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 percent 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.
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.
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.