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How COVID-19 and climate shocks are hurting children’s health in Guatemala

‘Usually, we have one case of acute malnutrition every year. Last year, we had four.’

Six-year-old Einar Vladimir is the only member of Rutilia García Pérez’s family who gets an egg for breakfast.
Six-year-old Einar Vladimir is the only member of Rutilia García Pérez’s family who gets an egg for breakfast. (Victoria Castañeda/TNH)
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2020 seemed like it was going to be a good year for Rutilia García Pérez’s family. Unlike previous years, it included a good rainy season. The maize they had sown in May grew tall, and García Pérez, a 43-year-old petite woman with jet-black hair, hoped for a rich harvest that would feed the family for at least six months.

“But the storms ruined it,” García Pérez told The New Humanitarian, grinding cooked maize in the wooden shed she uses as a kitchen. The family not only lost most of the maize harvest. Their beans were also destroyed by the heavy rains. What’s left is damaged and filled with holes. Instead of having food stocks for almost a year, García Pérez now has to buy maize and beans at the local market to feed her children and grandchildren.

At dawn, García Pérez starts baking tortillas in her self-made oven. Once they’re ready, the children add a pinch of salt and pour them down with watered down coffee.

That is what breakfast, lunch, and dinner looks like for most children in Tansha, a small village of roughly 250 families in the mountainous eastern region of Chiquimula, home to Indigenous Mayan communities. On a good day, beans and a fried egg complement this unbalanced, calorie-laden diet.

In Guatemala, nearly every other child is chronically malnourished, or lacking in balanced nutrition, despite having a full stomach. In remote highland regions, numbers rise to 90 percent. The pandemic made the situation even worse, but Guatemala is far from being the only country affected in the region.

Along the so-called corredor seco, or Dry Corridor, stretching from Costa Rica, Nicaragua, Honduras, and El Salvador to Guatemala – home to almost 11 million people, around a quarter of Central America’s population – roughly 7.7 million people are in need of food aid.

Even before the pandemic, the region experienced the worst dry cropping season in decades. While it has always been characterised by a drier climate than other areas of Central America, extreme weather conditions – aggravated by climate change – are making the lives of millions of people who already experienced scarcity even harder.

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García Pérez uses a mincer to grind cooked maize. Before she bakes the tortillas on an open fire, she grinds the dough again on a stone. The children are waiting for breakfast.
Oscar Villeda/TNH
García Pérez uses a mincer to grind cooked maize. Before she bakes the tortillas on an open fire, she grinds the dough again on a stone. The children are waiting for breakfast.

Repeated and prolonged droughts, as well as heavy rains and storms – including two devastating hurricanes in quick succession in 2020 – have ravaged maize and bean crops for several consecutive years, leaving subsistence farmers without food for their families or goods to sell.

COVID-19 restrictions further added to the strain. Forced to stay home, people’s food stocks ran out and the need to purchase more supplies increased, while closed markets deprived families of their primary source of income. Many sold their agricultural tools or livestock to survive – despite the damage that might do to their longer-term prospects.

For García Pérez, it was only their farm animals that allowed them to survive. “We pulled through thanks to our animals. We ate some, and we sold some,” she explained.

For the Tansha community, the nearby border to Honduras remained closed until October due to the pandemic, hindering men like Bonifacio Gutiérrez López – García Pérez’s husband – from earning a living on Honduran coffee farms or banana plantations.

Usually, Gutiérrez López works six days a week, but sometimes he stays away for almost a month. Working on the farms would bring around 35 quetzales a day, or roughly $4.50. For months, he received nothing.

Generations of malnutrition

Following hurricanes Iota and Eta, which devastated their harvest, and deprived them of employment opportunities during the pandemic, the family faces an uncertain future. Asked if her children suffered from malnutrition, García Pérez answered: “Thank God, no.” But data collected at the local health centre right across the street would suggest otherwise.

Contrary to acute malnutrition – relatively rare in Guatemala – chronic malnutrition is often not obvious to the eye. Unlike the former, it doesn’t involve skinny bodies. Children would generally not starve, but they do lack essential nutrients for long periods of time.

In young children, malnutrition can lead to stunting – or low height for their age – when they don’t get enough proteins, vitamins, fats, or minerals in their diet. Other consequences include slow cognitive development and feeble immune systems, making every infection a potential death sentence.

“Usually, we have one case of acute malnutrition every year,” said José Vidal Ramírez, a 24-year-old nurse who runs the health centre here. “Last year, we had four.” According to Ramírez’s records, most children in the village exhibited signs of stunted growth.

Nurse José Vidal Ramírez runs the health centre in Tansha (the view of the borderlands of Honduras can be seen in the second photograph). Because the Ministry of Health hasn’t provided enough anti-parasite medicine since 2019, the nurse sometimes buys it from his own money. (Oscar Villeda/TNH)

According to government records, 50 Guatemalan children under the age of five died as a result of malnutrition last year, fewer than half the 118 recorded in 2019. However, the number of diagnosed cases of acute malnutrition almost doubled – from 15,395 in 2019 to 27,913 in 2020, according to Guatemala's National Information System for Food and Nutritional Security (SIISAN), and 2021 trends to date appear to show a further deterioration.

“If by the time a baby turns two, he or she shows growth retardation, that is irreversible,” explained Kimberly Corado, a nutritionist and food security activist with more than 10 years of experience working in the Dry Corridor. “You can only break the cycle if the mother is well-nourished at the time of her pregnancy.”. 

