I am by no means a health or nutrition person. I love sugar and all things unhealthy, I try to get as many calories as possible when long walking and that is about the extent of it. This is to say, It takes a lot to get me to notice nutritional health issues. Walking across Bolivia we not only witnessed but experienced the effects of lack of basic and essential dietary needs.
One Country Study on poverty and malnutrition in Bolivia (World Bank, 2002) states “Malnutrition afflicts about one fourth of children under three years of age and between 12 and 24 percent of women in Bolivia. It contributes to high death rates, immune
deficiency, learning disabilities, and low work productivity.”
A later section of the study, “Myths of Malnutrition” goes on to state, “Debunking myths about the causes of malnutrition is also important. The dominant misconceptions are that malnourishment stems from: (1) food scarcity and a lack of self-sufficient farming, (2) lack of milk and meat, (3) high altitude, or (4) genetics.”
While their reasons stand, as these factors are not “causes” I argue that several contribute significantly. Some of which we became aware were: poverty, elevation, food preperation, and a lack of awareness about nutrition.
Let’s work our way down this list.
One point on which I think we can agree is that poverty is clearly a factor in the effects of malnutrition with which many Bolivians contend. One figure from the study laid out the interplay nicely:
An example of the privilege we have is that the effect of the nutrition issues on us were largely: observing those who lived with it and our experiencing temporary physical set backs.
At the end of conversations I would sometimes ask the kids how old they were and they always reported being 3-4 years older than what I would have guessed. The largest body of evidence I saw was talking to a school of 50 kids ranging from 5-12. Each grade appeared significantly younger than if they had been lined up next to, say, the Argentine schools we’ve talked at. Children are older than they appear, women were younger than they appear.
When the effects of making this diet a practice began to affect us we were able to offset it by taking transport to larger well supplied cities every few weeks to stock up on nutrient rich basics and vitamins. One area in which we suffered significantly and consistently was from the water, which wreaked havoc in our intestines and stomachs. Cramping, protracted bouts of diarrhea, all the fun stuff.
The study cited above argues that elevation is not a factor in malnutrition because of misplaced belief that greater altitude stunts children’s growth. While I agree with this, our experience as travelers through the highest and most isolated country in South America is that elevation has other effects.
We entered from the south at about 11,000 ft and left out the north at about 15,000 ft. The lowest we dropped to was around 9,000 ft. The first month we were lightheaded, dizzy each time we stood up, reduced muscle response to commands, and having to stop or slow often to breathe.
Another, unanticipated effect of the elevation, was that healing was dramatically slowed. About a month in and we were both going through rounds of illness ranging from dehydarrhea (my new favorite hiker word, as coined by Drag Man from the GPT and very accurate to the symptoms), fever, weakness, aches, etc. We also noticed simple things like cuts, split lips, etc took longer to heal.
Another effect of the elevation is persistently lower temperatures which affects the capacity for growing food.
Food Prep and Growth
The World Bank’s study cites, “Insecurity of the food supply is often held up as the chief cause of malnutrition in Bolivia (CEESA, 1997). . . . In reality, fairly recent data (1999) suggest that total food availability is 2,237 calories per person per day, an amount adequate to feed the population if distributed equally (FAOSTAT, Sept. 12, 2001).”
One frustration we had was that almost all of the cheap food was fried. Primarily it was fried in vats of obviously very old and low quality oils. In some regions pollo a la brassa (rotisserie chicken) was prominent and delicious but relatively expensive. Besides that the main meat was llama, whose health benefits were widely professed but also non-specific. They all told us llama meat was healthy, no one could explain why.
Most of the regions through which we traveled were dry, the soil was semi-arid at best, while prolonged cold temperatures and deep frosts limited growth periods. The land was largely used for llama grazing. If you are fascinated by soils, this is a good read. The planting we saw and talked with people about were: lima beans, quinoa, and potatoes. Not just plain, low value Yukon Golds, but a cool and crazy variety of potatoes from ancient lines.
So, I agree with the first point of the Nutrition Myths made by the World Bank study but if, even with growing season and capacities limited, they are able to grow such super power foods, why the malnutrition? The study offers interesting research which I encourage you to read. My experience, living out of a backpack in the field, limited my information gathering capacity to asking around.
I asked dozens of Bolivians this question.
“The price of our quinoa has dropped by 400%,” Naomi laments. Her family and entire community subsist on quinoa crops, “the people can’t even afford to buy rice at the shops!”
“Why don’t they eat the quinoa?” I ask.
“Because that is for export. If we don’t sell it we don’t get money. I hear people in China will pay a fortune for just a handful of quinoa but we make almost no money from selling it.”
“People pay a lot of money for quinoa because it has a lot of good nutrients and calories,” I explain, “In the United States we call it a super food’.”
“Then we should be paid more for it, then we could afford rice!”
“But if you are not able to sell it for a fair profit, why don’t you eat it yourselves?” I press.
“Because,” I can sense she is frustrated, that I am missing some link in her line of reasoning, “it is for export.”
The dissonance of this conversation has become familiar. Some say their grandparents ate it, others say it was for the animals. There seems a hint of prejudice against quinoa as a food for the very poor, even if they know it fetches a high price in foreign countries. The shop owners I’ve asked say no one buys it, that people want bleached rice and pasta instead, so they don’t sell it. This strikes me as a lack of understanding for the true wealth of the ubiquitous grain.
The small, one room or even closet size shops in most of the villages sell almost exclusively empty carbs: crackers, juice mixes, puffed cereal, Coka Quina (the national soda), “chocolate flavored” wafers, and mayonnaise. Bottles of 96% denatured alcohol (which we use for our stove) which is consumed as a beverage is in every shop.
We found quinoa only in La Paz, and a few towns as a pre-packaged “for distribution” good. Dried lima beans are also common when we found bulk sales shops (semi-regularly), and potatoes were also eaten as a staple.
In terms of what foods are available for purchase in the shops, the Bolivian altiplanos are a food desert beyond almost anything I have seen in the US. Therefore, basic and important nutrients come from what people can produce. I believe the gains they and their children would experience from directly consuming what they grow far outweighs the pittance they are paid for selling it but many fail to grasp this. Entrenched in poverty, immediate gains are always more pressing and evident than long term returns.
We tried to proliferate the values of the foods right under their feet but this is a matter requiring much more education, challenging of prejudices, and fostering opportunity than we were able to provide.
Though, I do hope we planted some seeds. . .