June 26, 2014 | By Roger Thurow

How Guatemala Finally 'Woke up' to Its Malnutrition Crisis

This video and post originally appeared on PBS NewsHour.

GUATEMALA CITY — In a hip restaurant set within a high-fashion clothing store, baristas created “Super Nutritious” drinks like the Sangre de Vampiro, a mixture of pineapple, celery, beets, lemon, orange juice and organic honey. “Rich in antioxidants,” boasts the menu.

Elsewhere in the restaurant, the subject of malnutrition was on the table. “Guatemala is fourth place in the world in chronically malnourished children,” Alejandro Biguria, a young architect in this capital city, was saying. “It’s outrageous.”

A tale of two Guatemalas: On the left, mostly Mayan families living in the highlands can receive staples like rice and beans provided by organizations like USAID. On the right, diners sample dishes at the high end Café Saúl in Guatemala City. Photos by Hari Sreenivasan

He was anguished by the “horrific numbers,” as he calls them: Nearly 50 percent of Guatemala’s children are malnourished, which often leads to physical and mental stunting. That’s the nationwide figure; in some areas of the western highlands, where the Mayan population is largely concentrated, the malnutrition rate is upwards of 70 percent. That’s the worst in all of the Americas — or, as Biguria would put it, a first place for Guatemala. An outrageous first.

Until a few years ago, Guatemala’s high society in the bustling capital was ignorant of the country’s malnutrition problem. For them, flights to Miami and Houston for shopping trips were shorter, and more fashionable, than a drive to the western highlands.

Then a social movement, led by Biguria and some friends and colleagues in the private sector and civic society, began to stir the nation’s conscience. They launched the “I Have Something to Give Campaign,” hoping to get Guatemalans “involved in something bigger than themselves,” Biguria says. The aim was to take advantage of a burst of interest in Guatemala as people around the world studied the Mayan calendar for predictions of transformative events at the end of 2012. The campaign rallied thousands of Guatemalans to come together and form a human chain to the top of one of the nation’s volcanoes; another group formed a giant heart.

Another novel idea was for city residents to spend a weekend in the homes of poorer families, mainly in the rural areas of the highlands. Biguria says he was astonished when more than 6,000 people volunteered. This included members of the government as well as business leaders. The country’s new president had launched a Zero Hunger Pact, which helped elevate Guatemala to the top ranking in the global Hunger and Nutrition Commitment Index (HANCI), which is maintained by the Institute of Development Studies in Britain. The government’s Food Security and Nutrition department was anxious to build momentum behind the Pact, to create a “social movement,” as Luis Enrique Monterroso, its director, says.

The participants in the home visits received a close-up view of malnutrition and the struggles of fellow Guatemalans. This lead to a new campaign — Wake Up, Guatemala! — to bring malnutrition, and the country’s disparities, into the national spotlight.

Eyes opened, minds engaged. Guatemala, it seems, woke up.

Juan Carlos Paiz, one of the country’s prominent businessmen, ate a meager dinner with his host family and saw how scarce vegetables and fruit were in the diet. “What you see with the very poor is that they think every minute about surviving,” he says. “Then they can’t think of the future.”

But Paiz, a leader of the country’s competitiveness council, left the experience thinking only of the future. What was child malnutrition and stunting doing to the economy, he wondered? If malnutrition held students back in school, how could they be prepared to join a work force demanding ever more technical skills?

Guatemala is the most populous country in Central America, with a population of about 15 million people, and nearly half of them are under 20 years old. This should deliver a “demographic dividend” from a generation of educated, creative workers. Instead, Paiz worries, the high rate of chronic malnutrition is delivering a generation with stunted possibilities. “If we don’t fix the malnutrition issue, we won’t have good education,” he says. “We’ll lose 20 percent of the brainpower of 50 percent of our people. Which is killing our demographic dividend.”

Spurred by this future-shock, Guatemala’s private sector magnates forged an Alliance for Nutrition and allied with the government and civil society efforts. “We reached the agreement that a country could not become competitive if the human capital that we had was malnourished since childhood, and it had its limitations,” says Alvaro Castillo, an Alliance for Nutrition founder. “How could we allow this to happen in our country? We have to do something.” (Watch excerpts from that interview here.)  

Biguria welcomes this wide front in the movement, for he knows that political commitment can waver. In Guatemala, presidential administrations are limited to one four-year term, which is precious little time for social reforms to take hold; one administration’s policies are often ignored, if not reversed, by the next administration. He hopes the fight against malnutrition can transcend governments.

In the restaurant within a clothing store, Biguria opens two boxes and retrieves a model of his Casita de los 1,000 Dias, the 1,000 Days House. He built it to give structure to the government’s commitment to reduce childhood malnutrition and stunting by improving conditions during the critical 1,000 Days period. That is the time — from the beginning of a woman’s pregnancy to the second birthday of her child — when good nutrition is vital for the proper development of a child’s brain and body. Any malnutrition shock during this time can leave a child stunted both physically and mentally, imposing a lifetime sentence of underachievement.

The casitas would serve as places for both health care and public education. There’s a room for maternal and infant care, a handwashing station for sanitation training, scales and measuring boards for charting a baby’s growth, an ecological stove that contains the smoke from wood fires, solar panels on the roof, and open-space classrooms for lessons on nutrition and hygiene. Biguria says all the building materials can be transported in the back of a pickup truck; he has the cost down to $5,000 a house.

He believes the 1,000 Days house can also be a place to unify Guatemalans. He would like to see the casitas constructed all over the country. But so far none have been built in Guatemala. So he keeps up the pressure on the government and business partners to act.

“We have to invest. We have to push and make people understand that we need to continue,” he says. “Now the discussion is on the table. It’s not just a political commitment, but a moral commitment to the country as well.”

Roger Thurow’s reporting on the 1,000 Days 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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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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