It's Tuesday and in the foundation that I direct there is a frantic movement that I follow from the office. I go out when they tell me that a visitor has arrived that I was expecting. She is a mother with her 4-year-old son, whom I see enter. They go to the general medicine office and the nursing station. In the consultation they discover that the infant has weight and height deficits: he should weigh 16.5 kilograms and measure 103 centimeters, but he lacks 3.5 kilograms and 9 centimeters to reach the minimum measurements. The medical team concludes that he has a picture of malnutrition that requires urgent intervention.

They inform me of the child's diagnosis and I agree to visit them later at his home. There we talked with the mother about her story and about what else we can do to help them since the foundation. She is originally from Venezuela. She left her country convinced that there she would have no prospects for her family or for herself. That is why it was established here, in the Ecuadorian city of Cuenca, in the province of Azuay, where there is a Venezuelan community of 12,000 people, a third of which is in an irregular migratory situation, according to data from the Casa del Migrante, an institution of the local municipality.

“We left Venezuela in 2017 because we couldn't buy enough food for my son even though his father and I had a job,” says 34-year-old Dorina González. She is part of one of a giant diaspora, such as has not been seen in Latin America and the Caribbean. More than 6 million people have left Venezuelan territory and have been scattered as migrants and refugees throughout the world, but especially on the continent.

Just over half a million arrived in Ecuador, according to the Regional Platform for Interagency Coordination (R4V), a multinational body responding to the unprecedented situation. Almost 44 percent of the total, according to the national government, lack regularized immigration status, which prevents them from having normal access to services, sources of employment and housing, among others. A third of those who live in Cuenca are precisely in that vulnerable condition.

Like González, I am Venezuelan and I also live in the same city, to which I emigrated in 2015. That, however, is not the only thing we have in common. Before dedicating myself full time to social work to serve the migrant and refugee community in my home country, I went through similar heartaches. The circumstances of my migratory journey ended up temporarily affecting my son's nutrition. I should have received assistance to overcome it. That is why I feel reflected in what he lives.

In the last quarter, the foundation has received at least two weekly cases of infants with chronic child malnutrition whose families come from Venezuela. DCI, as it is known, is a delay in the normal growth that boys and girls should have according to their age. It has multicausal origin, although it is commonly connected with poor nutrition. Those who suffer from it can return to their regular weight and height, but it is likely that they will carry sequelae, including learning problems, difficulties in the development of fine and gross motor skills or the propensity to suffer from non-communicable diseases such as hypertension or diabetes.

​Mothers and fathers cared for at the foundation agree that they left Venezuela, among other reasons, because they believed that this would save their children from malnutrition. A report by four United Nations agencies warned that undernourishment had multiplied by four in Venezuelan territory between 2012 and 2018, reaching a fifth of the population. In 2019, the World Bank made a report where it is mentioned that the rate of chronic malnutrition in Venezuela was 17.8 percent. However, in the absence of official figures in the country, last year the international non-governmental organization, Oxfam, estimated the rate of child malnutrition in Venezuela at 30 percent.

The paradox is that those who chose Ecuador came across a country where chronic child malnutrition is considered a public health problem that affects around a quarter of children under five years of age. “Having this DCI level of 27.2 percent, just below Guatemala, makes us think, and makes us identify it as one of the most serious problems the country has had,” Esteban Bernal, Minister of Inclusion, tells me. Social and Economic.

The United Nations Children's Fund (UNICEF) published an article this year in which it pointed out that the Ecuadorian State has executed 12 programs or projects related to health and nutrition since 1993 without significant impact on statistics, a reality that Bernal He affirms that he wants to change with the present management.

The journey of tens of thousands of people who have traveled from Venezuela by land has been added as an aggravating factor in the incidence of DCI. “Migration has exposed girls and boys to low nutrient intake during their journey and has prevented them from having access to drinking water services. In addition, living conditions are often precarious when they arrive at their destination. This way they will have acute or temporary malnutrition that can become chronic”, explains Pedro Arias, doctor of the foundation.

A study by Unicef ​​Ecuador confirmed that opinion last year: 43.7 percent of Venezuelan infants who were evaluated by the multilateral institution or by allied organizations on the borders of Ecuadorian territory were diagnosed with chronic child malnutrition. The Ministry of Health, however, has lesser statistics, according to which 10 percent of the Venezuelan child population in Azuay suffers from ICD.

