Practising what you preach: Rafael Pillco’s journey - Peru

By Victor Hugo Giraldo

Rafael Pillco, 33, takes great pride in his work as a health promoter for UNICEF in Huama, a small Quechua community perched high in the Peruvian Andes. He and other volunteers like him have triggered some dramatic changes in this remote place, and those changes are paving the way for a healthy new generation of children.

Rafael never had the kind of opportunities today’s kids here have. Indeed, his commitment to the cause of children in this rural corner of Peru, 70 kilometres from the ancient city of Cusco, is spurred by his own troubled childhood.

Rafael fled Huama when he was barely 11 years old because of an alcoholic father who severely maltreated him. He returned seven years later, keen to make a difference in his native community, where the social indicators were worrying. 60% of children under the age of three suffered from chronic malnutrition, most women were illiterate, alcoholism was rampant, the average height of an adult was 1.55 metres and agriculture was barely at subsistence levels.

Rafael’s chance to contribute came four years ago when the organsiation ‘Centro Andino de Educación y Promoción’ (CADEP – ‘Andean Centre for Education and Promotion’) launched the ‘Good Start’ project in Huama. This project is all about empowering parents, families and communities to give their young ones the best start possible in life.

After hearing CADEP health experts talk about the benefits of proper nutrition, care and stimulation of the child and their impact on the development of an infant’s brain, Rafael jumped right in, volunteering to become the point man for community mobilization.

While UNICEF has no visible presence in Huama, it is very much the catalyst for change here, working through its local partner CADEP. This non-governmental organisation (NGO) is one of seven in Peru implementing UNICEF’s early childhood development ‘Good Start’ project at the grass-roots level. UNICEF provides US$15,000 per year in funding to CADEP, earmarked for 20 to 30 communities in the Department of Cusco, each community composed of 40 to 50 families. The investment works out to not much more than US$500 per hamlet. But the ultimate worth is many times that amount thanks to a whole chain of valued-added efforts, starting with UNICEF, progressing through CADEP, and concluding with individuals like Rafael.

Training is one of CADEP’s major outlays (the cost of a two-day training workshop for 20 health promoters is US$250). Rafael, Huama’s health promoter (each community has one such person) attended several training sessions, after which he quickly encouraged the community to fund the setting up of a surveillance centre to support and promote early child growth and development.

At the centre, households with pregnant women and children are registered and noted on home-made community maps, calendars for control visits are established and updated periodically, and colour flags are placed on one side of the houses to show the nutritional status of children under the age of three and women due to give birth. At the centre, sessions are held to provide parents with the skills to improve care practices at home and make their own toys using local materials.

Improvements are applauded in the community assemblies, and are proudly marked by changes in the colours of the flags that then encourage and motivate parents to keep up the progress on childcare.

“The flag system we are using, posted in houses where children live, is of great help,” says Rafael. “A green flag means the child is healthy, a yellow flag means the child is not well. At first some people did not want to use these flags because they were ashamed to admit they had a problem. However, the community agreed on this method. The majority decided to use it and so we did it. Most are now fully aware. They have to take good care of their children and wife.”

Talk about flags leads to an amusing anecdote.

 “Some time ago engineers from the university came to Huama and asked if the flags meant where ‘chicha’ is being sold (chicha is a traditional brewed alcoholic drink prepared by fermenting chewed maize),” Rafael recalls. “In some Andean communities a red flag is posted to advertise ‘chicha’. I answered that the flags meant children's health or nutritional status. They congratulated us and said they would take this experience to other communities.”

Rafael’s training came in very handy with the birth of his own son. In fact, he put his knowledge to work from the moment his wife, Valentina, announced she was pregnant, so eager was he to assure they would have a healthy baby. He was careful about her diet, accompanied her to prenatal visits and reminded her to take her iron supplements. When Valentina went into labour, he immediately took her to the maternity home established by the community. Their son, Johann, weighed 3.8 kilos at birth, an impressive birth weight in Huama where the average is three kilos or less.

 “A child must be healthy from the beginning,” says Rafael. “He or she must be cared for even before birth. Both mother and father have to go to the health centre to learn.”

Johann, now a 14-month-old healthy toddler, was exclusively breastfed for the first six months and is being actively stimulated with care and affection. He hasn’t been sick once and laughs and plays like a bigger boy.

But Johann is no exception in Huama these days, which is highly encouraging. Some 56 of the 80 children under three years of age (70%) have adequate nutrition levels.

Under the stewardship of Rafael, the inhabitants of Huama are continuing to spurchange. They supported a fund aimed at helping families care for their health. Members can make loans that are paid for with agricultural produce sold in the local market. They also established mechanisms so that the community health promoter can be assisted in farm work while he conducts surveillance activities. Valentina, thrilled with her chipper son and eager to pass on all she’s learnt, is counselling other mothers.

The good news about Huama's healthier children is filtering out to neighbouring communities. As a result, Rafael and other health promoters have been invited to spread the word about what’s behind the hamlet’s success. Huama is being visited by people from far away who want to know more about this great experience of community leadership.

On a broader scale, the ‘Good Start’ project is being developed successfully in four departments of Peru, benefiting 20,000 pregnant women and 46,000 under-three-year olds every year. Through this community-based intervention, children are being given the chance to exercise the right to grow properly and reach their full potential of cognitive, emotional and social development.

“Good Start’ is our hope,” says Rafael. “We are poor but we can nurture and care for our young children. Before, we did not know anything about brain development and how our young children can have, later in life, a greater chance to become productive members of the community. Now we have this opportunity,” says the very proud father of little Johann.