The first women with their children arrive at seven in the morning. They are standing next to the fence that surrounds the health post in the La Palmilla hamlet, Talquezal village, in Jocotán, Chiquimula. It's Saturday, the day of Antigua's monthly day to the rescue, the NGO in charge of keeping track of the height and weight of children and adolescents, and delivers bags with food, clothing and medicine to mothers, as well as nutrients and vitamins to pregnant, lactating and older adults.

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Everything is donated by individuals, including the transfer of the members of Antigua to the rescue to La Palmilla and the shipment of donations by truck to Jocotán, from where Sesan takes them to the health post. There it is stored until the day of the monthly shift. The members of the NGO also donate their time; no one pays them to go. A fifth part of the road —about half an hour from Jocotán, headwaters— is rough, steep, and only passable in four-wheel drive pickups or motorcycles. The residents of Talquezal, who leave the village for work or to get water, travel the section on foot (one hour there and one hour back) if they cannot pay the Q20 for transportation (pickups that take people to and from the basin ). That is why many, even as adults, have never been to the Chiquimula town.

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On the day of the day with Antigua to the rescue, women and children from the La Ceiba and Cedral hamlets, in Talquezal, also attend. Between Saturday and Sunday they serve at least a hundred mothers and their children. They arrive with two or three children; some even with seven. The majority, of Chortí origin, wear vibrant yellow, fuchsia, turquoise or green dresses. The boys, in their everyday slacks, swapped T-shirts for long-sleeved shirts.

“You can tell they put on their best clothes to come,” observes Sofía Letona, director of Antigua to the rescue. These days are "the event" of the month for the three villages.

The only thing that would make them more excited would be the rain, especially after planting corn and beans, their staple diet. It is the food of the next months. Talquezal is in the heart of the Dry Corridor, one of the areas with the greatest malnutrition because the irregular pattern of rainfall makes subsistence agriculture insufficient.

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Seven years ago, in Jocotán, 67 percent of school-age children suffered from chronic malnutrition (low height for age), a percentage higher than the 55.6 percent departmental average in Chiquimula, according to a census and data from the Ministry of Public Health and Social Assistance (MSPAS). These are the most recent data, according to the Institute of Nutrition of Central America and Panama (Incap).

On the day of the journey with Antigua to the rescue in La Palmilla, each mother receives a bag of food and medicine if they or their children have a cold, allergies, or an upset stomach. Also dewormers (if the children need them before the next MSPAS vaccination and deworming day). Letona records the weight and height of each child. She compares them with the previous month's data to focus help on those who are below average. This process has marked a watershed in the numbers of cases of malnutrition in the area.

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Results despite the State

In October 2019, when Antigua to the rescue began arriving in La Palmilla, there were an average of five cases of malnutrition per month. By last June, it had been reduced to one case, according to Santiago Esquivel, one of the two nurses at the health post. Esquivel said that the improvement occurred, in part, also due to the sanitation projects that the NGO Action Against Hunger had in place, which affect general health.

The figure includes children up to ten years old; or older, if your weight and height are low for your age. In the area, this is the only source of help for those over five years of age and their mothers who receive medical attention for pregnancy, but do not have assistance for malnutrition —and it affects the conditions in which their baby will be born.

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No government entity keeps a nutritional registry of children at the end of the vaccination stage after they turn 5 years old. The system ignores. Food assistance for acute malnutrition is focused below that age, and "the Ministry of Health, as a rule" only reports cases in that age range, according to Celeste Bonilla, from the Sesan social communication office.

However, press reports of official data indicate that acute malnutrition in children under five years of age increased 81 percent in 2020. In addition, in 2021, the State budget only allocated 4 percent of the funds for the Great Crusade against the desnutrition. At Sesan, Bonilla did not answer why there is no nutritional assistance for those over five years of age.

Last June, Antigua to the rescue treated a six-year-old girl. Letona was talking to her mother, and Héctor Ángeles (also from that NGO) was rummaging through a bag of donated clothing, looking for a piece to give her. He pulled out a vest and checked the size tag. It was for three year olds. When the girl tried it on, it was too big for her.

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The impact of the pandemic

In March, when the presence of COVID19 in the country was declared, Antigua to the rescue suspended visits for six months, although it continued to send food each month: beans, corn, oats or Incaparina, Maseca, rice, salt and sugar, chocolate to boil among others, nutrients and medicines, with the support of Sesan and Esquivel. He resumed visits in August 2020.

