Roatan’s Malnutrition First-Responders
Clínica Esperanza Trains Promotoras to Identify and Aid Children at Risk of Hunger

October 26th, 2012
by Robert Armstrong

[private]

Olga Conner, promotora for Mudhole, receives chewable vitamin supplements from Clínica Esperanza to dispense to malnourished children. Emily Flowers (left) is seeking donations from local businesses to expand the health-intervention program.

Olga Conner, promotora for Mudhole, receives chewable vitamin supplements from Clínica Esperanza to dispense to malnourished children.

Floridalma (Flor) Del Campo spends her free time visiting her neighbors in Colonia Bella Vista, up the hill from Roatan’s Sandy Bay, to see what they have in their kitchens. She also measures and weighs their children to plot them on growth charts, advises mothers on proper nutrition and, if necessary, dispenses vitamin supplements, diarrhea medication or pills to kill intestinal parasites.

Flor is a promotora, a sort of paramedic trained at Clínica Esperanza in Sandy Bay to promote better nutrition and primary healthcare in Roatan’s poorest communities. Her Bella Vista neighborhood, populated mostly by recent migrants from the Honduran mainland, is considered the community with the highest malnutrition risk on the island.

There are currently eight promotoras, serving the communities of Sandy Bay, Bella Vista, Balfate, Mudhole, Crawfish Rock and Corozal. They were recruited in March, provided 16 weeks of training at the Clinic, then equipped with scales and blood-pressure measuring apparatus and sent into the field in August with a $2,000 seed grant from the Roatan Rotary Club.

Emily Flowers, a volunteer coordinator for the program, is seeking donations from local businesses to expand the promotora corps to 50, as well as to equip them with blood-sugar machines and test strips. For $85 a month, she said, a business can support one promotora.

Each promotora prepares a census of her assigned neighborhood, then endeavors to visit every household with children under 12 or pregnant women at least once a month, with more frequent visits to those with children found to be at risk.

Patrick Connell, a medical advisor for Clínica Esperanza, accompanys promotora Flor Del Campo to inspect the kitchen of Teodolinda Orellana (in yellow), who struggles to feed her seven children on her husband’s minimum salary as a watchman.

Patrick Connell, a medical advisor for Clínica Esperanza, inspects the kitchen of Teodolinda Orellana, who struggles to feed her seven children on her husband’s minimum salary.

“Nutrition up to age two is very, very important,” explained Patrick Connell, a doctor who volunteers at Clínica Esperanza and consults for the promotora program. “The majority of brain growth occurs before age two. So if you don’t feed them well, you affect them for life.”

Connell said young children were particularly at risk between the time they stop breast feeding, typically around a year, and when they are able to grab food for themselves off the table, around age 4-5. During that period they depend on their mothers to feed them. If the mothers do not know about good nutrition, they may make poor choices, and the children suffer.

For example, he said, many less-educated women in poor communities on Roatan give their toddlers bottles filled with sugary soft drinks or even coffee. This satiates their hunger without providing any nutrients. He said he saw the same thing when he worked in Vietnam a couple years ago, where women who could not afford meat or fish fed their children rice water or sodas. There he instituted a program called “Three Eggs a Week.”

“There were lots of chickens and ducks running around,” he said, and three eggs a week will give a child the nutrition she needs.

Connell said he did not expect to see such problems on Roatan, which is perceived as relatively prosperous because of the tourism economy. But he said the clinic noticed people from certain communities were bringing young children in who were discovered to be suffering from chronic malnutrition, including one girl, Jessica, who was more than a year old but weighed only 12 pounds. Children from these communities were not receiving basic preventive care.

Promotora Flor Del Campo in front of her home in Colonia Bella Vista after making her rounds. Bella Vista has been identified as the community with the highest risk for malnutrition on Roatan.

Promotora Flor Del Campo in front of her home in Colonia Bella Vista, which has been identified as the community with the highest risk for malnutrition on Roatan.

The idea of the promotora program, said Connell, is to proactively reach out to these communities and not wait for parents to bring children into the clinic after they get sick. Also, he said, mothers might be more receptive to nutrition advice from someone from their community rather than an “old gringo.”

An immediate goal of the program, said Connell, apart from completing a baseline census of at-risk children, is to encourage mothers to leave children on the breast as long as possible and not to give them sugary drinks, which he tells the promotoras are “del diablo.” In the long view, however, he thinks a more robust intervention may be required.

“I think we may need a food bank here,” Connell said. [/private]

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