Dietetics
on the Side of Volcano Agua
By Diana Bucey, RD
Today’s Dietitian
Vol. 7 No. 6 P. 46
An RD balances the effects of cultural beliefs
and globalization as she teaches nutrition and health to Guatemalan
villagers.
Every day I drive up a volcano to Santa Maria de
Jesus, Guatemala, to practice community health and nutrition. Though
Santa Maria sits on volcano Agua, it’s the least of the worries
faced by the people who live in this village of 17,000. As I walk
through the village, I see beauty in the Mayan people who populate
the area, the mixture of bright colors, and a huge volcano in all
its majesty. I have learned about various foods, tasted things I
never imagined I would eat in my life, and experienced the culture
through food and people. Yet I also see the ugliness in extreme
poverty, hunger, and a population still facing oppression and injustice.
The Village
The main crops grown in fields on the side of the volcano are corn,
beans, and snow peas. We see a high rate of diabetes, heart disease,
and intestinal disease, but respiratory disease and malnutrition
are still the top causes of death. Seventy percent live with chronic
malnutrition, which is the highest rate in the region.
Market Day
Agriculture provides most families with their income. The soil is
incredibly fertile due to the volcanic ash. Wonderful fresh fruits
and vegetables are in abundance at the central market. Here one
finds women and children sitting on the ground selling various fruits
and vegetables not found in many areas around the United States.
Some of these include quisquil, a squashlike/potatolike green vegetable;
pacaya, a bitter stringy vegetable; many different classes of squash;
chicos, a figlike fruit; jocote, a small tart fruit with a large
seed in the middle; and zapote, a fruit that is the size of a small
melon with a brown, barky skin but is bright orange inside and very
sweet. The produce is inexpensive compared with fruit and vegetable
prices in the United States. A pineapple costs approximately 25
cents, broccoli 20 cents, strawberries 25 cents per pound, and tomato
approximately 20 cents per pound.
La Tienda (The Store)
Many Santa Marian families own small stores that I call “bodegas
of empty calories.” One finds roughly three of these stores
on every small block. They are stocked with sodas, potato chips,
candy, salt, and high-sugar juices and are popular with the villagers,
especially children, because the snacks are cheap and accessible.
A bag of potato chips costs approximately six cents and a 12-ounce
soda approximately 25 cents.
Typical Dishes
Many of the typical dishes are heavy sauces made with different
herbs, seeds, chili, and tomato and are served on various occasions.
The most popular plate is called pepian and is served for weddings
and special events such as anniversaries. It is a thick sauce of
tomato, pumpkin and sesame seed, cilantro, chili pasa y mexicana,
and red pepper, which is poured over chicken and served with potato
or quisquil, rice, and tortillas. Another dish, hilachas, is like
a beef stew. Tamales are popular, especially at Christmas, and made
with corn and meat wrapped in a banana leaf and boiled. Most drinks
are served warm, such as rice milk or a sweet corn drink.
Daily meals include rice, black beans, tortillas,
and sometimes eggs. The big meal is usually served at lunch with
dinner being more of a snack, such as coffee with bread or tortillas
and salt.
Tortillas, Tortillas, and More
Tortillas
Most of the diet is comprised of carbohydrates such as white rice,
tortillas, potatoes, pasta, and bread. Many believe if one hasn’t
eaten five to 10 tortillas in a meal, then one hasn’t really
eaten. The idea that our bodies need various nutrients from a variety
of foods to function well doesn’t exist. For example, one
morning I prepared a breakfast of tortillas, eggs, fruit, and black
beans for a group of teenagers. When we ran out of tortillas, they
started to complain that they would be hungry, and of course, it
was my fault. I suggested they eat more eggs and beans since there
were plenty left, but as they rolled their eyes, I received the
response that those foods would not help them feel full and no one
ate them.
Infant Feeding Practices
Infant feeding practices contribute to the rate of chronic malnutrition.
Most mothers breast-feed until the infant is aged 1 to 2. The method
used to breastfeed is “snacking.” There is no schedule
and usually the infant only feeds for a small period of time. Whenever
the baby cries, the mother gives the baby the breast for roughly
five minutes, therefore babies rarely receive the quantity they
need during this rapid growth stage. Many infants are given coffee
or water in bottles. The mothers believe the liquids fill the stomach,
meeting for the infant’s needs.
Cultural Practices
Culture has much to do with the diet of Santa Marians. Many of the
beliefs go back thousands of years. Villagers put each food in one
of two categories—”hot” or “cold”—but
this has nothing to do with the food’s temperature. One’s
“state of being,” the weather, or other factors determine
the category of food one can have. For example, a friend told me
how her 4-month-old niece could not have rice cereal because the
infant had an infection that is considered “hot” and
so is the rice. She could not feed the child or she would become
more ill.
Many believe intestinal infections and parasites occur not through
poor hygiene or food handling practices but from the wrong mixtures
of food. Through our Western eyes, we see these beliefs as odd,
but many see our ways as odd.
