Brenda and her three children walk through the mountains to the community kitchen. Chon climbs a hill carrying a quintal of corn —more than 200 pounds— on his back. Rita returns from home after harvesting corn to feed her seven children. A group of women dig at a wall of earth to expand the school’s classrooms. Roberta searches for guanábana leaves to treat her diabetes. Such is everyday life in La Ceiba Talquezal and Pitahaya, two remote Maya Ch’orti communities in the municipalities of Jocotán and Camotán, in Chiquimula, the department with the highest rates of chronic child malnutrition in Guatemala — in turn, the country with the highest malnutrition rates in Latin America, according to a UNICEF report on child malnutrition in Latin America and the Caribbean.
These figures match data published by the international organization Action Against Hunger, which runs a nutritional monitoring program for children between the ages of one and five who live in the department’s most vulnerable communities. Chiquimula is in eastern Guatemala, in the heart of Central America’s Dry Corridor, where the climate crisis has hit especially hard in recent years. Lack of rain has made farming difficult and has destroyed the self-sufficiency of the families who depend on it. Many children die here. Many are also born into the care of midwives, who use ancestral knowledge to tend to the health of the mothers and infants of their villages — ancestral knowledge that is now included in the Guatemalan Ministry of Health’s official manual of care.
In these communities, midwives assist with births alone and use their own resources, without the requisite tools and without support from the government, which, in the past two years, has neglected to pay them the 3,000 quetzales ($378 U.S. dollars) to which they are entitled annually under the Guatemalan Midwives Law. Here, women become pregnant when they are still children. By the age of 30, they are mothers to as many as five, and are grandmothers, too, because their daughters follow the same path. The midwives have watched these girls be born and they have watched them give birth to children who add to the region’s growing malnutrition statistics. In the communities here, most women have mourned at least one child who died of hunger. Here, communities organize to meet their own needs, because the state has consigned them to oblivion.
Josefina Roque is a leader of the women’s movement in La Ceiba Talquezal, a remote community nestled at the top of one of the mountains surrounding the municipality of Jocotán, in the department of Chiquimula, Guatemala. She is 37 years old and has five children. She is a single mother and has raised them all on hard work and the harvests that her small plot of land has provided over the past ten years. She tells her story with pride. Roque also survives on the profits she earns from her small store, nestled in a little room in her adobe home, where her closest neighbors come to buy candy, soft drinks, sweet bread, French bread, bottled water, soap, shampoo, and bouillon. And sometimes, though not very often, some basic grains. Every afternoon, she slips on her rubber sandals and, machete in hand, follows the dirt paths through the community for 15 minutes to reach her guatal, a sloping stretch of land where she grows corn and beans to feed her family. Josefina is also the leader of a community project. In 2016, a group of women came together around her efforts to fight hunger in her village: they started a community garden on a small plot of land measuring 15 by 15 meters. They planted 400 seeds. Now, they harvest around 20,000 tomatoes every three months, bringing in some Q2,400 ($300 USD). Participants share in the harvest and each person sells their portion, then contributes a small amount from their earnings to pay for the next planting.
Hamilton was playing with some rocks when an adobe wall collapsed and buried his six-year-old body. No one saw it happen. He was trapped in the mud, but managed to pull himself out as best he could. He walked home alone to change his clothes. In La Ceiba Talquezal it is normal to see children walking alone, at any time and in any shape. There are others like Hamilton: Axel Pérez is ten years old. He started first grade in January 2024 and often wanders through the orchards in search of fruit to eat. During orange season, Axel will spend whole mornings under a big tree, eating as much fruit as he can. He always carries his machete, and he wears a red jacket with no buttons and black pants that he tucks inside his rubber boots. Three hundred meters from here, Jorvin would often run through the community’s small side streets, his face and clothes stained with “Nutri Niños,” the complementary food that the Guatemalan government distributes in rural communities to “reduce the country's malnutrition rates.” Jorvin liked to eat it as a treat, wrapped in a fig leaf.
Every month, the organization Acción Contra el Hambre (Action Against Hunger) conducts height and weight surveys to detect cases of children at high risk of malnutrition. Using this data, they bring together the most vulnerable children in each community and organize a community kitchen, where mothers learn to cook using new recipes and local ingredients. On Tuesday, Sep. 3, 2024, about 25 children gathered to eat chicken with local vegetables and herbs. The chicken was an exception, a special treat to close out the 12-day program, which saw 60 percent of the children who participated gain between four and eight ounces in weight. “Some had gastrointestinal illnesses a few days before the program, so there was no difference in their weight,” says Jackeline Hernández, a nutritionist for the project, which seeks to encourage good habits and to reach as many mothers as possible. In practice, this can be quite difficult: most of the households in the area only have access to corn and beans for their daily basic food basket.
