Wuqu' Kawoq

Wuqu' Kawoq's mission is to address the barriers to excellent health care that the majority of Guatemala's indigenous Maya population face, including principally the lack of access to health care in their own languages. As such, Wuqu' Kawoq develops primary care and health programs within a larger context of community vitality, family stability,and Mayan language revitalization.
Dec 31, 2013

Chronic Malnutrition and Impactful Interventions

Yoli, our health educator talking with a mom
Yoli, our health educator talking with a mom

We have launched a new intervention to aggressively intervene with home visits for severely malnourished children. 

As usual, we weigh and measure all the children under five years of age in our communities. We then chart  the children’s growth on World Health Organization curves for height and weight. When a child’s growth appears alarming, we then try to figure out what’s going on and how to fix it. 

Remember, stunting is diagnosed when a child is short for their age. When you see stunted children, they look like healthy, plump little kids until you realize that they are really short and look about 6 months younger than they should appear. Guatemala has one of the highest rates of stunting in world and the highest rate in the Western Hemisphere. 

Does it Matter is someone is a bit shorter?

You may think, “Does it matter if someone is a bit shorter?” Well, after fifty years of follow-up, the INCAP Nutrition Study has found that, as they grow up, children who were stunted have decreased school performance, reduced cognitive skills, higher probability of living in poverty, and some significantly worse health-related outcomes such as number of pregnancies in women. Think of this: A child whose height improves by one standard deviation at age three (e.g., going from from the 0.1 percentile to the 2.5 percentile) will earn on average 20% more money per year as an adult and will be 10% less  likely to be poor.

The New Intervention: In Home, One-on-One education and Food Supplementation

In this new intervention, we identify the kids under age two that are “severely falling off their growth curves.” We then make a visit to their homes, speak with their family, and conduct a medical work-up. We work to rule out things like hypothyroidism, congenital diseases, and parasites, and if children do have these–or any other–conditions we treat them. We send them for laboratory testing, imaging, and even surgery if they need it. We also give the child deworming medication and vitamins. We also focus heavily on one-on-one education with the family and mother on how to provide the best food and nutrition for their child.

We are particularly sensitive to the time when the child turns six months old, as this is the window when complementary foods should be given in addition to breastfeeding. Due to both economic considerations and education, many mothers delay the onset of complementary feeding or give foods that are very low in nutrients. Often, we see that children are growing just fine until they reach 6 months of age, at which point they basically stop growing. 

In the “small picture,” the intervention is exciting because we think we can really influence the individual children in our care.  We will evaluate this new program as we move forward and report back to you.

Our Harvard medical student David working with the program says, “I must also confess that I love visiting these children. They are so fragile, so small, so innocent. They have so much more living to do, but their future is at stake. Thankfully, we have some tools to help. I can’t think of anything that could be more worthwhile.”

Thank you friends for your amazing support. Together, we are saving lives and creating better futures!

Sheny, a child now growing in our program!
Sheny, a child now growing in our program!
Example of a growth curve for a malnourished child
Example of a growth curve for a malnourished child
Dec 31, 2013

Fulbright Fellow Collaborating with the Midwives on Capacity Building

Since August, we have had the great fortune of having Nora, a 2013-2014 Fulbright Fellow, work with us. Nora is a fourth-year medical student at Mayo Medical School in Minnesota, and she will be with us through June 2014. Her focus is to build capacity for data collection and training with our midwives. When Nora arrived, she immediately began to learn Kaqchikel. Since then she has been working closely with the midwives to complete an evaluation of the midwives training curriculum, which is unique because of its respect for Mayan values—among other things, it is one of the country’s only traditional midwife training program conducted exclusively in an indigenous language.

After several months in Guatemala, Nora has gained a better understanding of the midwives’ work and role in their communities and she is currently working with them on their program’s efficacy and acceptability, to set the stage for future internal evaluation.

Below is a Field Report from Nora

Yesterday, I met up with Elvia, one of the lead midwives, and we went to a larger outlying community or aldea about half an hour away. 

In the aldea, we met up with Romina, an elderly and smile-filled midwife. She speaks mostly Kaqchikel, so we were able to chat a little and work on my Kaqchikel. We saw four patients in their homes, spending nearly an hour with each. I mostly observed and listened to the rapid-fire, real-world Kaqchikel. 

At one point, we saw a patient whose baby was in transverse lie (which likely won’t be a problem, since she was only about 32 weeks along). I asked Romina for the word for transverse lie in Kaqchikel. 

“Kotz’ol,” she said, which literally means lying down. Logical!

“Chuqa’ ke ri’?” I asked, motioning breech position

“Tzuyül!” she smliled, which means sitting. Also logical!

“Chuqa’ wi rujolom wawe?” I motioned vertex.

“Ütz!”–which is simply “good!”

Looking forward to another day. 

Romina, Midwife
Romina, Midwife

Links:

Sep 9, 2013

Improving diet diversity through education

Nutrition focus group in session
Nutrition focus group in session

Dear friends, as I've written to you frequently over the last few years, we've been working hard to complement the core activities of this program, which include medical care and nutritional supplementation, with additional educational and support activities for mothers and fathers of young children. 

Although education can't solve all problems, it is an important part of a comprehensive solution. For example, in a report we recently published (see the link below), we discovered that many parents struggled to understand the manifestations of chronic malnutrition in their children and, therefore, tended to present late for medical evaluation. Similarly, although most parents understood the need to feed their toddlers complementary foods starting at 6 months of age, they were less likely to appreciate the importance of meal frequency and a diverse range of food groups for their children's health. 

Therefore, this year, our health promotion staff have launched an exciting range of new educational activities, which include dynamic small group classes and also individualized home visits. We've seen really positive changes in health behaviors and knowledge as a result. For example, when we tested parents knowledge before and after their participation, we discovered that, before participation, only 45% of parents felt well prepared to care for children with an episode of acute diarrhea. After participation, that number increased to 71%. As another example, before participation, only 52% of parents had a good sense of how frequently a young child should consume solid foods; after participation, this number increased to 81%. 

Most importantly, our staff have been conducting followup evaluations of dietary quality in the children of participants. We are seeing that, after participations, children are consuming more food and more diverse foods as a result of their parents' new knowledge!

In conjunction with our ongoing medical care programs, growth monitoring, and nutritional supplement, we are really excited to see the additional accrued benefit of education to our communities as these programs continue to unfold this year. 

House based nutrition visit
House based nutrition visit
Individualized nutrition assessment
Individualized nutrition assessment

Links:

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