“When there is a diagnosis of chronic child malnutrition, it means that the institutional support system failed to find and prevent this problem,” says Arias, who is Ecuadorian and works with a nurse graduated from Venezuela, Laura Caridad, who shares her concerns upon seeing mothers and fathers without the income to provide their children with a diet rich in nutrients and protein. “No child deserves to be malnourished,” she says.

​The foundation where we work – which is called GRACE, an acronym for the English phrase Give Refugees a Chance, which in Spanish means Give Refugees a Chance – seeks to offer support to mothers who come through medical care and delivery of micronutrients. Other related organizations work in similar areas. HIAS - a global Jewish organization that helps migrants and refugees in vulnerable situations - benefits between 500 and 600 Venezuelan families in Cuenca each month with a $25 monthly food card to be used only in affiliated businesses.

In this context, the stories of women like González and other mothers like Deinessix Pitre and Wilna Cedeño, treated at the Grace Foundation, are a living portrait of the scope of a problem that I went through and that changed my vocation.

Escape

I arrived in Cuenca two years before Dorina González and then began an eventful journey that became a definitive migration. In my case, settling here was not a planned decision but an unexpected twist of fate. In October 2015 I was traveling to the city with my boyfriend at the invitation of a friend. On the stopover in Quito I learned that she was pregnant and that she had also attempted an abortion caused by her efforts with the luggage. The doctors told me that flying back to Venezuela would be risky. We then decided to arrive by land to the capital of Azuay, on a journey of eight hours. We stayed and my stay was extended until today.

By then, the Venezuelan crisis was growing like a snowball and was on its way to becoming a humanitarian emergency, as recognized later by multilateral organizations such as the United Nations. In 2015, inflation soared to 180.9 percent, which was just a prelude to the astronomical jump that it later made to become the worst hyperinflation in living memory on the continent. The shortage had also been unleashed in an unexpected way. You had to stand in long lines in supermarkets to buy the little that was supplied, including basic supplies such as diapers, baby milk or meat.

Settled in Cuenca, I witnessed two transformations. The one from Venezuela that I followed from a distance and the one from Ecuador that I saw before my eyes. In my country things got worse. A piece of news that struck a chord with me helps me to explain it. It was an event that occurred in 2020 in Cagua, Aragua state, a town neighboring Santa Cruz, where I grew up. They burned cane fields and a group of children decided to go into them to hunt rabbits and iguanas that were fleeing from the fire and bring food to the table. The little ones suffocated and lost their lives. Everything happened in a place where I had enjoyed part of my childhood in a completely different way.

While that was happening there, waves of people from Venezuela were arriving in Cuenca and Ecuador. The government of Lenín Moreno established in 2019 for those who wanted to set foot on Ecuadorian territory the mandatory requirement of the so-called Exception Visa for Humanitarian Reasons (Verhu). Its establishment sought to stop the migratory flow and open a process of temporary regularization for those who were in Ecuadorian territory in irregular status. The costs and the requirement of documents, not always at hand, became obstacles that increased in the case of boys and girls.

One fact illustrates this. In the entire province of Azuay, for example, only 125 visas had been issued to minors between January and September 2021, as confirmed to me by Ingrid Ordoñez, zonal director 6 of the Ministry of Foreign Affairs and Human Mobility. “The reason for this low number is that they are not with the father and mother together. Most of the boys and girls are only with the mother and do not have a power of attorney from the father to have taken him out of the country or to apply for a visa in Ecuador.”

The families await the new policies whose implementation President Guillermo Lasso announced on June 17, 2021 in the framework of his participation in the International Conference of Donors in Solidarity with Venezuelan Refugees and Migrants. At that meeting he said that a new regularization process would be carried out that would be complemented with economic inclusion strategies that can impact child welfare.

vulnerabilities

The migrant population has had special vulnerabilities. Many pregnant women have suffered from malnutrition and have suffered complications due to lack of prenatal care, which has affected their sons and daughters. Others, due to lack of employment, have even ended up in informal street sales or being victims of organized groups that, according to the authorities, have turned begging into a business.

