Doña Eulalia lives in a small village called San José Calderas in the Guatemalan highlands, where she works as a traditional, community-based midwife. Her home is an agricultural center for the production of corn and beans, nestled beneath the revered Volcano of Fire. Amidst a daily struggle of grinding poverty and lackluster to nonexistent health services, my hostess is the community’s sole source of maternal, reproductive and postnatal health care.
Though my own belly is full, my work shadowing a traditional midwife and conducting graduate research for the London School of Economics has awakened me to the horrifying realities of persistent hunger.
In a society characterized by 500 years of racial subjugation and oppression, the health and well-being of indigenous women and children is a national emergency. Even with the highest GDP in Central America, Guatemala suffers from the worst chronic child malnutrition rates in the Western hemisphere, and the third worst in the world. At 5-7, I tower above men and women alike. Mayan Indians -- approximately 42 percent of the population -- are stunted by malnutrition, not genetics. Recent studies show that children born and raised by Mayan immigrants in the United States are on average 12 centimeters taller than their cousins in Guatemala. In some indigenous communities, four in five children are chronically undernourished. Child malnutrition has a synergistic relationship with poverty, infectious disease and low educational attainment in Guatemala, all of which may increase the severity and duration of hunger.
Mariana greets us at the gate of her wooden shack. Her limbs are thin like sticks and her face appears hollow. Is she the sister of the patient whom we have hiked over two hours to reach? Instead, it is Mariana who loosens her corn-crusted apron and brightly embroidered belt before easing onto the rusty bedsprings. She asks me if there is a medicine that will give her enough strength to push this eighth baby into the world.
I think back to a lecture given by legendary doctor of the poor, Paul Farmer, in which he announced a breakthrough medical cure for his famished patients in the deforested central plateau of Haiti: food.
With the baby at the door, it is too late to discuss the importance of maternal nutrition with Mariana and her husband. I want to explain that when a fetus experiences intrauterine growth retardation due to inadequate maternal nutrition, the resulting low birth weight can have an impact on cognitive and physical development throughout the child’s life. Mothers who do not receive adequate nutrition and care during pregnancy frequently transmit their nutritional status to their babies, increasing the infant’s vulnerability to childhood killers like diarrhea and pneumonia. Worldwide, malnutrition accounts for more than half of childhood deaths.
For Mariana’s growing family and hundreds of millions of hungry people around the world, the crux of the problem is access to, not availability of, food. Even if the lands are lush and the supermarkets are stocked, poor people still need resources to cultivate, sell and purchase their meals. For Mayan peasants, land ownership is the primary means for generating a livelihood, enhancing food security and practicing their cultural heritage.
And yet, Guatemala has one of the most unequal land distribution patterns in the world: an estimated 2 percent of the country’s population owns 70 percent of the fertile land. Many argue that such inequities stem directly from a lack of political will to ensure basic human rights for indigenous peoples, whose rural livelihoods are inextricably linked to agriculture. Instead, Guatemala continues to prioritize an export-led agricultural model that almost exclusively benefits wealthy plantation owners and multinational corporations at the expense of indigenous peasants.
In a bold vision for addressing the underlying causes of hunger, President Barack Obama recently launched the Global Health and Food Security Initiative (GHFSI). Instead of relying on costly and inefficient food aid that undermines local agricultural production, the GHFSI must advocate a unified food security strategy that is resilient to the whims of corporate profit motive. By ramping up resources for pro-poor, community-based agricultural programs, as well as for ready-to-use therapeutic food as a treatment for childhood malnutrition, the USA could lead the world in the fight against extreme hunger.
Though environmental changes, conflict, and poverty all contribute to chronic malnutrition, they can be mitigated if national and international institutions are committed to ensuring marginalized communities’ entitlements to the resources they need to cultivate, buy and sell food.
It is with a heavy heart that I am leaving Guatemala, just days before Mariana’s due date. Her gentle girls seem to be wasting away before my eyes. Though Mariana’s family has not been displaced by one of Guatemala’s horrendous earthquakes or tropical storms, they suffer from the silent and ever-present reality of hunger, poverty and inequality.
I am moving to Boston to help coordinate the advocacy and policy branch of the nongovernmental organization, Partners in Health (PIH). With nearly 7,000 community-based health care workers in Latin America, Africa and Siberia, PIH has shown the world that it is possible to control diseases of poverty by extending the paradigm of health interventions to include food, housing, public infrastructure, water and sanitation. PIH is effective not only in providing band-aid solutions, but in redressing the underlying causes of health and inequality. I hope you will join me in helping build the movement for health and social justice by contributing financially or taking political action at www.pih.org.
Meredy Throop graduated from Lander Valley High School in 2002. She writes from Guatemala, where she has just completed her MSc in Development Management from the London School of Economics. After spending several years working on global health and poverty issues in Latin America, Africa, Asia and Washington ,D.C., Throop will be serving as Policy and Advocacy Coordinator for Partners in Health.