By Helga Bjørnøy Urke
Peru is a rich country in terms of resources, geography, nature, people and culture, but it is also a country of great inequality. The coastal region has in recent years experienced increasing economic growth, whereas the Andean highlands and Amazon basin are still struggling with poverty and low investment in health and education. One of the greatest health challenges is chronic malnutrition in children under 5, affecting about 45% of children in the rural Andean region.
In relation to my master’s study and work as a research assistant on the subject of chronic child malnutrition, I had the opportunity to visit Peru on two occasions, both times in the Andean highlands. The first time I worked as a volunteer for the NGO Tierra de Niños, partner of the Norwegian Stromme Foundation. The second time I collaborated with PRISMA, a Peruvian NGO doing qualitative data collection on the subject of social, cultural, and familiar determinants of healthy child growth in the rural Andes.
During these visits I was involved in two health promoting projects working in areas of extreme poverty doing community development. In circumstances of economic adversity, hard physical work and work overload, children are often deprived of time to play because they are needed as labour in the fields. Together with Tierra de Niños I assisted in mother-and-child groups where awareness of the importance of a well-balanced childhood was emphasised. Women learned and practiced how to take care of their children not only in terms of hygiene and good food, but also how affection and attention towards the child would enhance healthy child development. Holding the baby tight to the chest and caressing it while breastfeeding, speaking to the child, not to mention singing, were all strange elements to most mothers. Some were even embarrassed to do these new practices in the beginning. During the sessions with Tierra de Niños, women would play, share their feelings about what they had learned, the difficulties of practicing, and the joy they felt when they managed to fulfill their goals. Seeing how confidence and pride took place in them when accomplishing even small improvements was truly inspiring, and I am full of admiration for these women.
I also attended sessions organised exclusively for children between 3 to 5 years old. Aside from practicing basic hygiene (i.e., washing hands and combing hair), these sessions were dominated by socialisation through play, and facilitation for the curious child to unfold. I remember one particular session when we explored the nature around us with magnifying glasses: it was great to see how much they loved this new experience.
For my second visit I worked with PRISMA in Ayacucho which runs a health project to enhance health and nutrition in the rural farming communities in the state. The project is called Integrated Health, and as the name indicates, it takes a holistic approach to community development. Parallel to constructing latrines, installing safe tap water and improving ventilation in the kitchens, the project runs informative and practical health knowledge sessions, focused at empowering the people to use the new installations, and raising their knowledge about basic health and nutrition.
At PRISMA, I did in-depth interviews with mothers about their perceptions and practices regarding food and nutrition, especially child diet. Due to both culture and economic deprivation, the diet in the rural Andes is sometimes monotonous and lacking important nutrients. To ensure some economic income people often sell the most nutritious food products they have, like milk, meat, eggs and cheese, instead of consuming it themselves. Selling also creates the possibility of buying larger quantities of less nutritious, but filling foods like rice and noodles. With few resources and many mouths to feed, mothers and fathers are often forced to seek this solution. This leads to low intake of important sources of certain vitamins and proteins, and in turn the high malnutrition rates in the region.
Talking to these women, it was clear how much they appreciated the presence of PRISMA and the sessions where they learned and practiced new knowledge about food and food preparation. Several of the women expressed that they felt better about themselves and their families now that they knew more about how to prepare a healthier and more varied diet. As one mother put it: “We have changed. Now it is easier and we feel better.” A simple statement, but one that tells a lot about how small improvements can mean important changes in the lives of people who are struggling for the daily survival.
Comparing the two visits, they were very different both in terms of my activities and how the programmes were structured. However, it was not difficult to identify health promotion aspects in either of the programmes. Sessions were participatory with women and children actively involved in, and responsible for the execution of, several of the activities. In spite of few resources, time constraints and difficult access to communities, both the people of the communities and the NGO workers showed an impressing dedication and willingness to participate and work to improve the communities. I was given clear examples of how health promotion works when practiced by and with the people concerned. The real health promotion is not necessarily in the offices of research institutions, or in industrialised contexts, but can also be found in action 4000 meters above sea level, 6500 miles “away from home”.
I would like to thank Tierra de Niños, Stromme Foundation, and PRISMA for their hospitality and collaboration. All three organisations are doing invaluable work in very difficult circumstances, all for the bettering of the lives of the people of the Andes.
Published: February 2011