With food and play, Argentinean health initiative goes the extra mile to tackle child malnutrition

A weary rhythm marks the hours over the humble dwellings on the dirt streets in Herrera. I have only been for a short time in this town 150 kilometres from the capital of Santiago del Estero, where 2,000 people live, and the question that will hang over the next 48 hours is already appearing: how does one raise a child in the midst of poverty?

The context is challenging: according to the Ministry of Health of Santiago del Estero, 31.1% of children under five years of age in the province suffer from chronic malnutrition. At the same time, poverty among children between 0-14 years of age reaches 56.2%, according to data from the first semester of 2023 of the National Institute of Statistics and Census.

Housing is precarious, many lack access to drinking water or sanitation, and unemployment or under-occupation abound. “My husband is away on a trip,” say almost all the women I visit. Most of them are seasonal workers: hired seasonally by rural companies in other provinces, they leave their homes for several weeks at a time.

“The combination of comprehensive care of the child by specialised professionals and the training of the mother in daily care is the best strategy for the psychomotor recovery and the recovery of the children’s weight and height,” says Gabriela Rao, the technical referent of the Early Stimulation Area of Haciendo Camino.

The nonprofit Haciendo Camino has 12 centres in Santiago del Estero and Chaco, two of Argentina’s poorest provinces. Last year, 1,646 children (almost always up to the age of five) received comprehensive care, 2,947 had growth controls and 1,413 mothers participated in health education talks, received family support, and were empowered to become agents of change in their communities. Of these mothers, 120 attended the centre located in Herrera.

More than two years: that was the time that passed between the last month that Demir was in Cinthia Farias’ (31-year-old) womb and the day he received his nutritional discharge. During that time, his mother regularly took him to the centre where Haciendo Camino works in the town of Herrera, Santiago del Estero, with mothers of children suffering from malnutrition. There, Cinthia learned about the importance of incorporating vegetables, fruits, and proteins in her son’s diet and how to establish a bond with him focused on his needs through play.

“I made my baby’s first baby blanket and changing table at the Haciendo Camino centre. They also taught me how to breastfeed and start feeding him. I learned things I didn’t know with my first daughter – Ivana – like avoiding sodas and juices and instead giving her lots of fruits,” she tells me as she leaves the consultation with Greta Willi, the nutritionist, who suggested that Demir start eating with a plate more similar to the rest of the family.

raft time is one of the moments mothers enjoy the most: it is a time of recreation and relaxation. Credit: David Flier, The Human Journalism Network.

“We took an integrated care model from CONIN – the Argentine foundation dedicated to combating child malnutrition. That is, providing nutritional assistance with social support and early stimulation. We noticed that it worked for the mothers to have spaces such as handicraft or education workshops in addition to coming for check-ups,” says Cecilia Lecolant, director of the Herrera centre, after making rice pudding for the afternoon snack during a break in ETEC’s biweekly workday.

“The Haciendo Camino programmes aim to provide nutritional treatment and accompany the families in their homes,” adds Natalia Fernández, technical referent of the Nutrition Area.

During the three-hour day, the participants take a workshop in which they learn practical aspects of parenting at home. This afternoon, Lecolant leads the workshop. She proposes that they make posters to prevent accidents and make them think about their experiences. One idea they came up with is keeping medicines out of children’s reach.

About 19 women are usually invited to each meeting, and about 12 attend, most of them in their 20s and 30s.

“Once the nutrition programme was up and running with the integrated methodology, we noticed that families with children without malnutrition wanted to stay connected,” says Lecolant.

Haciendo Camino thus added the ETEC service, which follows a logic similar to that of nutrition but with a greater emphasis on promoting positive parenting, a set of practices centered on respectful treatment and adapted to children’s interests.

Beatriz Gómez (26) has a shyness that is not seen in any of her three children: eight-year-old Sebana, six-year-old Valentina and two-year-old Gael. They play between the inside and the house’s entrance, surrounded by chickens that wander around like those who inhabit the territory. With the three of them, she attended the Haciendo Camino Center.

She works cleaning a church, and her partner assembles bags of charcoal in the village when he’s not a seasonal worker.

