Written by: Belén Mateo, MD.
Photos by: Maria Cristina Mateo -
My name is Belen Mateo, I am a physician from Ecuador and since June 2020, I have been volunteering with FIMRC, a US-based non-profit organization with a project site in rural Ecuador, whose mission is to aid in the access to healthcare in different locations around the world through self-implemented health programmes for patients of all ages. These pictures were taken in November 2020 in a community venue, in Anconcito, Santa Elena, Ecuador, where the assessment of growth parameters of local children took place as a monthly intervention to monitor malnutrition within the community.
This photo essay explains the problems facing many of Ecuador's children living in rural areas, especially those whose communities’ access to public healthcare is impaired.
Chronic Malnutrition is a medical condition that has longstanding and major consequences for children. During infancy, it hinders a child’s normal physical and neurological development, which causes not only stunted growth but also prevents them from reaching their developmental milestones at the same time as their well-nourished counterparts.
But the repercussion of this pathology goes far beyond infancy. Children who are chronically malnourished during their first two years of life and who gain weight rapidly during childhood have a higher risk of developing chronic diseases as adults, such as hypertension and diabetes. Socio-economically speaking, children with a history of chronic malnutrition are more likely to have lower education and thus, have low-income jobs as adults.
In comparison to other developing countries, Ecuador performs slightly better regarding the prevalence of stunted growth and wasting (low weight-for-height) caused by nutritional deficits, with 23.5% under-age five stunting versus the developing country average of 25%; and 1.6% under-age-five wasting versus the developing country average of 8.9%.
Despite these differences in the data, Ecuador still experiences a malnutrition burden among its under-five population. According to Unicef, one out of four children under the age of five suffers from chronic malnutrition in Ecuador.
Most of these children are clustered in the rural areas of the country, where access to efficient health care is difficult. The origin of this problem is multifactorial, but perhaps the main issue is that government-administered health posts in rural areas usually lack the resources necessary to provide effective and continuous health care to their allocated populations, who rely heavily on the free medical coverage provided by these institutions.
An example of this is the coastal town of Anconcito, located in the province of Santa Elena. With a population of about 14,000 habitants, the government has designated a single health clinic that provides primary care for the community. Its services include, among others prenatal care, well-child visits, management of chronic illnesses and psychological counselling. However, due to the increasing demand and lack of resources, it is many patients are continuously left un-treated. As a result, excessive waiting times for a medical consultation render the public health system inaccessible for its habitants, except in the case of emergencies or in times of lower demands.
Acknowledging that this is an obstacle that’s difficult to overcome, people are usually very open to receiving help from other organizations operating in the area, such as national or international non-profit or non-government organizations, Peace Corps volunteers, entrepreneurs or anyone that is willing to help the community. Their work is vital to reach the ultimate goal of universal pediatric health for rural communities; to provide the necessary medical care to children under two years of age and to ensure their correct development that will set them on the right path throughout their childhood; and in turn, the rest of their lives.
The interventions in the communities aim to use a combination of resources from both parties- government health clinics and NGOs, to first collect data that including the weight, height and other developmental indexes of children that will allow the mapping and calculation of the prevalence of nutritional deficits such as stunting and wasting within a certain population.
For this purpose, both NGOs and government health post rely on the grassroot work of locals, who are willing to take an active part in these activities and use their knowledge of the community’s necessities to help create a bridge between the organizations and the local people. Understating what the population needs and expectations from these interventions are of utmost importance, as it impacts the confidence they place on their local government-provided health services versus those from the NGO’s; thereby affecting the continuity of these interventions and their effectiveness.
These programmes also need volunteering health professionals such as physicians, registered nurses, nutritionists and psychologists that can help not only to collect the data from the intervention but also to interpret it and make decisions about treatment and follow up consultations. One of the difficulties in recruiting these professionals is the lack of resources to pay them for their services. Most of the work done is pro bono, that is, an unpaid service for the sake of community welfare. Moreover, during these difficult pandemic times, it’s very hard for professionals to accept these types of services instead of a regular, paid job. In spite of these setbacks, many health workers are still willing to volunteer their time for this cause.
The responsibility of treating these children shows how important it is for the local and state governments to better relocate the resources provided in order to offer everyone quality health care that can be reliable, continuous and effective, in benefit of society’s most vulnerable members. Solutions to these deep-rooted systemic problems are complex, but nonetheless, achievable. A society in which children can experience successful development that allows them to transition effortlessly to adulthood; is a thriving society, as the reflection of these efforts comes in the shape of higher education levels, higher-income jobs and all-around social development for the country.
Please note that all parents consented to the photographing of their children for the purposes of this photo essay.
Global Nutrition Report: Ecuador. Website: https://globalnutritionreport.org/resources/ nutrition-profiles/latin-america-and-caribbean/south-america/ecuador/ #:~:text=Ecuador's%20adult%20population%20also%20face,14.9%25%20of%20men%20h ave%20obesity.
Unicef Malnutriton Statistics in Ecuador. Website: https://www.unicef.org/ecuador/ desnutrici%C3%B3n
FIMRC website: https://www.fimrc.org/ecuador
Reinhardt K, Fango J. Addressing chronic malnutrition through multi-sectoral, sustainable approaches: a review of the causes and consequences. Front. Nutr., 15 August 2014. DOI: https://doi.org/10.3389/fnut.2014.00013