Ten children are sitting with their mothers in a waiting room at a health center in Santa Lucia, in the Paz Castillo de Valles del Tuy municipality, Miranda state, waiting for their turn to see the doctor. 

They are children whose bones can be easily seen poking out under their thin skin. Their eyes are sunken in deep bags. With a blank stare, fixed on some point on the white walls.

Any energy seems to have slipped away from these young 1-to-3-year-olds. They don’t laugh or cry. They don’t fidget. None of them wants to get up and run about.

Perhaps this lack of enthusiasm is the result of not eating properly: they only eat one corn arepa without any filling, or a cup of rice per day.

Their young mothers anxiously await their turn to go in and see the specialist who has called them in this February morning, in 2019. They were told that he could help their children reach the normal weight for their age and develop normally.

The doctor’s office door opens and a young, tall man begins to call each patient in. He has a kind look in his eyes, a gentle tone in his voice and smiles. These are details that a mother always remembers and appreciates.

Once inside, the man welcomes them. The children are first examined by doctor Francisco Peñalver, to determine their health condition, confirm malnutrition and verify that the child doesn’t suffer any other ailment that could be counter-productive to the treatment they’ll receive.

Then, the young man takes over again. He asks them about their dietary habits. They respond by saying they only eat corn arepas on their own, or with margarine spread, beans or lentils and rice. Then, he checks the complete blood results of the tests they’ve had.

All of this information is enough to begin a treatment that intends to bring these ten children back to the appropriate weight and size for their age (which they haven’t reached because of nutritional deficiencies in their early years), in just 21 days.

Illustration: Carmen H. Garcia.

This kind man is Oscar Vasquez, a nutritionist who graduated from the Central University of Venezuela (UCV). He believes in this process: he has waited two years before being able to carry out the final test for his research.

Oscar has always wanted to help people. He used to dream of being a doctor when he was a little boy. However, growing into a teenager, he realized that Medicine isn’t what they show you on a TV series. He didn’t like the sight of blood. So, when he graduated and got his Batchelor’s degree, he applied himself – and ended up – studying Nutrition and Diet at the UCV.

Over time, he began to like the field. He realized that nutrition is just as important as Medicine. It’s the basis for preventing diseases, and is also key in treating some. He liked doing rounds in the hospital and carrying out research.

He received his degree in 2010. He began to work at a health clinic, taking care of patients. In 2016, Venezuela was already elbow-deep into a profound economic crisis, that took its toll on the population’s diet. That year, there was not a single child out of the 20 that he would see every day, that left his office without being diagnosed with moderate or acute malnutrition.

Mothers, fathers and grandmothers would come crying buckets out of desperation, which meant they didn’t have the financial means to take home a decent shopping, or because they spent all day waiting in long lines at food stores and they weren’t able to get the food they needed.

Every day, Oscar would run into skinny children, skin hanging off their bones and with a lost gaze, in the streets of his community in Los Valles del Tuy, and in Caracas’ streets.

Oscar did everything he could to help his patients. They were children living in extreme poverty, so he would refer them to a soup kitchen in his community where they could at least eat one decent meal, every day.

He knew that he couldn’t prescribe them drinks like PediaSure or Sustagen for two reasons: 1) the children’s parents didn’t have the means to pay for them and 2) the child’s condition was already precarious, because these supplements need to be mixed up with water. Plus, in communities where running water supplies are neither regular nor quality, the product can become contaminated. This would only make things worse.

It was in 2016 that Oscar began to study his Masters in Food, Nutrition and Meal Preparation. He had to develop the subject for his thesis from the very beginning. Thinking about everything he would see day in and day out, he knew he had to focus on doing something that could help alleviate the situation.

He had the great idea of creating a food supplement to counteract the effects of malnutrition. He went through all of the possibilities. He carried out market studies for the ingredients he needed. In early 2018. Oscar began to develop his food after his teachers gave him the green light.

First of all, he took recommendations from the Codex Alimentariusm the UN’s international food regulations for the Food and Agriculture Organization (FAO) and World Health Organization (WHO), as his guide.

This manual stipulates that a requirement of this product is that it is enriched with “premix”, a combination of vitamins and minerals that provide the child with a daily percentage of nutrients, to make up for any deficiencies.

In order to get the perfect mix, Oscar researched the components of an endless list of possible ingredients for his food. Then, he evaluated the formula of different products with trials, analysis and statistics.

All of the ingredients he chose for producing his food were bought in Venezuela. That was part of his objective: for it to be made with local ingredients, with no need for imports.

Illustration: Carmen H. Garcia.

Oscar’s project was ambitious and fascinated those who work in the nutrition and food manufacture business. One person from the acquaintances of his professors, advisers and his tutor, came forward and wanted to make a significant and anonymous contribution: they funded the purchase of supplies to make the premix, food trials, lab exams and the final product.

Sesame, nance fruit, peanuts and cocoa were the ingredients Oscar chose to begin his preparations.

At that time, the investment was 700,000 bolivars (approximately 1700 USD) after the currency revaluation on August 20th 2018, a significant amount and Oscar wouldn’t have been able to pay this out of his own pocket.

