Connect to share and comment

President Obama's ambitious Global Health Initiative — announced to a receptive international community in 2009 — is faltering as budget constraints and shaky implementation limit the impact of the multibillion-dollar program.

GHI targets chronic malnutrition in Guatemala

'Invisible killer' stunts Guate's youth.

CAJOLA, Guatemala — High in the mountains, a narrow and practically impassable mud trail leads to the dirt-floor shack where Isabella Hernandez is rhythmically patting tortillas, the main source of sustenance for her nine children.

A wisp of a woman, clothed in her community’s signature colorful dress, Hernandez is illiterate and a single mother who ekes out her family’s existence on less than $1 a day. Nearly 60 percent of this mostly indigenous Mayan town lives in such extreme poverty.

On this day a health worker had come to weigh and measure the children while delivering a nutritional supplement for the poor. A veteran in the hunger wars, Julissa Garcia knew what she would find. Sure enough, they were not only underweight but about half a foot shorter than the minimum recommended height for their age. Known as stunting, such a height deficit is a key indicator of chronic malnutrition.

“Almost all the kids here are malnourished,” said Garcia, who has pioneered a support group for Cajola mothers with stunted children.

It is communities like these that President Barack Obama’s Global Health Initiative (GHI) is focusing on in Guatemala. Slow in its implementation and hampered by little new money, GHI is targeting Mayan women and children in the mostly indigenous Western Highlands, a mountainous area with a single maize harvest per year. The strategy’s cornerstone is reducing one of the highest rates of chronic malnutrition in the world. According to the United Nations Children’s Fund, only Afghanistan and Yemen fare worse. Half of all Guatemalan children under five are stunted and in the Western Highlands, it's seven out of 10.

“These children have been lost. They can’t learn, they can’t be productive.”
~Dr. Baudilio Lopez, project development specialist at USAID office in Guatemala City.

Called the “invisible killer,” chronic malnutrition isn’t necessarily a lack of food but a shortage of the right kind. Faced with insufficient nutrients, especially protein, the body compensates by simply stopping to grow. More importantly, brain capacity and productivity is reduced by as much as 40 percent. That can’t be recouped.

Such a lack of nutrients is obvious in Hernandez’s small shack. Lunch is their highlight, when the children fall silent as they shovel down tortillas flavored by salt, potatoes, and plants their mother picked in the fields. They eat while they can. Their bellies will predominantly rely on hot maize drinks for the rest of the day.

There are no beans or eggs. Meat is a rare luxury.

Garcia gasped when she saw how the three middle boys, each more than a year apart, essentially weigh and measure the same — at or below the minimum recommended amount for the youngest. It’s difficult, however, to gauge the effects of stunting on their cognitive development. None of the Hernandez children have ever attended school and all are illiterate, most speaking mainly their indigenous language of Mam.

An overwhelming problem

The magnitude of the problem is stunning, as are the consequences. Such children are particularly susceptible to diarrhea and other illnesses. Chronic malnutrition is the single biggest contributor to the deaths of children under five. As concerning is the effect on their brains, thus the consequence on Guatemala itself.

“These children have been lost,” said Dr. Baudilio Lopez, a project development specialist at the Guatemala City office for the U.S. Agency for International Development (USAID.) “They can’t learn, they can’t be productive.”

GHI, which Obama unveiled two years ago, has been slow to implement, according to critics. And, due to the U.S.’s own budget woes, it has been hampered by less funding than expected. In Guatemala, USAID received basically the same level of funding, about $14 million, over the past two years, and just over $16 million for FY 2011. Cuts are likely ahead, given Washington’s budget crisis.

Nutrition efforts will also benefit from funding to Obama’s global food security initiative, which channeled about $25 million annually into Guatemala over the past two years.

The amount of funding pales in comparison to the seven other GHI focus countries. Guatemala’s GHI program receives by far the smallest amount of aid, just 1/37th received by Kenya, which has a $600 million GHI budget.

Still, officials at USAID and the Centers for Disease Control and Prevention, GHI’s two main implementing actors here, remain buoyant. They say the tightened focus on specific global health issues in a targeted geographic area combined with better collaboration among U.S. agencies is revolutionary.

For their