Beyond the disease itself

Guest post by Victoria Rainbolt, a Watsi volunteer

This summer I had the pleasure of sharing the stories of 104 patients from 13 countries as a Watsi volunteer writer.

Watsi acts as a constant source of inspiration by widening my perspective on healthcare. When writing a patient’s story, I look at how certain variables -- such as culture, politics, education and economics -- might directly link to the patient’s condition. Over and over again, I find that certain external factors influence health in the areas of the world where Watsi operates.

Although I have worked in epidemiology research for over five years, I previously concentrated my efforts on the United States. Now, having turned my head to look more closely at international health concerns, I have just begun to scratch the surface about the factors that may influence the health of individuals around the globe.

This sparked my substantial interest in prevention -- if certain exposures link to repeated health outcomes, how can we use research to identify and improve environmental triggers of health disparities?

I have been looking at this question since I began volunteering with Watsi. Specifically, in the rural, indigenous areas in Guatemala where many patients are referred to Watsi for funding. With about one out of every two children under age five diagnosed with the condition, Guatemala has the fourth highest rate of malnutrition in the world. However, among the indigenous populations Watsi works with, the number of children under five expected to be diagnosed as malnourished is 80%.

While malnutrition is highly preventable, health research focusing on rural Guatemala is incomplete. Malnutrition in these regions is part of a more complicated cycle.

Breastfeeding is one example. Breastfeeding impacts a child’s nutrition from the day they are born -- it provides infants with proteins, vitamins, minerals and antibodies to protect against infection. I learned that lactation failure and maternal fatigue are prevalent in indigenous Guatemalan populations. Interestingly, some research shows that factors including rural status, age, education and family structure may associate with a woman’s inability to produce enough milk.

It comes as no surprise then that health concerns such as lactation failure could hold substantial health ramifications for regions of the world with limited access to breast milk alternatives. Food supplements are both costly and require a certain level of education or training to be used properly.

However, issues may persist even where breastfeeding is involved. To truly understand why malnutrition occurs so frequently in Guatemalan children, we must understand their caretakers. Upon closer examination, the cultures of indigenous Guatemalan communities seem to pressure women into being the primary caregivers. This is elegantly described by Dr. Peter Rohloff, the Chief Medical Officer of Watsi’s Guatemala-based medical partner, Wuqu’ Kawoq (WK) in the report "But One Gets Tired." Over the years that they have spent working in these communities, Dr. Rohloff's research team noticed that breastfeeding bears a heavy cost. They observe, “breastfeeding practices require physical and emotional sacrifice by indigent women...Cultural ideas surrounding breast milk and motherhood serve to reinforce and amplify political and gender inequalities,” [5]. In doing so, breastfeeding could be perceived as a constraining burden rather than appreciated as a provider of essential nutrients that help raise a healthy baby.

Separate work conducted in Guatemala contributes to the problems mentioned by Dr. Rohloff, suggesting that gender inequalities are common in this part of the world. In particular, education and income stand out as key issues. Women often experience “limited schooling, early marriage, frequent childbearing, and chronic poverty”. In their roles as wives and caregivers, women are regarded as secondary to their male counterparts and receive a fractional amount of the income that their husbands earn. In rural areas, women often receive a “weekly salary,” from their husbands—called gastos. However, Dr. Rohloff and his team assert that these, “gastos are rarely adequate to meet basic survival needs,” while the men in the same communities are permitted to spend the remainder of the salary at their own discretion. Thus, while malnutrition is preventable in practice, its prevalence in these areas could be a reflection of deeply embedded cultural issues.

Health is never an isolated issue. The causes of a community-based health problem must be recognized in order to begin to tackle the problem itself.

There are certainly other possible factors that may tie into Guatemala’s high rate of pediatric malnutrition, and as a Watsi volunteer, I am excited to charge forward and learn more about health concerns like those faced in Guatemala. I look forward to using research, awareness and communication to help tackle and expose the root causes of health disparities to remodel healthcare around the world.

Victoria Rainbolt
B.Sc. Honors Management student at the University of St Andrews with a focus on public health