He made five products for his study in labs at the Department of Biological Sciences, in the Postgraduate Tech and Food course at Simon Bolivar University.

One was made with nance fruit, another one was made with nance fruit and chocolate, another one was made out of peanuts and another one was made out of peanuts and chocolate, with the last one being made with just sesame seeds. They were all accompanied by powdered milk, oil and a mineral and vitamin premix and iron.

Then, he moved to the assessment stage in which he asked 100 children to taste the five samples, as well as “Ready-to-use therapeutic food”, an international protein food that NGOs use, that even the National Institute of Nutrition in Venezuela uses, to treat malnutrition in its patients.

The latter he took the initiative itself, as a challenge and for the product that was being created. He wanted to weigh the acceptance of Oscar’s food with the international formula.

This test was carried out so that children could indicate which product they liked the most, through descriptions of taste, smell and tact.

89% of children said that the food they liked the most was the peanut and chocolate one. When comparing Oscar’s food to the international model, the children continued to like the peanut and chocolate one.

There was a winner.

Unlike other products, including Ready-to-use therapeutic food, Oscar wanted his product to forego the need to be mixed with any liquid for ingestion, which would reduce the risk of contamination.

So, he concentrated on creating a kind of chocolate-colored paste, with a creamy consistency, that can be eaten on its own by squeezing it out of the packet. As it would be consumed by children with deficiencies and a lack of strength, the consistency of a cream was better than that of a biscuit, as children normally lose their energy to chew.

It was a fact: he had created the perfect formula in two years.

It wasn’t easy to work with hyperinflation working against him: in addition to food prices going up and the blockade on vitamins (for the premix), there were also shortages in Venezuelan stores, as well as expensive costs for microbiological trials and nutrient analysis.

Oscar wouldn’t have been able to dodge certain obstacles without the support he found along the way. As quotes were only valid for 24 hours that had Oscar chasing after his funder for the money before prices changes, labs helped him by freezing their analysis prices, or only increasing them only slightly.

That February morning in 2019, in that doctor’s office in Los Valles del Tuy, Oscar thought about the journey that had led him to this moment of applying the treatment to these children.

He had decided to carry out the practical aspect of his thesis in the community where he lives because it’s easy to travel to, and because he can dedicate the time he needs to every child’s consultation and the product’s administration without any interruptions.

Knocking on door to door, Oscar and Francisco found children with different ailments in addition to malnutrition: diarrhea, fever, vomiting, infections, rashes… They were referred to hospitals so they could recover a little and then opt for the malnutrition treatment. The children that didn’t suffer from any other disease, and weren’t allergic to peanuts or cocoa, were called to the doctor’s office.

Ten children aged between 1-3 were chosen. The treatment is designed to prevent the loss of intellectual abilities because of a lack of nutrients, and to be used in children under 5, because they are more vulnerable during this phase of their lives and their nervous systems are developing.

That morning, they were diagnosed to figure out what their nutritional deficiencies were. Before a clinical check-up, they were told to remove parasites. Many of them had inflated bellies. They were all anemic, without energy to even walk.

Illustration: Carmen H. García.

 

Then, Oscar told every child how much food they needed, depending on the kind of malnutrition they were suffering. UNICEF states that children with moderate malnutrition should be given two 100g packets of the supplement (like the one he developed), while children with acute malnutrition should have three.

After that first session, which began the treatment, Oscar and Francisco would go to see the children every week and check them over to see if everything was going well.

Every consultation took approximately 40 minutes, because they needed a nutritional assessment as well as a medical evaluation. They wanted to make sure that they were taking the right amount of food.

Over the days, the children’s recovery was so great that it could be seen with your eyes. Soon, smiles began to appear of the faces of those children, their bodies took on a better composition. Oscar saw that they were more lively and awake. He noticed that their eyes were now twinkling.

Seeing their children make such progress with this food, the mothers thanked Oscar and Francisco, and were moved to tears.

On average, the product managed to make the group gain 2.5 kg each in body weight, an extremely significant figure which children were able to reach in less than a month.

On the whole, they went from moderate malnutrition to a healthy weight. This recovery in record time was due to the high calorie concentration in the product, which makes the child recover a lot faster.

These results were a lot more encouraging than what even Oscar was expecting: the product can be used in food and nutritional emergencies where acute malnutrition happens the most.

In order to not lose progress made, Oscar referred the patients and their parents to an NGO after the study finished, so that they could continue to receive assistance.

Oscar’s thesis got the highest grade: the jury gave him a published mention. He presented it on February 13th 2020.

When he thinks about a word to best sum up everything he experienced with his project, “gratitude” is the one that shines in Oscar’s mind. Gratitude is what he feels for all of the people and centers who helped him. Gratitude for what he sees in the mothers of his recovered patients’ eyes, and in the children themselves, who are now smiling and restless.

This is why now he has an even more ambitious dream, and he hopes to be able to make it true as soon as the COVID-19 emergency ends. For the food he created to be mass produced. He says that this is how he will continue to help people. Which is what he has always wanted to do.

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* This article was originally published in La vida de nos in Venezuela, and has been reproduced as part of the Human Journalism Network. It was translated into English from its previous reproduction in Spanish.