By June 2021, the day of the day, most of the women and children in the queue around the health post are not wearing masks. Antigua to the rescue doled out enough for everyone. Most of the children in line can be heard coughing and sneezing, but no one seems alarmed. After almost a year and a half of the pandemic, the biggest concern here is still getting food. The bag of food they will receive, if they ration it, will last them about ten days (depending on how big the family is), according to Letona.

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Eduardo Roque, representative of the villages before the Community Development Committee (Cocode), says that some families finish the bag in three days. “People are used to eating only beans and tortillas, so when they have something different, they eat it quickly,” he knows. For many, it's more food than they'll see for the rest of the month. That is why these days are the great event.

This year, in Jocotán, poverty will not drop below 80 percent and could reach up to 100 percent, according to estimates by the Central American Institute for Fiscal Studies (Icefi), which indicated in 2020 that poverty would increase throughout the country due to the pandemic. .

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Erick Yovani Sosa, from Sesan in Chiquimula, assures that the State has provided food assistance in the area since before 2012, although he clarifies that this secretariat only coordinates and manages food assistance from other state entities, and the delivery to the departmental delegations of Sesan “for the most needy communities”. In addition, the Municipal Emergency Operations Center, chaired by the mayor, decides who will be the beneficiaries of the food assistance for COVID19, according to the Sesan headquarters in the capital.

However, this type of state aid eluded La Palmilla, Cedral, and La Ceiba. Last July, in the health center there was a sack with a quintal of powdered atole bags, which was the first food received from the State since at least 2017, says Esquivel. The rest of the aid that reaches these villages is the food that Antigua to the rescue has provided since 2019.

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State aid on paper and in practice

The Ministry of Health must diagnose acute malnutrition in children under five years of age for their families to receive food assistance from the Ministry of Agriculture, Livestock and Food (Maga). Separately, El Maga also assists the families that the Cocodes identify as the most needy due to hunger, but only if the Municipal Food and Nutritional Security Commissions approve the list.

This is the explanation on paper.

In practice, management is more complex.

Last July, Antigua to the rescue began to help the Cocode to manage help from a program of shares for food from the Maga. It consists of a single delivery of food (with a lot of calories) in exchange for work, such as cleaning the basins of water sources, according to Fernando Barillas, a member of Antigua to the rescue. The community did the work, but after three months, they had not received the aid because the Maga rejected the file three times.

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“It has been cumbersome, bureaucratic, slow,” Barillas complains. “They asked for the certificate of the municipality that accredits the Cocode. For a farmer in La Palmilla, it involves buying a round trip ticket, with money that he does not have (because sources of employment are scarce) to go to the municipality to manage it. For that document they returned the stationery the first time, because it should have said Talquezal Centro and the municipality only wrote Talquezal.”

The second time the Maga rejected the file because the signatures were not written with a blue pen, to guarantee that it was the original signature of the president of the Cocode. The collection of signatures in La Palmilla involves a seven-hour drive from the capital. It was a process that should have lasted two weeks, and it already added up to two months.

“They ask that color photographs be printed, signed and sealed by the Code, that the listings go in a certain way, signed and sealed by the Code, that their DPI be valid. At what time is a peasant going to go to Renap for proof that his DPI is being processed?”, Asks Barillas. "People are disappointed because El Maga has done this kind of thing to them before, like once they cleaned the basins and he brought them two rabbits for I don't know how many families."

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The process progressed when Antigua to the rescue sought the support of the Parliamentary Front Against Hunger and, according to Barillas, deputy Jairo Flores (National Hope Unit, UNE) pressured Maga. The food bags were finally delivered on October 1.

In the middle of the bureaucracy something works.

In June, Antigua to the Rescue cared for Jason, a six-month-old baby, one of the recovered, who weighed almost normal for his age (14.6 pounds). Letona met him in December 2020, a seven-month-old premature newborn. “When I picked him up, his little head was smaller than my hand,” says the director of Antigua to the rescue. "He was 10 inches tall and weighed four and a half pounds."

But four months ago, Jason's little head was already bigger than Letona's hand. He had gained weight and everyone was celebrating: Kenneth Garnaat (also from the NGO) was writing the information, and Ángeles, who was looking, in the huge bag of donated clothes, for a baby piece for Jason's new size. Barillas captured the moment in a photograph. Jason's mother smiled. She had a look of relief.

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In August there were also news: 32 children from 2 to 5 years old with severe malnutrition gained weight, according to Letona. Everyone else didn't lose a pound.

"It's the first time it's happened," she says.

