MEDLIFE Intern Amara Channell writes about a new facet of our educational programs — health and nutritional workshops for the poor in Latin America:
“What can I do to make my child eat more?”
If you have ever attended one our Mobile Clinics, chances are you have heard at least one mother ask why her child is not eating and what medicine the doctors can give her to fix it. Each time the doctors patiently explain that picky eaters are not sick — they just have a behavioral or taste issue.
Through our expanding educational programs, we have found that one of the biggest problems is that patients lack or misconstrue basic nutritional knowledge. Very few Peruvian schools offer health education, and even if they did, many of our patients have not completed school. The mothers we work with sincerely believe that the more they can make their children eat, the healthier they will be. Their goal is to have chubby children because to them it is a sign of health. Unfortunately, this means that these children are eating fattening diets, not balanced ones, with large amounts of white rice and potatoes, but not much else. Along the way they are developing greater risk of diabetes.
Although very few of our patients show signs of traditional malnutrition, Kwashiorkor or Marasmus, many of them do suffer from micronutrient deficiencies (or “hidden hunger”) which are harder to spot. Worldwide, over one billion children suffer from micronutrient deficiencies. Even though these children may seem perfectly healthy, they have depressed immune function, smaller attention spans, decreased muscle development, height stunting, and poor teeth. They are less likely to complete school because of increased illnesses and decreased brain development. As adults they continue to have issues because the lack of nutrients causes them to be more susceptible to obesity, illness, and muscle weakness. A recent Economist article states that these adults will end up with lower paying jobs, die sooner, and have poorer partners.
In the past few weeks, MEDLIFE has started trying to counter these problems with nutritional “talleres,” or seminars, for local Peruvian women. The seminars last about an hour and give women the absolute basics about nutrition as well as a chance to ask individual questions.
The presentations start by suggesting affordable changes that the women can make, such as eating eggs instead of bread for breakfast, and emphasizing how important variety is. There is an incredible abundance of affordable fruits and vegetables here, but it is not a cultural norm to include them in most meals. By adapting the new MyPlate program (developed by USDA), we can show them a healthy and balanced way to think about preparing their plates.
To further explain the importance of healthy eating, we show a variety of foods and explain how mothers can help prevent the problems they are facing. For example, we explain how a sweet potato can help with eyesight through its vitamin A, bell peppers can help prevent illness through their high anti-oxidant content, spinach can help with bone health through its calcium content, lentils can help muscle development with protein, and quinoa can help regulate insulin through its high fiber content. We show how they can increase the iron content of their food by pairing these foods together, such as pairing broccoli with something with high vitamin C content to help absorption.
The presentations also emphasize the importance of exclusive breastfeeding. The majority of women do breastfeed but they do not understand not to give anything else for the first 6 months — instead, many young infants are regularly fed juices. We help them to understand how to slowly introduce the first few foods at 6 months to prevent and discover food allergies.
The last section addresses ways that mothers can get their children to eat without bribing or punishing them. We tell them to introduce one new food at a time, allow the children to see their parents eating the food, to allow them to be hungry if they refuse the food, and to turn off the TV or any other distractions. The hope is they will begin to understand that it is normal for children’s appetites to change and that most children will refuse certain foods at some point in their lives. If they are still eating sweets or other things that they like, then the children are not sick. We also encourage them to serve smaller plates with the options of seconds and to offer 5 small meals a day instead of 3 huge ones.
Although many of the nutritional issues are culturally ingrained, the women seem to respond very positively, and we hope they can start to make small changes in their diets. We plan to return to each community with further presentations and to repeat the chicken blood workshop that we did this fall. The hope is that we can slowly change unhelpful customs so that the health of the next few generations will begin to improve.