We are working on encouraging people to include
more fiber in their diet because of the high rate of gastritis and
other intestinal problems. Bran is highly available because it is
fed to the horses. I frequently suggest that people add it to their
hot oatmeal drink or in cereal. I usually get a weird stare and
get called a horse. As dietitians, we must find the balance in working
with the cultural food habits as they are but also encouraging people
to be open to change.
Nutrition Concerns in Santa Maria
de Jesus
Santa Maria de Jesus is a small example of the reality of nutrition
problems that affect many poor populations globally. The high rate
of chronic malnutrition in the region and an increasing rate of
chronic diseases reflect the culture’s poor diet and lack
of exercise. Heart disease, gastritis, diabetes, and cancer are
prevalent in the village.
A common question I am asked is, “Why so much
malnutrition if there are so many vegetables and farms?” One
theory is that many people do not eat the fruits and vegetables.
When I ask “why,” I’m given the explanation that
it is not “cultural” to eat them; they must sell them
for money. Another reason given is that it is too expensive to buy
them when they only have so much money to go around.
The diet has a high intake of refined carbohydrates
and sugars but very little nutrient content. As seen in the practice
of giving water or coffee to a newborn instead of breast milk, there
is a cultural belief that it doesn’t matter what you eat as
long as you are full.
If the high rates of intestinal infections and parasites
in the village are not treated, children may have diarrhea for months,
if not years, thus preventing their bodies from absorbing many nutrients.
Due to poverty and large family size, often there is not enough
food and money to last, which fosters a sense of food insecurity.
Due to lack of education and healthcare, many people do not have
an understanding of proper nutrition or a respect for individual
physical health.
Globalization is affecting the nutrition of people
everywhere. Says Popkin in the article “The Nutrition Transition:
An Overview of World Patterns of Change,” “While the
penetration and influence of modern communications, technology,
and economic systems related to what is termed globalization have
been a dominant theme of the last few decades, there seem to be
unique issues that have led to a rapid increase of globalization
and its impact.”2
Nutrition Transition
The idea of the “nutrition transition” is reaching Santa
Maria de Jesus with the increase of chronic diseases such as diabetes,
gastritis, cancer, and heart disease. Many stores in the village
offer sugar-filled, fatty, calorie-dense food, which is being seen
all around the world in poor countries. One study by Rivera et al
showed that in Latin American countries from 1984 to 1998, the consumption
of fruits and vegetables declined 29%, but the rate of refined carbohydrates
and soda consumption increased from 6.3% to 37.2%.1 This trend is
reflected in Santa Maria de Jesus. Though many of these foods are
not from the culture, they are highly accepted. Entering Santa Maria
de Jesus, one cannot miss the Pepsi and Coca-Cola signs painted
everywhere. Many people have television and are exposed to promotions
for high-energy foods.
Socioeconomic and political factors affect nutrition
in Santa Maria de Jesus. Guatemala is still recovering from a 36-year
civil war and remains in a state of political unrest. Also many
Mayans and women are oppressed as racism and macho mentality runs
deep. Many people live in rural areas with little access to transportation
and opportunity. Due to the poor economy, many people see little
hope to advance even if they are educated. These factors also influence
the nutritional well-being of each individual. We cannot “fix”
the nutrition status without addressing the circumstances around
it.
How Can We Help?
Here are some practical ways we can have positive effects in the
world of nutrition:
1. Be aware of what goes on in the world around
the issues that directly and indirectly affect global nutrition
status.
• Use the Internet: World Health Organization
(www.who.org), United Nations Development
Program (www.undp.org), USDA (www.usda.gov),
Food and Agriculture Organization (www.fao.org).
• Network with other professionals in international
health and nutrition.
• Read recent literature on health and nutrition
in the developing world.
2. Get involved.
• Write your congressional representative
about international health policy.
• Join an international practice group such
as the Hunger and Environmental Nutrition Practice Group.
• Volunteer time working at a food kitchen,
shelter, or even with a group working overseas by having a food
drive.
• Financially support organizations working
overseas.
• See for yourself what is happening by joining
a group for a short-term trip and experience it first-hand.
• Educate others about hunger and disease
around the world.
Many times it is easier for us to close our eyes
to the sad reality of malnutrition and disease, especially when
we are well, but we are called to more. We have been given a gift
of education and resources to share with others. I encourage everyone
to get involved with these issues. Every person counts.
— Diana Bucey, RD, practices community
health and nutrition in Santa Maria de Jesus, Guatemala, with the
organization Mission Impact. To learn more about her work, visit
www.dianabucey.com.
References
1. Rivera J, Barquera S, Gonzalez-Cossio, et al. Nutrition transition
in Mexico and in other Latin American countries. Nutr Rev.
2004;62(7 Pt 2):S149-S157.
2. Popkin BM. The nutrition transition: An overview
of world patterns of change. Nutr Rev. 2004;62(7 Pt
2):S140-S143.
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