But most often very young mothers have themselves been malnourished since childhood, suffering from iron deficiency, for example. Full iron reserves reduce the risk of both mother and child mortality. Babies born with iron deficiency are often underweight and more susceptible to disease. In addition, low iron levels have a negative effect on their mental development.

The worsening situation comes amid ongoing cuts to Guatemala’s public health budget. In May, the health ministry announced reduced funding for programmes addressing malnutrition, including cuts of 11.3 million quetzales ($1.5 million) to help address chronic malnutrition, and $650,000 slashed for a plan to provide micronutrients to children under five. 

“The fact that acute malnutrition increased, and the number of people who need food aid also increased, is proof that the money put in social programmes is not enough and is not effective,” said Iván Aguilar, humanitarian coordinator for Oxfam Guatemala.

But while the government recently launched a National Grand Crusade for Nutrition – sharing what it considers to be its achievements on fighting malnutrition, including a guide on how to feed newborns – the country’s overall record has lagged within the region. Unlike its poorer neighbours Honduras and Nicaragua, Guatemala is the only country in Latin America that has long failed to decrease its malnutrition burden.

Limited options

For children to reach their full potential is already hard enough here: Education normally ends after primary school. But with COVID-19, even this basic education is at risk. 

Schools remained closed for about a year, and Guadalupe del Rosario Ortiz, principal at Tansha’s school, had to start from scratch when they reopened in April. “It’s like starting from zero,” she said. Digital classrooms were not an option, so teachers distributed learning materials to the families. But either parents were illiterate and unable to help their kids with their homework, or the children needed to contribute to their family’s incomes.

“There is child labour in this area,” Rosario Ortiz said, adding: “None of the kids who graduate from sixth grade continue their education. After school, they have three options: they start a family – yes, at that age – they start working, or they go to the US.”

Migration is usually the last resort for many people in the Dry Corridor. But the numbers of people leaving – mostly to the United States – have skyrocketed, even as US Vice President Kamala Harris, following a meeting in Guatemala with President Alejandro Giammattei in June, told would-be migrants not to come.  

For many people in Honduras, Nicaragua, El Salvador, and Guatemala – recognised as amongst the most vulnerable countries globally to the effects of severe climate change – living conditions are only expected to get worse. “Climate models predict: a rise in temperature for the region; overall less, but stronger rainfall; more hurricanes; and extended periods of drought,” said climate scientist Enrique Pazos, from the Universidad de San Carlos de Guatemala.

As one of the world’s most unequal countries in the world, discrimination is also an entrenched reality for much of the Indigenous Maya population, who represent around 40 percent of Guatemala's 17 million inhabitants.

Twenty-five years after a peace accord put an end to nearly four decades of civil war that left between 140,000 to 200,000 people dead and missing, social divisions remain stark. Nepotism within the ruling classes and rampant corruption further complicate matters.

Development aid and crisis response

Since 1999, ASORECH, an association of local farmers funded by German NGO Arbeiter Samariter Bund, has supported families in Tansha and surrounding villages with seeds, fertilisers, and technical assistance and provides an outlook into what the future could be for people in the Dry Corridor.

In nearby Tontoles, it has trained men in resilient agricultural techniques: helping them to build terraces to increase their yields, and to set up a seed bank. Members of the seed bank can borrow seeds to eat or plant, and can repay the bank a year later. Non-members must buy the seeds, but at a lower price than they would pay in stores.

As one of the project’s beneficiaries, Mercedes Olivio Hernández Amador was able to build a rainwater irrigation system in his vegetable garden in the steep hillside village, home to 89 families. He grows tomatoes, onions, aloe vera, coffee, pumpkins, and chilies. Small fish in the rainwater pool eat the mosquito larvae in the water, keeping the family at low risk of diseases such as dengue fever. 

When The New Humanitarian visited in May, Hernández Amador and several other men were digging a trench in a field not far from his house under the blazing sun. When it rains, the trench will hold back water that would otherwise flow over the edge of the terrace and be lost for irrigation.

Mercedes Olivio Hernández Amador’s family has a rich vegetable garden, but also access to a secondary school in Tontoles. Hernández Amador and other men from the village dig irrigation trenches nearby. (Oscar Villeda/TNH)

A government recovery centre in the nearby town of Jocotán provides for some of those less able to support themselves. Inside its recently built blue-and-white painted structures, there’s room for 15 malnourished children and their mothers. New patients arrive every week.

Four-year old Ivania López came whizzing out of the centre’s playroom in her red jumpsuit. At first glance, everything appeared normal. But Gilma Montenegro, a 45-year-old nurse, explained that Ivania only recently started growing hair. Her inhibited hair growth was a clear indication of malnutrition. Protein deficiency causes hair to fade, while acutely malnourished children lose entire tufts of hair.

Little Ivania was one of only four patients at the centre. “We have never been full,” nurse Montenegro said. That’s not because families do so well in this region. “If all the cases that we detect in the villages could be brought here, we wouldn’t have room for them,” Montenegro told The New Humanitarian.

But some of those who need help live up to 15 kilometres away and can’t afford to pay for the transport. The centre itself, though government-run, has no means to maintain a car for referrals. While the most severe cases are referred to hospital, others receive outpatient care at local health centres.  

For the children at the Jocotán centre, the nurses work out special diets that include specific nutritional supplements. It takes between two weeks and two months for the children to recover. After that, they’re still not out of the woods. “Some of these children do relapse,” explained Montenegro. “They return worse than the first time we got them.”

The New Humanitarian used transportation provided by ASORECH.

This article was partly funded by the European Journalism Centre (EJC) via its Global Health Journalism Grant Programme for Germany.

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