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BOLIVIA: Mothers Teaching Mothers to Combat Malnutrition

Julia Velasco Parisaca and Wendy Medina

BETANZOS, Bolivia, Jan 9 2009 (IPS) - One of every two children under the age of five in the southwestern Bolivian highlands municipality of Betanzos suffers the effects of chronic malnutrition.

Betanzos, a rural municipality of Quechua Indians located 3,500 metres above sea level in the north of the department of Potosí, has the worst child malnutrition rates in Bolivia, South America’s poorest country.

According to the National Nutrition Survey conducted in 2007 by the Health Ministry, municipalities where 38 of every 100 children are malnourished are classified as having a high degree of food vulnerability. In Betanzos, the rate is 50 out of 100.

Dr. Braulio Escalante, the municipality’s top health authority, told IPS that the living conditions of Quechua families have a major impact on their children’s nutrition and health.

“Most families are involved in agriculture, but they only raise enough food for their own subsistence and a small amount to barter (for other goods) or to sell in order to acquire other foodstuffs, such as sugar or rice,” he noted.

Almost 80 percent of the population of Potosí lives in poverty, which is exarcebated by environmental problems like drought. Out of the 10 poorest provinces in the department, nine are Quechua, according to figures from the 2001 census.

The Quechua are the largest indigenous group in Bolivia. A total of 1,557,689 respondents identified themselves as Quechua in the 2001 census, out of a total population of 9.2 million.

The extreme poverty in this region is combined with another problem: local eating habits are not based on the high-protein foodstuffs that are grown and harvested here, such as fava beans, corn, potatoes and wheat, nor on fruit like peaches, said Escalante. Instead, local peasant farmers prefer to trade or sell this fresh produce for processed flour-based products like pasta.

“They consider rice and pasta easy to prepare, and will often only cook mote (boiled corn kernels) and potatoes with a bit of spicy flavouring, because of a lack of knowledge about how to prepare nutritious food,” he said.

Zero malnutrition

The United Nations Convention on the Rights of the Child, in force since 1990, states in article 6 that “every child has the inherent right to life,” and that states that are parties to the Convention must “ensure to the maximum extent possible the survival and development of the child.”

One of the main goals of the Zero Malnutrition National Programme launched in July 2007 by the administration of indigenous President Evo Morales was to improve the nutrition of pregnant women, nursing mothers and children under five.

As part of the programme, Betanzos set up the Municipal Nutrition Commission (CONAM), the first of its kind in the country, in November 2007. The Commission is made up of monitoring committees formed in each of the municipality’s ten districts, which comprise teachers, local government authorities, the Departmental Health Service and civic committees, among other social and governmental entities.

To pursue its goal of combating child malnutrition, CONAM created the Integrated Nutrition Unit, staffed by a nutritionist and nurse who are responsible for monitoring the nutrition and health of the municipality’s children, as well as distributing food supplements for children under two.

This local initiative contributes to fulfilling Bolivia’s commitment, under article 24 of the Convention on the Rights of the Child, to take appropriate measures to combat malnutrition, including within the framework of primary health care, through the application of readily available technology and the provision of adequate nutritious food and clean drinking water.

“Mindful mothers”

As part of the initiative, women from communities throughout Betanzos, such as Buey Tambo, with a population of around 600, have been organised and trained to act as “madres vigilantes” – “mindful mothers” – who are responsible for monitoring child nutrition in their communities and teaching other women.

“Our task is to weigh and measure children from the time they are newborns until they are five, to see whether or not they are malnourished and whether or not they are gaining weight and growing. As madres vigilantes we train other women how to feed their kids so that one day malnutrition will disappear,” Eva Juchani from Buey Tambo told IPS.

Juchani and the other 1,500 madres vigilantes throughout Betanzas also work to inform and educate their communities about better eating and cooking habits.

“It’s hard to get people organised. We started with meetings, markets and festivals. We teach women that as mothers, we must keep ourselves very clean, and give our children food that is well prepared and nutritious,” commented Reyna Caba, a community health worker and madre vigilante in Buey Tambo.

The women’s training was sponsored by Plan International, a UK-based non-governmental humanitarian organisation that is collaborating in the implementation of Community Integrated Management of Childhood Illness (C-IMCI), a programme that targets children under the age of five.

C-IMCI was developed in 1996 by the World Health Organisation (WHO) and the United Nations Children’s Fund (UNICEF).

“Madres vigilantes are trained about children’s growth, development and nutrition, and at the same time, they pass on this training to other mothers in their communities, while monitoring the growth and development of their children,” explained Aurora Gutiérrez, the health programme coordinator for the Plan International branch in Bolivia, based in Sucre.

Many of the more than 100 indigenous communities in Betanzos are not served by public transportation, because of the long distances that must be covered and the lack of decent roads. People get around on foot or by bicycle. Clean water is frequently in short supply.

“Until recently, our community did not have drinking water or a health centre. Organising the community members has made it possible to gradually improve living conditions. Many communities still depend on rainwater or well water,” said Marcelino Caba, a community leader from Buey Tambo.

The people of Buey Tambo organized, and with the support of organisations like Plan International and in coordination with the municipal government they have succeeded in providing their community with a supply of drinking water.

Impressive but insufficient efforts Another effort aimed at fighting child nutrition is the National Programme for the Care of Children Under Six (PAN), a programme implemented by departmental governments since 2005, which encompasses the areas of health, nutrition, protection and early childhood education.

Although this initiative was scheduled to conclude in 2007, the government has extended it to 2012, thanks to an agreement signed with the World Food Programme, which contributes five basic foodstuffs: rice, lentils, cooking oil, flour and salt.

“The children’s centres run by PAN provide the children who go there with four meals a day – breakfast, lunch and two snacks – and they operate from eight in the morning until five in the afternoon,” said Ximena Chacón Quispe, head of the PAN Unit in Potosí.

In the department of Potosí there are 360 of these centres in 35 municipalities, which serve 7,600 children.

However, despite the efforts of the Potosí departmental government, which even increased the funding for PAN almost sevenfold, the programme reaches only around 20 percent of children in the most vulnerable municipalities, because it does not reach the children living in scattered, isolated communities.

Out of the more than 100 communities in the municipality of Betanzos, the programme only operates in 17.

The Zero Malnutrition National Programme is creating community family health care brigades to reach these currently unserved communities. With the support of doctors sent to Bolivia by the government of Cuba, the brigades will travel to isolated villages and hamlets without health posts, reported Maria Julia Cabrerizo, head of the Health Ministry’s Department of Nutrition.

In order for the programme to succeed, it will require health professionals with a devotion to service and a commitment to helping children, willing to work in impoverished rural areas like Betanzos.