A Peruvian Nutrition Clinic

For the past two weeks I forged ahead alone far, far away from our house (an hour walk there and back) to the nutrition clinic where I worked with a Peruvian nutritionist.  Before I went, I was looking forward to the experience and had done some research on the nutritional issues in Cusco.  I knew iron deficiency anemia was a huge problem.  Being here six weeks, I could now see why.  We have been pumped with so much rice, corn and potatoes that it isn’t even funny anymore.  The clinic is called MONET and basically is like the American version of Early Intervention, WIC and a cooking class all in one.  There are seven MONET clinics serving the city of Cusco.

The nutritionists name was Catalina (Caty) and the woman has many responsibilities.  Each family that comes into the clinic must have an updated growth chart on the kids.  Caty checks the charts to insure each kid is growing.  The families pay 1 sole for both breakfast and lunch for each kid they have, which is about 33 cents per meal.  If the kids are not growing well, she calls them out on it and gives them a talking to.   I thought I was direct with my patients.  This woman is a force to reckon with and has to be given the situation.  She gives them nutrition handouts to emphasize variety and the importance of protein and fat, which is often deficient in these kids’ diets.  There is also this huge push for hand washing.  Many of the kids have parasitic infections, which stunts their growth and brain development.  This has all been traced back to lack of hand washing so she spends loads of time teaching the kids and parents to wash their hands before they eat, after they change diapers or go to the bathrooms themselves.  Once they are checked in, the kids are free to play and we cook.  Aside from Caty, there is another woman that comes in as an assistant cook, but takes orders from Caty.    There is a very small play area where they also eat.

Here is the kitchen they work out of.  NOTE:  The kitchen is smaller than it appears here.
There is a four week menu cycle in this clinic.  I have been able to order food in restaurants, tell taxis where our home is located and buy tickets to museums, but learning the Spanish words for Peruvian food was a challenge. I had to ask Ana, my Spanish teacher at Maximo Nivel and then did a lot of Googling (when I could find internet access) to figure out what the hell the menu items were. Once I did, I realized the menus were very well balanced.

As they cooked through breakfast and lunch, Caty and the cook graciously offered me food to try. Sometimes I took it.  Sometimes I did not.  I watched food preparation very closely and asked a lot of questions to learn their techniques, especially on how to cook quinoa (I am the world’s worse quinoa cook).  While there are many wonderful things about Peru, food safety standards in the country are not the same so I was hesitant to try the food because where they cut the fish is where they may make a salad.  Wouldn’t you be nervous?

Before I went to the Monet clinic I envisioned sitting at a desk, asking families to be patient with my Spanish and telling them how to feed their kids so they grow well.  That is not what I did.  I did do some simple nutrition counseling, especially when I saw a mother force feeding her kids.  (THAT DRIVES ME CRAZY IN PERU AND AMERICA!)  Here my responsibilities were broader in a larger effort to support the clinics day to day operations, which they desperately needed.  And…I was OK with this.

  • I cut potatoes, carrots and onions with the dullest knives you could imagine. It took me 25 minutes (no exaggeration) to cut an onion until they told me it was just right for the lunch that day.
  • I washed and dried dishes in the coldest water you can imagine in that tiny kitchen.
  • I swept and mopped the floor with a broom that had a towel around it that kept falling off.  Mopping took twice as long.
  • I cleaned the kiddie plastic tables and chairs over and over again and organized the developmental toys for the kids.
  • I held and played with some of the cutest babies and kids.
  • I sat on the floor talking to mothers in broken Spanish about the differences and similarities between Peru and America. They had a lot of questions for me.  We talked about everything from feeding kids to Barack Obama and how horrible they thought guns were.
  • I bought wipes and diaper cream for a mom who I saw changing a kids diaper the day before and taught her how to properly clean and change the baby.  He had diaper rash (and many other medical issues).  I was stunned watching her change him and will spare you intricate details about how she changed and cleaned him.  His diaper was a thin washcloth she wrapped around him and then secured a plastic grocery bag (the kind they are trying to phase out in the US) as “rubber pants”, similar to the 1970’s version some of us may have worn.
  • I made grocery lists for the clinic.
  • I served food and tried some, when I felt it was safe.
  • I read the Peruvian governments goals for a healthier population (more about hand washing and lots about the importance of safety of children from abuse…of all kinds.  Violence in homes seems to be a big problem.

While it wasn’t what I expected, I learned more in those two weeks than I would have sitting at a desk talking protein the whole time.

About Melanie Silverman

Melanie is a pediatric registered dietitian nutritionist (RD) and a board certified lactation consultant (IBCLC) working primarily in pediatric nutrition for well over 15 years. She spent seven years as a clinical dietitian at The University of Chicago Medical Center in the neonatal intensive care unit, pediatric intensive care unit, adult and pediatric burn units, and high risk pediatric follow-up clinic. She also served as an adjunct faculty member at Loyola University Chicago. Melanie has presented at state and national meetings for the American Society for Parenteral and Enteral Nutrition (ASPEN), March of Dimes, Prader-Willi California Foundation, Texas Prader-Willi Association, Oklahoma Prader Willi Syndrome Association, Foundation for Prader-Willi Research (FPWR) in the United States and Canada and the Prader-Willi Syndrome USA (PWSA). She worked hard for her Bachelor of Arts in Chemistry and Spanish from Indiana University and a Master’s degree in Clinical Nutrition from Rush-Presbyterian St. Luke’s Medical Center. A member of the Academy of Nutrition and Dietetics, California Dietetic Association, Pediatric Nutrition Practice Group, Women’s Health Group, Nutrition Entrepreneurs and an active member of the International Lactation Consultant Association.