Chronic Undernutrition:

1
Chronic Undernutrition

• Why Nutritional Interventions Come Up Thin

2
Themes

• Interventions mask the larger problem of
  structural social inequality
• People that are suffering are the ones blamed for
  their suffering

• There are three types of problems that can be
  associated with interventions
• More collaboration across disciplines regarding
  human rights work is needed.

3
Chronic Undernutrition

• According to UNICEF, more than half of
  Guatemalas children are undernourished
• In parts of Guatemala, rates of undernourished
  children reach 80

4
Chronic Undernutrition

• Undernutrition is associated with many physical
  problems failed organs, weak muscles, hair loss
  and changed hair color
• Undernourished children are also at risk for
  learning disabilities and for living in poverty
  as adults

5
Methods

• Semi structured interviews
• Focus groups with women from Aldea Aguas
  Calientes, Comalapa.
• Surveys with women participants in the BPD
  nutritional and educational programs in Cruz Nueva

6
Methods

• Key informants included Curendera, staff from
  Behrhorst clinic and ambulatory team, and staff
  from Chimeltenango Hospital
• Informal conversations with locals including host
  family members and Spanish instructor

7
Key Theoretical Concepts

• Paul Farmer, Pathologies of Power (Structural
  Violence)
• Engle and Nieves
• Food Distribution among Guatemalan families.
• Contribution Rule versus Needs Rule
• World Views
• Activist versus Adaptor

8
Western Medical Concepts

• Calories
• Energy
• Nutrients

9
Guatemalan traditional beliefs

• Hot and Cold
• Food avoidances

10
The Programs

• Behrhorst Ambulatory Teams
• Assess nutritional status
• Provide a nutritional supplement (Vitacereal) for
  children assessed as undernourished

11
The Programs cont.

• Hermano Pedro Nutrition Unit
• Cleft palate surgery repair program
• Intervention to improve weight

12
The Programs cont.

• Behrhorst Health Clinic
• Nutrition unit
• Family Planning Unit

13
The Programs cont.

• BPD nutrition program
• Charlas
• Cooking classes
• Educational classes for children

14
Findings

• 3 types of issues associated with interventions
• Programmatic
• Logistical
• Structural

15
Programmatic Issues

• Behrhorst Ambulatory team
• Food supplement is often undesirable for
  undernourished children.
• Behrhorst Health Clinic
• Unaffordable private facility.

16
Logistical Issues

• Hermano Pedro Nutrition Unit
• All children are fed and cared for on the same
  schedule regardless of special needs.

17
Structural Issues

• Governmental decisions affect
• access to jobs, land, and food supplies
• health care
• protection against violence, ethnic
  discrimination

18
Conclusions

• The diseases that afflict the indigenous shed
  light on the larger social context in which the
  community exists.
• The approach that Interventions often take are
  not practical for the structural circumstances
  that indigenous live in.
• The problems that interventions do not address
  are those connected with the economic, social,
  and political structures that govern access to
  land and food
• As suggested by Farmer (1999) a focus on the
  human rights dimension of health must also be
  present alongside food aid and related
  interventions.

19
Discussion

• Keeping in mind the adaptor vs. activist concept,
  as an interventionist trying to help relieve
  suffering, where do we accept the limitations of
  what we can change?
• How do we think about attempts to relieve
  suffering on a micro level( i.e. nutritional
  interventions) vs. a macro level (i.e. combating
  social injustice.)?
• If Interventions must go beyond addressing
  individual needs, who should be responsible for
  this?