Fabián León, executive secretary of the Cuenca Rights Protection Council, affirms that from that institution they want to promote a policy to reverse the situation of begging children. The protocol includes referring children to care centers while mothers and fathers work on the street and training responsible adults so that they can improve their sources of income. In cases of persistence of the situation, complaints will be filed against the parents to establish whether there is negligence and eventually refer the affected minor to foster homes temporarily. "What is sought is that boys and girls are well," he says, although attempts to separate have created some situations of tension in the streets of Cuenca.

I was also an immigrant who carried her son on my back while he worked. Without further contacts or knowledge of the city, my first job was to walk dogs for US citizens living in Cuenca, a city preferred by many of them for retirement. I dedicated myself to that precisely because it was the only job having my little one with me wherever I went.

“I am Venezuelan, from the Valles del Tuy, but my son was born in Ecuador. He is two years old and underweight,” says 23-year-old Deinessix Pitre. “In Venezuela he worked as a waitress in a restaurant in Caracas, but I left my country because of how ugly the situation got and to start a new life. I came with the father of my son. The first time it was two years. I returned to Venezuela, but decided to return. On this second opportunity, I've only been here for months: I returned in August 2021. A few days a week I clean in a pizzeria, but they can't hire me full time because I don't have papers. The rest of the time I sell lollipops (pacifiers) on the street and ask for collaboration.

“I always carry my son with me. He was born underweight. I did all the pregnancy tests here in Cuenca and thank God they helped me a lot. However, I had a very poor diet because I didn't have a job. He ate only rice, eggs, pasta and cheese. The cheapest. In December 2020 I returned to Venezuela. In the months that I was there my son got sick several times and on one occasion he had a fever of 40 degrees. He was already convulsing and in the hospital of Santa Teresa del Tuy they had nothing to put him. They didn't even have a thermometer. I took one from here in Cuenca.

“That's why I came back. Here sometimes we make an arepita with cheese. In the afternoon we make rice with chicken or with eggs. At the foundation they told me that he is malnourished, that I should give him soup, meat, but I can't buy not only because I sometimes lack money but also because I don't have anywhere to store food, in a refrigerator. What I do is buy daily. Now I live with several Venezuelans. We slept on a mattress that they lent me and the kitchen belongs to the owner of the house, but she also lends it to me. I have to collaborate with the rent but I have not been able to. Today I sold a dollar and already bought a piece of bread and fruit for my baby. I have not eaten".

I was not only a dog walker with my son in tow in Cuenca. While he was growing up I worked for a rose export company as a salesperson to florists in the United States. In addition, he wrote for various outlets targeting Americans in the city. On weekends I took a job as a waitress in a bar and on Sundays I cleaned the houses of several friends. Sometimes I even ate an egg a day, to save the chicken and meat for my mother and my son. By then he had separated me from my partner and I asked my mother to come from Venezuela not only to help me with the upbringing but also to be able to treat her for a kidney condition that required dialysis that was not possible in our country.

My son, in that difficult season, was once admitted to a regional hospital with an asthma attack. There they told me that he had acute or temporary malnutrition. Knowing it shook me. While he was confined in the health center, I received help from women who lent me clothes every morning to change into.

I also ate thanks to a civil society initiative called “Cuenca Soup Kitchen”, which maintains a kitchen for migrants in the city and currently supports 150 families a month. The project was born in the hospital where my son was precisely to help mothers and fathers who could not afford a lunch at the establishment. That help I received to overcome the crisis made me convince myself that I had to do the same for other people, especially other women.

Education

Everything was improving when my son started his classes in the first year of initial. Through schools and colleges, the Ministry of Education grants each student a snack consisting of 18 liquids and 14 solids that are used to cover food for 18 days. The package includes, among other things, whole milk, flavored fruit nectar and cereal bars. With the passing of time, more boys and girls of Venezuelan origin are enrolled in school. According to data from the Ministry of Education, 1,638 were registered for the 2021-2022 school year in Azuay: 91.33 percent are in Cuenca. However, there is a large number of young migrants or children of migrants who remain out of school and without access to snacks that save many from malnutrition.