Sosa agrees that with Antigua to the rescue, she has improved the situation in the villages. Last June, almost a third of the children weighed less than the desirable minimum. Some had lost weight. When Letona asked the mothers what had happened, they replied that her baby had lost her appetite because she had a fever or diarrhea, signs of parasites or infections.

According to the nurse Esquivel, some of them are due to ignorance, precarious living conditions, and lack of hygiene. In part, due to the scarcity of water.

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A war on several fronts

Other times, deaths are not prevented just by gaining weight. This was demonstrated by the case of Yesmin Anayeli Pérez, a malnourished two-year-old girl who died last January from a respiratory complication. The girl had weighed 6 pounds. By December 2020 she had grown to 16, although her normal weight for her age is 28 pounds. While this was happening, the 2021 State budget included a recommended cut of Q44.8 million to promote health and preventive medicine, to treat acute respiratory and diarrheal diseases, according to data from Icefi.

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In fact, Yesmin's health was complicated since her birth, a consequence of her mother's precarious medical and nutritional care during her pregnancy. Her family —like others in La Ceiba and the other hamlets— lived in a house made of mud and pressed grass, with a palm or tin roof. For this reason, the rain and wind caused by storms Eta and Iota in 2020, and which caused the collapse of an iron bridge between the head of Jocotán and Talquezal, caused devastating damage to homes. The president of Cocode said that a current of water split the Yesmin family's house in half.

"In January, the rain forced them to leave their house almost at midnight to take refuge in a shelter," says Roque. Esquivel says that Yesmin had pneumonia and getting out of it with that weather complicated her picture. Her body did not resist and she died the next day.

By then, her mother was almost five months pregnant, and Ella Antigua to the rescue kept her under monitoring with Esquivel's support and a constant supply of nutrients, prenatal vitamins and medications to ensure the baby's health. Four months later, her son was born at a normal weight and remains healthy.

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The battery of nutrients that each child receives from Antigua to the rescue includes cans of Pediasure, fortified atoles, Incaparina and vitamins for nursing mothers, to ensure that your baby receives the benefits of breastfeeding. “We started treating only children, but we included pregnant mothers so that they are born with a normal weight—this is the challenge—and not with malnutrition,” explains Letona.

In addition to Yesmin, the nurse recalls that since 2019, two other children have died in Talquezal from causes related to their living conditions in general, and not just from malnutrition. Across the country, in 2020, 46 children under the age of five died from symptoms linked to malnutrition. Between last January and August there were 26, according to a press report.

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There are no total solutions

Progress against malnutrition also depends on the frequency of pregnancies.

"Some women have children every year," says Esquivel. “The youngest is eleven months old when the next one comes, and they neglect the oldest, and so on. They have tried to make them wait for at least two years, but some do not understand or do not want to, [although] at least they are more attentive to the health of their children.”

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It is not always a matter of will. For example, Elsa is a mother who, at 37 years old, already has ten children. In June, Letona noticed that her newborn baby began to cry within 15 minutes of being fed, because the mother's milk did not sustain her. "She did not fill up because the mother could no longer produce milk due to anxiety conditions (due to poverty) and because she does not drink water either, key to the production of breast milk," explains the director of Antigua to the rescue. In the area, they do not usually drink water, possibly due to scarcity. In fact, stores do not sell it. The only drinks available are beer and Big Cola.

Other factors that affect children's health in these villages are the children's birth order, if it is an only child or the age of the mother.

The NGOs cover the gaps in the State, which fails by not addressing malnutrition from a multisectoral perspective, according to Lucrecia Hernández Mack, former Minister of Health and current deputy for the Semilla caucus. The parliamentarian affirms, as the cases in Talquezal show, that the problem also includes living conditions, precarious crops, access to jobs, etc. However, Hernández adds that the progress made by NGOs is in danger of vanishing once their projects are finished. In that sense, Antigua to the rescue has no plans to stop.

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At the end of the June day, some children gather around the windows and the door of the health post to watch the team pack and store food, clothing and medicine to distribute the next day.

Letona, Barillas, Ángeles and Garnaat continue to and fro between the health post and a pickup, until they leave. The director hugs one of the children she knew from the first day. He makes a joke and everyone laughs, even those who observe the painting from afar leaning on the perimeter fence of the health post. The doors are closed. The key remains in Roque's hands until the next day when the nurse on duty returns.

Antigua's pickup to the rescue pulls away. The farmhouse falls silent again, only interrupted by some distant wave of band music. The children stare down the dirt road until the vehicle disappears in a cloud of dust.