Millions of adults fled Venezuela convinced that abroad they would be able to give their children better opportunities in the face of the food access crisis that worsened in their country of origin seven years ago. Thousands arrived to Ecuador and while being vulnerable, they settled in a territory where child malnutrition is one of the highest in Latin America. A journalist and director of an NGO that provides medical aid to Venezuelan migrants and refugees in Cuenca, describes the challenges generated by the situation from her perspective.
By Karla Sánchez Arismendi
It is Tuesday and in the foundation that I run, there is a frantic movement that I follow from the office. As I make my way, I am informed that a visitor that I was waiting for has arrived. It is a mother with her 4-year-old son, who I see come in. They go to the general medicine consultation room and the nursing station. In the examination, they discover that the infant has weight and height deficits; as he should weigh 16.5 kilograms and measure 103 centimeters, but he lacks 3.5 kilograms and 9 centimeters to reach the minimum measurements. The medical team concludes that he is the picture of malnutrition and that he requires urgent attention.
They inform me of the child's diagnosis and I agree to visit them later at their home. Once we are there, we talked with the mother about her story and other ways the foundation can help them. She is originally from Venezuela. She left her country convinced that there she would have no opportunities for her family nor for herself. That is why she settled here, in the Ecuadorian city of Cuenca, in the province of Azuay, where there is a Venezuelan community of 12,000 people; according to data from the Casa del Migrante, a local municipality institution.
“We left Venezuela in 2017 because we couldn't buy enough food for my son even though his father and I had a job,” says 34-year-old Dorina González. She is part of a giant diaspora, never before seen in Latin America and the Caribbean. More than 6 million people have left the Venezuelan territory and dispersed as migrants and refugees throughout the world, but especially on the Latin American continent.
Just over half a million arrived in Ecuador, according to the Regional Inter-Agency Coordination Platform (R4V), a multinational body in response to the unprecedented situation. Almost 44 percent of the total, according to the national government, lacks regularized immigration status, which prevents them from having normal access to services, job opportunities and housing, among others. A third of those who live in Cuenca are in precisely that vulnerable of a condition.
Like González, I am Venezuelan and I also live in the same city, to which I emigrated to in 2015. That, however, is not the only thing we have in common. Before dedicating myself to full time social work to serve the migrant and refugee community from my home country, I experienced similar hardships. The circumstances of my migratory journey ended up temporarily affecting my son's nutrition. I had to receive assistance to overcome it. That is why I feel reflected by what she lives.
In the last quarter, the foundation has received at least two weekly cases of infants with chronic child malnutrition whose families come from Venezuela. CCM, as it is known, is a delay in normal growth that boys and girls should have according to their age. It has multiple causes of origin although it is commonly connected with poor nutrition. Those who suffer from it can return to their regular weight and height, but it is likely that they will have long lasting effects including learning problems, difficulties in the development of fine and gross motor skills or the propensity to suffer non-communicable diseases such as hypertension or diabetes.
Mothers and fathers cared for by the foundation agree that they left Venezuela, among other reasons, because they believed that this would save their children from malnutrition. A report by four United Nations agencies warned that undernourishment had multiplied by four in the Venezuelan territory between 2012 and 2018, reaching a fifth of the population. In 2019, the World Bank made a report where it is mentioned that the chronic malnutrition rate in Venezuela was at 17.8 percent. However, in the absence of official figures in the country, last year the international non-governmental organization, Oxfam, estimated that the child malnutrition rate in Venezuela was at 30 percent.
The paradox is that those who chose Ecuador came across a country where chronic child malnutrition is considered a public health problem that affects around a quarter of girls and boys under five years of age. "Having a CCM level of 27.2 percent, just below Guatemala, makes us think, and makes us identify it as one of the most serious problems that the country has had," says Esteban Bernal, Minister of Inclusion, Social and Economic.
The United Nations Children's Fund (UNICEF) published this year an article in which it pointed out that the Ecuadorian Government has implemented 12 programs or projects related to health and nutrition since 1993 without significant impact on statistics, a reality that Bernal affirms he wants to change with the current administration.