“I participated in talks and sewing workshops. For example, I learned what to give them when sick or take their fever. It helped me in the development of my children,” he says. However, not everything started well: “It was hard for me to adapt; I thought they were going to be mean and that they were going to challenge me because my daughter was underweight, that they were going to tell me why I didn’t take her before. But instead, they congratulated me for taking her,” she recalls.

Trust is an important pillar of Haciendo Camino’s work.

“Some are waiting to meet you to open up. And it’s good for them when we sometimes open up and tell them things like ‘this happened to me too,’” adds Silvia Burgos. She is one of the leaders at the centre in Herrera. “I like how they treat us and what they teach us about how a child should develop. For example, I learned not to sit her down so early,” says Fabiana Maldonado (33) after reviewing a booklet on baby behaviour. Her daughter, Larisa, a year-and-a-half old, looks withdrawn to the side. Fabiana tells us she just stopped breastfeeding.

Lecolant leads a workshop where they learn how to prevent home accidents. Credit: David Flier, The Human Journalism Network.

It is not by chance that many women find in the professionals and other mothers who have gone through Haciendo Camino someone they can trust. According to an impact evaluation of the nonprofit programmes carried out last year by the UCA, “the deficit of social support perceived by the women mothers is greater in the participating group because they do not have someone who can help them in the preparation of meals, they do not have someone to talk to, or to help them with the care of the children.” I read that, and the women’s wary (perhaps fearful) faces make even more sense.

“Mothers lack a lot of knowledge about their rights and those of the children, and we put a lot of emphasis on teaching them that, especially through workshops and talks,” Mendoza elaborates after having the individual interview with Gabriela. “For example, we work with many women who suffer gender violence: we try to empower them, show them that it is not normal and that they should not allow certain situations in their homes.”

In addition to assisting with paperwork (for example, with the municipality, the health post, or obtaining subsidies or documents), the social area also works on hygiene and safety habits. Although the programme is not exclusively for women, in practice, it is the mothers who attend.

Fathers usually spend a large part of the day out of the house working and it is important that mothers take care of their upbringing. “I’m happy that my wife and children go to the centre,” Mario, 27, the father of Alejo and Neythan, tells me. He is the only adult male I come across during my visits to the homes of those who attend the centre.

The entrance to the Haciendo Camino centre in Herrera, about 150 kilometers southwest of the capital of Santiago del Estero. Credit: David Flier, The Human Journalism Network.

Siesta time (a short nap) has been over for a while, but the peaceful rhythm in the rural area of Herrera is not disturbed. Flavia Pérez (30) excuses herself and takes a basin with clothes hanging a few meters away. We wait for her, sitting in front of Giovanni, her six-month-old son, and Romeo, her oldest son, who is five years old, with whom Flavia started attending Haciendo Camino.

Carabajal, the referent in charge of the visit, takes out a bubble box to show it to Giovanni. Flavia brings the textured blanket she assembled to sit her son on the floor. Carabajal teaches Flavia songs and emphasises the importance of the child looking in the mirror.

“The ABC of what we want to transmit at ETEC is the importance of playing with the children, bonding with the baby, talking to him, and paying attention to his needs. We see progress in families when they have a daily space for play and bonding,” summarises Lecolant.

“They teach us to play and enjoy the moments with them,” says Marisol Paz (24), mother of 15-month-old Neythan and six-year-old Alejo. Fabiana, meanwhile, laughs, saying that her daughter Larisa “looks in the mirror and pretends to be pretty.”

For many, this playful part of parenting is a real discovery. “Many moms have told us, ‘They didn’t play with me’. So we have to try to make the click and invite them to try how it feels for the child. That’s where the differences are noticeable,” says Lecolant.

“During visits, you sense when there is someone else in the house, especially the mother-in-law,” Burgos tells me. “I have raised like this and like that” is the grandparents’ catchphrase.

Poverty and under-occupation in the area are just some of the challenges in dealing with raising children in small towns in Argentina. “On the one hand, perhaps there are recommendations that clash a lot with what the family thinks, and they are not convinced. It’s not that they don’t believe what we propose is correct, but sometimes they seem offended when we insist on some aspects, such as the importance of breastfeeding or a varied diet,” says Lecolant.

