Last day of work—Nutrition in Providencia

It is fitting that our last day of work was in Nueva Providencia, the poorest of the communities we serve. A few months ago, we discovered that more than 50 % of our children in Nueva Providencia are severely malnourished (-3 SD weight-for-age vs. mean CDC curves), marking a significantly elevated risk of mortality from intermittent illness. Every month, we have come here and been overwhelmed by the sick, malnourished kids. Ending with a morning in Providencia, then, reminded us of all the work that remains to be done.

Dominga gave a talk on the prevention of respiratory problems before we began seeing patients. It was fabulous! I was very, very impressed today. In general, she sometimes loses her train of thought and her audience in Spanish, but in Kaqchikel she is an engaging speaker and educator. The women loved it, chiming in and laughing throughout! It is always very different when the rest of us help with the talks, whether it is me or Vicente, whether in my halting, three-quarters Kaqchikel or Vicente’s oscillating KaqchiSpanish (all Kaqchikel, switching occasionally to lines like: “Si yix se dan cuenta, yix van a ver que hay mucho yab’il awe pa comunidad…”). Something about Dominga’s comfort with Kaqchikel, something about her being a respected Kaqchikel woman from the communities, something about the women’s identification with her make for wonderfully interactive and fruitful preventive health talks.

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Dominga, talking about contagion!

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She spent a long time discussing the importance of breaking the transmission of disease in preventing acute upper respiratory infection, which is often completely absent in people’s understanding of the etiology of gripe (the common cold). When we have tried to explain the concept of contagion to patients, the best response we have gotten has been, “Oh, thanks.” Very rarely has it appeared that patients were listening, understanding or believing what we were saying. But with Dominga on Thursday, things were completely different—the women became really engaged with this concept!

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Dominga, interacting with her audience.

---"Don't let your children play in the rain"

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Everyone got a little fixated on the lack of shoes on these children (above), playing marbles outside in the rain. And so the talk got a little side-tracked momentarily as we learned about hookworms, which, honestly, is not much of a problem here. I think things like hookworms come up so frequently because the materials made for health promoters and workers in settings like ours are written generically for the “tropics” or for the Third World, and because visiting physicians and nurses who love to include exotic parasites in their diagnostic thinking (without having explored local epidemiology) unduly influence the health promoters.

--- "Avoid dust; sprinkle water."

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Throw water on the ground to keep the dust from kicking up. This may have something to do with preventing environmental allergies, but almost nothing to do with respiratory infections (as it was presented). Either way, the women seemed to have had enough by this point in the talk. But Dominga plugged away, nonetheless. It is always difficult to know how to keep people’s attention, to know how to present things in a way that will be engaging and fit with people’s cognitive frameworks, thereby turning into pragmatic knowledge.

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Dominga, seeing patients with the assistance of Kate. Once we are gone, Vicente has said that he thinks they should continue with their mini-consulta after nutrition days. I agree.