Josefa Aldana is 47 years old and has seven children. The oldest is 29, and a mother of five. Aldana is studying to become the midwife for the central sector of La Ceiba Talquezal. Like most of the others, she was chosen by the leaders of her village. Midwives assist women in the process of pregnancy, deliver babies, and provide care after birth. It is an ancestral Indigenous practice that has been integrated into the Guatemalan Ministry of Health’s manual of care. According to a report by UNICEF, midwives attend 29 percent of all births in Guatemala. On Mar. 16, 2022, the Guatemalan Congress declared May 19 “National Day of the Midwife,” to honor their ancestral experience and knowledge and their contributions to ensuring maternal and child health in rural and impoverished areas of the country. The decree also mandates the recognition of the work of midwives; guarantees their right to be free from discrimination; facilitates the means for them to carry out their work in the communities; and orders financial support in the form of Q3,000 per year for each of the more than 23,500 midwives in the country. This latter provision, however, has not been fulfilled. Three midwives —two in Chiquimula and one in Guatemala City— told El Faro that they have not received the annual payment since 2022.
A wood shack with a tin roof is the closest health outpost in La Ceiba Talquezal. Community members built it with their own hands and resources. It’s the first space in the area dedicated to caring for children at risk of malnutrition, and a general practitioner is expected to perform height and weight evaluations here every month. For the community, it’s a dream come true. It’s also a fundamental right, which the authorities have neglected to uphold. “We live in a place that’s been totally abandoned, with terrible health and education. The people in power are always loyal to a small group, and often the only people who benefit are the ones who identify with their party’s colors. Community leaders like myself, who defend our territories, are always ignored,” says Israel Ramirez, president of the Community Health Commission of La Ceiba Talquezal.
Seven women prepare food for more than 25 children in the home of Vitalina Morales, one of those who takes part in the community kitchen. The women involved in the communal garden project divy up work aimed at improving their children's lives. The two gardens require the work of 50 people, 40 of them women, and the participants have also constructed a clinic and expanded a classroom that no longer had room for more children.
Lidia Hernández is the midwife everyone thinks of when asked. She is 40 years old and has eight children. She has too many grandchildren to count. In the past, she would attend as many as fifteen births in a single year. Now she attends between three and five, because there are two more midwives in her village who take on a share of the births. Lidia also suspects that there are fewer deliveries these days, because family planning is more common. Midwives are increasingly counseling women not to have as many children, but more often than not, the men reject their recommendation. “We don’t receive any pay for our work. The government wants us to work, but they forget about us when they make their policies,” she says. During her ten years of service, Hernández has received just one payment of Q3,000 from the government, which was delivered in 2022. The state has failed to fulfill this obligation for the past two years. She survives off her small plot of land, where she harvests corn and beans. Sometimes she gets help from her four children, who no longer live with her. Her first husband, with whom she had six children, was murdered 14 years ago. Her second husband abandoned her five years ago, leaving her alone with her two other children.
“I don’t remember anymore. After so many emotions piling up over the years, I’ve forgotten,” Saturnina says of the death of her youngest son, Nery. “It was on April 18,” yells her neighbor Juana, overhearing the conversation from a distance. Nery was born on Dec. 11, 2023, at the National Hospital in Chiquimula. At three months old, the child began to cough heavily and lose weight. Saturnina took him to the communal clinic in Palmilla, the nearest village. She walked for an hour with her baby in her arms. “They saw him, then told me that they’d come to my house in a week to check on him again, but he died before they could come,” she says. Saturnina says that her son died of ansia , a term that means “yearning” or “craving” in Spanish, used locally to describe various symptoms of child malnutrition that cause weight loss following an illness or starvation. Saturnina does not know how to read or write. She plants corn to feed her three other children. Sometimes her husband finds temporary work, earning Q50 (less than $7) per day.
About 600 people live in La Ceiba Talquezal. One hundred and fifty, or 25 percent of the total population, are children under the age of five. Health worker Israel Ramírez says that, since assuming his position in 2013, they have recorded the deaths of 18 children in the community. The three most recent deaths were in April 2024, according to figures from the community health commission, which attributed their deaths to anemia. The Ministry of Health and Action Against Hunger also recorded three deaths of children during the first months of the year, attributing two of the deaths to dehydration and prolonged diarrhea without medical attention, and one to respiratory problems. In August 2024, Action Against Hunger conducted a nutritional study of 91 children in the community. The data are worrying: 78 percent of the children were chronically malnourished and ten children were at risk of acute malnutrition.
“We struggle. We have to figure out how to provide care with what we have. The government is over there, far away, and we are here, forgotten,” says Lidia Hernández as she displays the supplies that she has on hand to attend births. Her first-aid kit is a clear plastic bag hanging from the ceiling and containing a few basic supplies: umbilical tape, scissors, a box of gauze, a box of latex gloves, a box of masks, a small scale and large scale. Sometimes, the kit includes an umbrella. “We have no resources. They don’t give us any supplies, but they demand that we have safe and clean deliveries. We have to buy our own supplies and oftentimes we rely on the voluntary collaboration of the families we serve,” said Febe Guarcas, a midwife from San Lucas Tolimán, Sololá, and the treasurer of the National Movement of Midwives, who spoke to El Faro during a presentation that the organization delivered to the Guatemalan Congress on Wednesday, September 18. The only member of Congress to attend was Sonia Gutiérrez, of the Winaq party. The other deputies invited were not present, as has been the case since 2016.