Lecolant also points out that at the nutritional level, ” many habits are rooted in the local culture. For example, the iconic food is the stew, which responds to an economic issue because you disguise the meal for the whole family with a little piece of meat or some chicken giblets. But perhaps with the same ingredients, you can make a less overcooked dish or use a legume to make it more nutritious. And at snack time, mate cocido (mate tea) with bizcochos (biscuits) is very popular”.

Another challenge for the organisation is achieving frequent attendance of mothers at the centre. Many are often absent due to their lack of mobility to travel (many live in remote homes) or the fact that they take care of their children alone.

The entrance to the Haciendo Camino centre in Herrera, about 150 kilometres southwest of the capital of Santiago del Estero. Credit: David Flier, The Human Journalism Network.

– These days of humidity make the floor very ugly, replies the mother.

– You can put cardboard on the floor, says Coria Olivera. She also asks her to create a mobile by hanging different objects so the child can reach them.

“The main lesson they teach you is to adapt to what is available, both in the activities and the meals. Sometimes they ask us to incorporate an ingredient that I don’t have, and they give me ideas to replace it,” Flavia tells me at home after hanging the clothes and about to unfold the blanket on which Giovanni will play.

Beatriz keeps another example of how the integrated care model takes different forms. “It’s hard for me to do the activities in the booklet because I can’t read or write, but they told me that if I forget to send an audio message.

“We try to make sure that the work with each family is handcrafted. There are no prefabricated recipes of what the family should or should not do. For example, we will not ask them to buy beef every five days. For example, we try to get them to replace these proteins with cheese, eggs, or legumes,” explains Lecolant.

The centre’s director also says they sometimes work with other civil and state organisations. For example, the Civil Registry processed ID cards for children who were still undocumented. Or with the Posta Sanitaria to complete the vaccination schedule for those who are behind in their vaccinations.

Belén Coria Olivera, the stimulator, with Giovanni, a baby who has to spend more time on the floor. (Photo: David Flier).

The photos look like trophies in that office. Next to the scales and the table where Willi, the nutritionist, interviews mothers with their children, posters are piled up with photos of the children who were discharged after being admitted with signs of malnutrition, along with the height and weight at which they entered the programme and at which they were discharged.

The impact on parenting is, a priori, less quantitatively measurable, says Lecolant.

In 2023, the UCA’s Social Debt Observatory conducted an impact evaluation of Haciendo Camino’s programmes. “The programmes evaluated have positive effects on structural aspects of a child’s first years of life such as weight, and developmental aspects such as communication, expression and problem-solving skills,” says one of the reports resulting from the evaluation.

“Many families point out that the children who participated in the programme have an easier time or are more receptive to the activities in the kindergarten. Especially those with older children who did not go through the programme notice the difference,” says Lecolant. And I think of Alejo, Marisol’s son, who proudly showed me the medal he received at the end of preschool. And his mother told me how what she learned in the primers and put into practice helped the boy to stand out in his classroom.

What these indicators say is echoed to me by the mothers themselves during our spontaneous conversations. They also expressed it in the UCA evaluation when asked about Haciendo Camino’s work: “The evaluation in terms of satisfaction with the programme is excellent in 33%, very good in 35%, and good in 29%. About 2.6 % rated it as fair or bad. What stands out from experience is having learned aspects of baby care and stimulation (81 %), issues related to feeding (66 %), aspects of baby development (62 %), handicrafts (58 %), health care (55.6 %) and to a lesser extent aspects of hygiene, sex education, and human rights”.

As we walk with Lecolant along the main street of Herrera, the only paved street in the town, a mother from the ETEC group approaches us and explains to the centre’s director that she cannot attend in the afternoon. They agreed that she should come the next day when the mothers from the Nutrition group were there. Lecolant emphasises, “It is very gratifying that the families show such interest in attending.

Hours later, Flavia will summarise why many moms like them choose to maintain the link with Haciendo Camino: “It’s a place where they help us with what each one needs, where we can always come.”

This story was originally published in RED/ACCIÓN (Argentina) and is republished within the Human Journalism Network programme, supported by the ICFJ, International Center for Journalists.

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