August 15, 2013 | By Roger Thurow

Guatemalan Children: Problems with Parasites

Washing hands. Practice makes perfect in a Guatemalan clinic. 

Palajunoj Valley, Guatemala

It was a good day at the Primeros Pasos clinic when a kindergarten class from the Tierra Colorada Baja school came for their annual checkup and health lesson.  Sixteen of the children, mainly five and six years old, brought stool samples to be tested.

“A big success!  Only 14 have parasites,” declared Irma Yolanda Mezariegos, the clinic’s lab technician, after a morning of testing.  “On most days, it would be 15 out of 16, or 16 of 16.”

That “only” 14 rates as a success indicates the toxic mixture of poor nutrition and poor sanitation that leads to widespread stunting of Guatemalan children.  Nearly 50% of children under five suffer from chronic malnutrition.  More than one-quarter of the rural population doesn’t have access to clean sanitation facilities.

The endemic presence of parasites, beginning in a child’s first months, can trigger malnutrition by absorbing nutrients meant for the human body.  Malnutrition isn’t only due to a lack of nutritious food; it can be exacerbated by worms, bacteria, aflatoxins and pathogens found in the food, water and soil.  The impact of poor sanitation in the 1,000 Days, from a mother’s pregnancy to the child’s second birthday, can last a lifetime.

“People here live and die with parasites,” explained Irma.  “It’s one of the reasons that Guatemala has such a malnutrition problem, and stunting.  The children just stay short and small.”

And so the nutrition and sanitation education begins early.  Primeros Pasos works with 10 schools in the Palajunoj Valley in the western part of the country.  Each day, a class comes by.  One morning in July, it was the turn of the Tierra Colorada Baja kindergartners.

After the children had been weighed and measured and examined, they gathered in a small classroom beside the medical facilities.  Lucy Alvarado, director of Primeros Pasos’ children’s health education program, stood in front of a wall covered with posters.  One was titled “Comidas Buenas”, another “Comidas Malas.”  Good Foods, Bad Foods.

Good Foods, Bad Foods. To eat or not to eat, that is the question asked by Lucy Alvarado of Primeros Pasos in Guatemala.

She pointed to the pictures of processed foods and artificially sweetened products on the Comidas Malas poster.  “If you eat too much of these, you’ll stay small,” she said.  “You don’t want to stay small, do you?”

“No,” came a chorus in reply.

“You all want to be big and strong?”


“Then you have to eat these foods,” Lucy said, pointing to the Comidas Buenas poster covered with pictures of fruits, vegetables, meats and dairy products.

“You’ve seen cars on the road.  What do they need to run?,” she asked.

“Wheels,” said one boy.

“Well, yes,” Lucy said.  “What else?”

The children pondered. 

“Gas,” one finally blurted.

“Yes!  Fuel.  And what if the car runs out of fuel?”

“The car stops,” a girl shouted. Lucy smiled at the connection. 

“Good foods are the energy, the fuel, for us.  What if we don’t have energy?”

“You fall down,” was the unanimous reply.

Lucy opened up a simple picture book and told a story about a girl named Marequita, teased by her friends as “the dirty one.”  She always played in the dirt and didn’t wash up afterwards.  She drank dirty water from the river.  She ate carrots straight out of the ground without washing off the dirt.  She didn’t wear shoes, brush her teeth or use a toilet.  Marequita gets worms in her stomach.

With an audience of kindergartners, Lucy Alvarado of Primeros Pasos tells the tale of Marequita and Valentin, a parable of nutrition and sanitation.

Lucy turned to a page with cartoon-like drawings of worms and other parasites.  One is named Valentin.  “Marequita ate bread with dirty hands and Valentin came into her stomach,” Lucy said.  “Valentin eats the food that you need.  You may be eating good foods, but Valentin is eating them once he gets into your stomach.  Valentin gets the benefits of the vitamins and nutrients, not you.  Valentin grows, you don’t.”

Marequita gets a stomach ache.  She gets a fever.  She is sick in bed.

“Have you ever had a stomach ache, a fever, been sick in bed?,” Lucy asked.

“Yes.  Yes.  Yes,” the children replied.

Marequita visits the doctor, who finds her parasites.  He gives her medicine to fight the worms.

“Who has taken pills?,” Lucy asked. All hands shot up.

Marequita learns to wash her hands, boil water before drinking.  She promises to wear shoes and use the toilet.  She becomes known as “the clean one.”

“So what do you need to do?,” Lucy asked.

“Wash Hands.  Use soap.”


“Before eating.  After using the toilet.”

The class walked outside to a water tap.  The pupils practiced washing their hands, top and bottom and between the fingers, and their wrists and arms as well.

With clean hands, they enjoyed a snack, a bread roll; no Valentins here.  And they clutched their takeaways for the day: a toothbrush and soap, and medicine if needed.  And a new role model: Marequita the Clean.

Roger Thurow’s reporting is supported by The Pulitzer Center on Crisis Reporting.


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Digital Preview of The First 1,000 Days

In his new book, The First 1,000 Days, Council senior fellow Roger Thurow illuminates the 1,000 Days initiative to end early childhood malnutrition through the compelling stories of new mothers in Uganda, India, Guatemala, and Chicago. Get a first-look at photos and stories from the book in this new web interactive.

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» Order your copy of the book.


The First 1,000 Days

Roger Thurow’s book will tell the story of the vital importance of proper nutrition and health care in the 1,000 days window from the beginning of a woman’s pregnancy to her child’s second birthday.

The 1,000 days period is the crucial period of development, when malnutrition can have severe life-long impacts on the individual, the family and society as a whole. Nutritional deficiencies that occur during this time are often overlooked, resulting in a hidden hunger. It is a problem of great human and economic dimensions, impacting rich and poor countries alike.

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The Last Hunger Season

In The Last Hunger Season, the intimate dramas of the farmers' lives unfold amidst growing awareness that to feed the world's growing population, food production must double by 2050. How will the farmers, Africa, and a hungrier world deal with issues of water usage, land ownership, foreign investment, corruption, GMO's, the changing role of women, and the politics of foreign aid?

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Roger Thurow and Scott Kilman, award-winning writers on Africa, development, and agriculture, see famine as the result of bad policies spanning the political spectrum. In this compelling investigative narrative, they explain through vivid human stories how the agricultural revolutions that transformed Asia and Latin America stopped short in Africa, and how our sometimes well-intentioned strategies—alternating with ignorance and neglect—have conspired to keep the world’s poorest people hungry and unable to feed themselves.

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