8 Nov 2012
At the age of two and a half Manuel, because of his epilepsy, is one of Asociación Pop Wuj’s chronic patients. After he was brought to the association’s attention he was sent to a neurologist and had a succession of tests. With a medicine regimen of Depakote he stopped having seizures. But his mental development continued to be slow.
In August of this year Manuel came to Pop Wuj sick. It was a Monday, a day the clinic is not open. A volunteer took him to La Bendición, another clinic project. The pediatrician there prescribed an antibiotic for Manuel’s pneumonia. She also diagnosed him with malnutrition and recommended food supplements.
Carmen is one of Pop Wuj’s founders and the director of the social programs. She has a big heart for the scholarship children and the chronic patients. Whenever she talks about Manuel’s pediatric consult, she shakes her head and facepalms.
“I can’t believe we looked over the obvious problem.”
She did a home visit and is now worried that malnutrition is a problem for the whole family. Manuel’s father works in construction. His mother takes care of the four children. They live in one room, six people sharing one bed. Their modest dwelling doesn’t have running water. The oldest child spent five years in first grade and was never able to pass to second. He now works collecting and selling garbage. The second just repeated first grade. She passed, and will receive a scholarship from Pop Wuj for the next school year and beyond. The third is four years old; he hasn’t entered school yet. Manuel is the youngest.
The family is now the subject of a comprehensive health effort. In addition to Manuel’s Depakote, Pop Wuj provides scholarships, nutrition supplements, and vitamins. They are on the schedule to have a wood-burning stove built. Carmen is trying to get his mother a nutrition consult at the hospital so that she can have more guidance.
In an earlier blog entry it was noted that over 50% of Guatemalan children suffer from stunting (height-for-age below -2 SD) because of chronic malnutrition. It is a millstone that continues a cycle of: poverty → poor nutrition → developmental effects / diminished intellect → weak educational achievement → poverty → poor nutrition.
In clinic we measure every child’s height and weight and plot them on a growth chart where age is on the x-axis. Much too often I plot height and weight points in the bottom tenth percentile, and even below the lowest percentile line drawn on the chart.
Once in clinic I was trying to plot a girl’s height and weight. Her chart said that she was 13 years old, but her birth date was left blank. I asked her when her birthday was.
“I don’t know. I’m about 13.”
I called her father over. In response to my question about his daughter’s birthday he said,
“Ay, no me acuerdo.” I don’t remember.
Something I did not believe until I saw it for myself: It is not uncommon for parents to not know the exact age of their child. The many children born at home do not automatically receive a legal record of birth. And some parents do not make note of their child’s birthday. Pop Wuj once started assisting a child who had no documentation: no birth certificate, no equivalent of a social security number, no nothing. They had to hire a lawyer to get her “into the system” so that she could attend school.
The data that we have on development and nutrition status is based on age; it’s virtually impossible to know how a child is doing without knowing their exact age.
In the mountains, in a town called Llanos del Pinal, Pop Wuj runs the Guardería. It is a family support center with a before and after school program for 36 children, ages 1-18. Nutrition-wise the Guardería kids are better off than other children in Llanos; they receive two hearty snacks a day as part of the program. And children in Llanos are better-off than children in more rural parts of Guatemala.
Twice a year our mobile clinic does well child checks with Guardería kids. During the last mobile clinic Allison, a fellow fourth-year medical student, diagnosed a lot of the children with failure to thrive. It is a complex term that basically signifies poor physical growth of any cause, usually defined in terms of very low weight for age. This, despite their better nutrition.