Roberta García is the shining light of her village. She is a midwife, a community leader, and has taught 158 women how to plant home gardens. She lives in the canton of Pitahaya, in the municipality of Camotán, about eight kilometers from La Ceiba Talquezal. At 16, she became a mother, and has delivered six of her eight babies herself. This is how she learned her trade. And this is how she delivered all of her grandchildren and many others in the village. “I don’t make a living from this. The state doesn’t help us, but we keep at it anyway. No midwife is going to tell you that she has received help from the government,” she says. When a family calls, García only asks for help with transportation. It’s hard for her to walk due to complications from diabetes. In her four years serving as president of the Community Development Council (COCODE), she oversaw the construction of a community center, a soccer field, and a drinking water project. Beginning in 2007, she spearheaded the home gardens project, which has supported 158 women in securing their own food autonomy. The gardens were a prime example of the community’s approach to development. She met with many journalists, as well as former Vice President Roxana Baldetti, who is currently serving a prison sentence for illicit association and tax fraud. She left the project in 2020. “Now there are only 20 orchards. There is no more interest or willingness to work for the community,” she says. The last time El Faro visited her home, García had just returned from harvesting guanábana leaves. She uses them to prepare the tea that relieves her diabetes, a disease she has suffered since 2019.
Herminia Gutiérrez and her son live in the same house where five-year-old Adalicia and six-month-old María Isabel died in September 2021. Her little sisters have joined the malnutrition mortality figures registering the deaths of 18 minors in the community since 2013. Her house is built on a hillside, with no access to drinking water, and is surrounded by coffee plantations, ducks, chickens, and some emaciated dogs that sleep on the dirt patio. Herminia is 20 years old now, and is only 4 feet tall. She grew up in extreme poverty and seems to have lost her sense of hope and any notion of time. As she tells it, one day, Adalicia fell over in the dirt. A worm had gotten into her stomach, making her sick. Then the worm found its way into the six-month-old girl and gave her the disease too. They were both really dirty, she says, and they died of “affliction.” According to her neighbors, the girls died of dehydration due to prolonged diarrhea. Gutiérrez has to be both a father and a mother, she says, and only finds work during the coffee harvest. Her partner abandoned her three years ago, a few days after the birth of their child.
Brenda buried her second daughter on Dec. 11, 2020. Since then, she has not visited her grave. “When you do everything for your children, there’s no time for sadness. That’s why I don’t mourn her. I gave everything for her when she was alive. Now I have to take care of my other three children,” she says. Jazmín lived only two years, mostly between hospitals in Chiquimula, Zacapa, and Guatemala City. “In the capital, they did all the tests and told me it was pneumonia. That was all. When I took her to intensive care, she was nine months old and weighed 16 pounds. When she came out, she was 16 months old and weighed 13 pounds. She lost weight in the hospital. Maybe because of all the blood they were taking,” says Brenda. She and her husband work as day laborers on farms near their home, where they make about Q80 a day (a little over $10).
Two brothers —Santos Alfredo, seven, and Santos Adilson, four— play at home in the canton of Pitahaya in the municipality of Camotán. A total of twenty seven children live here, born of six sisters who became mothers when they were children themselves, of 13, 14 and 16 years old. The kids live crowded together in small huts distributed across their grandparents’ land. They run barefoot from one side of the yard to the other, with swollen bellies, playing in the dirt and with dogs and a litter of baby pigs that wallow in the mud. Camotán is part of Central America’s Dry Corridor, and is one of the areas most impacted by the climate crisis. Camotán also has the highest rate of chronic malnutrition and the second highest rate of acute malnutrition in the department of Chiquimula. The main causes of illness in children are gastrointestinal infections, colds, and pneumonia, all caused by malnutrition and deficiencies in the body's immune system, according to the Assessment of Municipal Public Finances published by UNICEF in September 2022.
A family walks home after the day’s work: a quintessential image of rural communities in Guatemala, where both adults and children work in agriculture. These communities are located in the heart of Central America’s Dry Corridor, and are some of the hardest-hit by the climate crisis in recent years. Lack of rainfall has made farming difficult and has destroyed the self-sufficiency of the families who depend on it. Many villagers believe that 2024 will be better because there has been more rain, that the fields will yield better harvests, and that this will bring health and happiness. “Without decent food you can’t live,” says Israel Ramírez. “And let’s be honest, here we live on beans and corn. It’s not dignified, it’s survival. It’s what we do every day. And it’s the main problem facing our children. The older ones pull through, but the little ones don’t survive.”
*Additional reporting from Yuliana Ramazzini. Translated by Max Granger. This story was produced with support from the Catalan Agency for Development Cooperation (ACCD) and the Government of Catalonia.
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