I was able to overcome the situation I experienced with my son with help. But since then I have tried to better understand how DCI can be avoided. UNICEF points out that medical check-ups are key in the first thousand days of life of boys and girls. The organization, however, warns that the problem is not exclusively related to the lack of food, but can occur when mothers do not receive adequate prenatal check-ups or when infants do not have access to appropriate water sanitation services or live in poor conditions. inadequate.

“My daughter has never had the height or weight for her age,” says Wilna Cedeño, 27 years old. “She was born at just 660 grams and she spent eight months in the neonatal service before she was able to take her home. A lot had to do with a brain tumor that I was diagnosed with and faced in the middle of pregnancy. They discovered it here, in Cuenca. I am from Apure and I arrived in Ecuador on July 8, 2017. She was studying systems engineering in Venezuela while working as the manager of two legal gambling establishments. When I was in the seventh semester of my degree, there came a time when I stopped studying. I had two salaries and lived with my daughter's father. But she didn't have enough money for us. We didn't even have to eat. That's why I came to Ecuador.

“My partner came first and it was my brothers-in-law who paid for my bus fare. As soon as I arrived, I got on my phone, looked for a job on the weekends, and two days later I started working in a restaurant. A year later I got pregnant. Two months later, in the middle of a pregnancy check, I fainted. That was when the doctors discovered the tumor. I lived with him without knowing it. He fed on the placenta. He had been in the hospital the day before, because he had headaches. A doctor saw me and told my whole family that I was crazy, that the pain was due to pregnancy. The next day, however, I went into the emergency room where a valve was placed that to this day helps me drain encapsulated fluid from my brain. I had surgery pregnant. They told me it was my life or my daughter's. I didn't let them take it from me. The doctors thought that she was going to die and they even asked my relatives to carry out the paperwork with the embassy to transfer my body to Venezuela if she did not survive.

​“A couple of hours after the operation I woke up, against the most optimistic forecasts. A few weeks later, I was referred to the Cuenca Cancer Institute where I was told that the tumor was encapsulated and that I could continue the pregnancy if I could stand the headaches. I said yes. I can. Three months later, when I had an echo, the doctors discovered that the tumor had grown but my daughter had not, and that her heart rate also dropped. It was then that they decided to perform a cesarean section, after which I went back into the operating room to have the tumor removed from my head, which by then was not just one but two. After the operation I received chemotherapy, radiotherapy and here I am.

I separated from her father, but he has a stable job that pays for the therapies for her development. I now work as a kitchen assistant in another restaurant. Luckily luckily I have the VERHU visa that allows me to work legally. I don't earn much, but with that salary, I have to pay rent, food, clothes, medicine for my daughter. I practically spend everything I make on her. What worries me most is her health, I don't think about anything else. Nor do I think about going back to Venezuela. Can't. My daughter and I need medical attention and we will not get it there.”

In Wilna I have seen an example of resilience. Maybe I wouldn't have met her if I had never worked at the foundation. I came to the institution by chance. After receiving help from the Cuenca Soup Kitchen, I wanted to give back by helping out at their downtown soup kitchen. As I was putting silverware on the tables one day, she was approached by an American and started helping me. His name is Saxon Gotfried, the founder of Grace, he was recruiting people to join the project he had created. At that time he asked me to work with him at the institution. Do not accept. But it was not until a year later that I saw clearly what my mission should be.

He was in the office where he worked as a sales executive. I heard a noise that took me out of concentration. I learned later that a boy had committed suicide by jumping off the bridge into the river just ahead. Those present commented that he had been a Venezuelan, with three children, who had lost his job at the beginning of the pandemic. That week I resigned and sought out Saxon to accept his offer. My first position was as a public relations officer, but later I became the executive director. Dedicating myself to supporting migrants and refugees derives from the fact that I am part of them and I went through similar burdens to what they have gone through. I am also motivated by having received support from other organizations and how much it was worth to me and my family, it encourages me.

The foundation offers free or low-cost consultations in general medicine, pediatrics, dentistry and psychology. It also provides clothing donations and educational support to refugee children with online classes. The little or a lot of help that the beneficiaries receive represents either a significant change for them or at least a refuge to rest before continuing.

Dorina, Deinessix and Wilna wanted to escape from a country where the only possible future for them and their children was malnutrition. Without knowing it, they arrived in a country where that is the present for many children. Although none of them are over 35 years old, they all have something in common, they work every day to save their children.

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