Heather in Ecuador

Malnutrition Program

Most days I attend to children who come to the clinic, and are of a "pediatric age." Here the cut off tends to be a bit lower, where as I could see children up to age 21 in the states, they usually only send kids my way who are about 14 years and under. Maybe this is because kids here grow up a lot faster, and many may be parents already by their late teen years. I think word has spread through the communities that two "foreigner pediatricians" are in town, because our numbers of patients each day have started to steadily increase.

Yesterday, however, was a different day. It was a Monday, and since there is no clinic that day, Mike stayed here to do pediatric Call, and I got to go into the community and participate in the childhood malnutrition program. This is a program that has been around for almost 11 years. When children are identified in the hospital, or clinic as being underweight and malnourished, they are enrolled in this program. In my five weeks of working here, I have already enrolled a handful.

The main star of the show is Hermicu, a native Zumbahuan, who visits a total of 24 communities over the span of two weeks. Therefore, each child is visited by Hermicu every 14 days. She tracks their growth with her portable scale that she hangs from the rafters, and the measuring tape that she uses in the doorway of the home. Then she plots it on a chart to track their progress. Each child also receives a bag of non-parishable goodies, such as fortified formula, quinoa, rice, pasta, etc. to help lessen the families' burden of feeding the child generously. Lastly, she talks with the parent in their native Kichwa language, to see if there are any concerning signs of infection or reasons the child should come to clinic to be seen. If Mike and I are along, we do a brief little assessment of the child, make a few recommendations, and write a brief note of our visit.

On Monday, Hermicu and I visited the village of Iracunga, about a 30 minute drive from the hospital. We get dropped off by the car that continues on in a nearby village visiting the elderly. With heavy food bags in each hand, we begin hiking on steep trails toward the houses. Even though Hermicu is in her traditional clothing, with a skirt and penny-loafer type shoes, she is like a mountain goat, more nimble than I who has the fancy hiking boots on. Small school children out for recess chase behind us as we walk along the dirt road, teasing and asking if we are here to vaccinate.

We visit four houses that day. Most are made of cinder block, with a tin roof, usually a few large rocks placed on top to prevent the wind from lifting it up. Inside, the homes are dark, generally having electricity, but conserving it for the most essential times at night. All of the homes have a dirt floor, packed down and swept clean. The beds are modest, with falling apart mattresses or foam pads, and layers of alpaca blankets upon them. When furniture, such as dressers and wardrobes are rare, most of the families hang their clothes from the low rafters of the ceiling, one item piled on top of another.

Getting ready to head out into the community. We start out by car, in the make-shift ambulance. The white bags contain all the food stuffs that the families each receive.