When Doris Guacho Haya brought her twin daughters into the local health post to get them their state required vaccines, the doctor told her they were healthy and normal for seven-month old infants. But at 9 months, the doctor delivered some bad news: Doris’s twins were falling ill to the same condition that plagues so many other children in the impoverished farming communities of Ecuador’s Chimborazo province- malnutrition.
“It’s not their fault,” she said, as she stared at her twin girls simultaneously breastfeeding in her arms. She gives her twins breast milk 4 times a day, and sometimes some rice or soup when there is money. But the doctor told her she needed to feed them 5 times a day, not just breast milk, but fruit and meat. She didn’t have money for that, the work she had one day a week cleaning houses and doing laundry only brought in about $30 a month. She didn’t know how she was going to afford to get them more food. Despite her efforts, her kids hadn’t put on weight 6 months later when Doris brought them into a MEDLIFE Mobile Clinic.
In Ecuador the minimum wage is $354 a month, the poverty line is $82 a month, and the extreme poverty line is $46 a month. Making only $30 a month, Doris sits well below all of these markers. Doris lives in a small agrarian community in Chimborazo, located in the heart of the Ecuadorian Andes. Doris’s economic situation is not unique here. In Ecuador, 43% of rural people are living in poverty, and 19% are in extreme poverty, as compared to 24% and 8% nationally. The parroquia (a small subdivision within provinces with its own smaller local government) where Doris lives, San Juan, is particularly impoverished, with 84% of residents living below the poverty line.
Ecuador’s population is comprised of 38% indigenous peoples, which makes Chimborazo the home of a large portion of Ecuador’s indigenous population. This population continues speaking Quetchua, dressing in traditional clothing and living off the land much like they have for centuries.
Families often have multi-generational roots to their land and homes, and these roots typically remain deep and unbroken. Doris lives in a small home with 4 rooms, two bedrooms, a bathroom, and a kitchen with a wood fire stove. She shares this home with 14 people, her parents, eight of her 10 siblings, and her own three children. Bedrooms are packed full at night, there is barely enough room for everyone to fit indoors at the same time. “We have never had a bank account or a credit card, a car, or even a donkey,” Doris’s mother said. Doris was born there, her mother was born there, and so were her grandparents. “This is the home of our family,” she said.
Life is hard in these places. A subsistence farming lifestyle, harsh climate, physical isolation and lack of access to services contribute to a host of economic and public health problems. Here, the elderly hobble by with stooped postures and creaking joints swollen by arthritis created by years of hard physical labour, the mothers are young and the children are skinny, with cheeks cracked and scorched red from the cold dry air that sweeps across the hillsides where they live.
Doris is a single mother, her first daughter and her twins are from different fathers, both whom offer her no support and refuse to recognize the children as theirs. “One of them is married, and the other is poor,” she explained. She dropped out of school when she had her first daughter at 18 . She had her twins at age 23, now 24, she is left to care for the three children on her own with the support of her parents and siblings.
That is why there was never enough to go around- that is how everyone got so skinny, her young twins dangerously so.
Malnutrition is among the most serious of the many public health problems in this area. Government data from 2013 put national rates of chronic malnutrition in children under five at 26%, but it is much higher, at 52% in Chimborazo. Malnutrition, along with lack of access to health services are among the major factors that contribute to infant mortality and other developmental deficiencies. The government has put forth a plan to reduce malnutrition rates, but its effects often don’t reach, or hit as a mere drop in the bucket, residents living in remote communities like Doris.
When her doctor told her that her nine month old twins were underweight, she was given a small packet of Chis Paz, a micronutrient supplement being handed out as part of the government’s plan to combat malnutrition. She quickly ran out of it, and when she went back to the doctor, her twin’s condition had not improved. Her kids were still underweight, but this time she was told there were no more vitamins.
“They say that public healthcare is free with the government’s campesino (peasant) insurance policy,” said MEDLIFE nurse Maria, who has lived in Chimborazo her whole live, and worked with MEDLIFE patients there for years. “But when you go to the health post, nothing is available, or the waiting list is so long you could die before getting the treatment you need.”
I heard this sentiment expressed whenever I asked about the local health posts in the Chimborazo region; “they didn’t have what I needed, nothing is available,” people told me again and again. It is not uncommon for a single health post staffed with less than twenty people to serve all rural communities a three hours drive in every direction. Given the costs in time and money to make the often long and arduous trip to the nearest health post and the lack of available services, many don’t bother going.
After 6 months of working to help her daughters put on weight with no results, Doris brought her daughters into a MEDLIFE mobile clinic. We gave them supplements of milk and vitamins, and her daughters have finally begun to put on a little weight after a few weeks. When MEDLIFE encounters children who are experiencing chronic malnutrition in clinics, we give vitamins, try and give guidance to the mothers, and in more serious cases add them to our patient followup list. MEDLIFE followup nurses will continue to check in with Doris’s family to monitor their progress and help provide them with supplemental nutrition to get their children back to good health.
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