/publications/the-world-factbook/geos/gt.html Nutrition country profiles: Guatemala summary. (n.d.). Retrieved February 24, 2016, from http://www.fao.org/ag/AGN/nutrition/GTM_en.stmhttp://www.fao.org/ag/AGN/nutrition/GTM_en.stm Why is nutrition important for children. (2007). Retrieved February 15, 2016, from http://www.childrensheartcenter.org/whyisnutritionimportantforchildren.html http://www.childrensheartcenter.org/whyisnutritionimportantforchildren.html 1,000 days of nutrition in Guatemala. (2016). Retrieved March 24, 2016, from http://www.borgenmagazine.com/1000-days-of-nutrition-in-guatemala/http://www.borgenmagazine.com/1000-days-of-nutrition-in-guatemala/ “ I eat green”, a campaign for healthy eating. (2015). Retrieved March 24, 2016, from https://www.hivos.org/news/i-eat-green-campaign-healthy-eatinghttps://www.hivos.org/news/i-eat-green-campaign-healthy-eating