The journey of tens of thousands of people who have traveled from Venezuela by land has been added as an aggravating factor in the incidence of CCM. “Migration has exposed girls and boys to a low nutritional intake during their movement and has prevented them from accessing clean water services. In addition, living conditions are often precarious when they arrive at their destination. Thus, they will have acute or temporary malnutrition that can become chronic”, explains Pedro Arias, the foundation’s doctor.
A study by UNICEF Ecuador confirmed this opinion last year: 43.7 percent of Venezuelan infants who were evaluated by the multilateral institution or by allied organizations on the territory of Ecuadorian borders were diagnosed with chronic child malnutrition. The Ministry of Health, however, has lower statistics, according to which approximately 10 percent of the Venezuelan child population in Azuay suffers from CCM.
"When there is a diagnosis of chronic child malnutrition, it means that the institutional support system failed to find and prevent this problem," says Arias, who is Ecuadorian and teams up with a nurse graduated in Venezuela. Laura Caridad, who shares her concerns when seeing mothers and fathers without the income to provide their children with a diet rich in nutrients and proteins. "No child deserves to suffer from malnutrition," she says.
The foundation where we work –which is called GRACE, an acronym for the phrase Give Refugees a Chance seeks to offer support to mothers who approach the foundation through medical care and delivery of micronutrients. Other like-minded organizations work in similar areas. The HIAS - a global Jewish organization that helps migrants and refugees in vulnerable situations - assists between 500 to 600 Venezuelan families in Cuenca each month with a 25-dollar monthly food card to use only in affiliated businesses.
In this context, the stories of women like González and other mothers like Deinessix Pitre and Wilna Cedeño, cared for by the Grace Foundation, are a living portrait of the full extent of a problem that I went through and that changed my vocation.
"My son was born in 2017 when you could not buy food in Venezuela because it was not available or because everything was very expensive and the money was not enough," says Dorina González. “I lived in El Hatillo, Caracas. I went to high school and graduated from a university. Before emigrating, I worked in a private bank as an accountant. I was already married and my husband worked as an auto mechanic.
“During the pregnancy everything was normal. Since I had a job, I was able to buy the iron, calcium, and folic acid prescribed to me, and the private insurance would reimburse me for the money. My son's underweight, however, started when he was a year old. Even though my husband and I had jobs, we couldn't buy him enough food. We gave him rice, grains, pasta or a chicken when it was obtainable, but it wasn’t enough. That is why we decided to embark on a migration plan.
“My husband came to Ecuador first to see if it was feasible to support us. He got a job as a delivery man in a delivery service. Eight months later my son and I arrived. Here I have not been able to exercise my career, because I do not have legalized papers in the country and I stopped handing over my resume after my folder was torn when I went to an interview in a shop in Cuenca. Now I get by taking care of a child in the afternoons. We have not been able to get my son's papers because we have not had the money and we are waiting for the new visa process. My husband had the Unasur visa but it expired and I thank God I have the VERHU visa (Exception Visa for Humanitarian Reasons).
“Every month I take my son to the health center for his pediatric check-ups. They prescribed iron and recommended that I feed him at least three times a day and give him plenty of fruit. But I can't afford iron and that's why a friend recommended that I go to the foundation. This year I enrolled my son in school. He is in his second year of preschool (virtual). There they provide milk and cookies for him and I give them to him. He is nourishing, although we also have the need for meat, sausages, pasta and more.
“We buy daily. The first year when we arrived we received the HIAS food card, but not anymore. I like Cuenca. It is beautiful and calm but I would like to return to Venezuela because of my family. Now I can't because I'm pregnant. A doctor told me that I couldn't have any more children, but that was not the case”.
Photography: Xavier Cavinagua
Dorina González has been recommended to reinforce her son’s diet and to give him iron
Living in Venezuela
I arrived in Cuenca two years before Dorina González and then a bumpy journey began that turned into a definitive migration. In my case, settling here was not a planned decision but an unexpected turn of fate. In October 2015, I was traveling to the city with my boyfriend due to a friend’s invitation. During the layover in Quito, I learned that I was pregnant and that I also had a threatened miscarriage caused by struggling with the luggage. The doctors told me that flying back to Venezuela would be risky. We decided then to go by land to the capital of Azuay, in an eight-hour long trip. We stayed and my stay has lasted until today.
By then, the Venezuelan crisis was growing like a snowball and was starting to become a humanitarian emergency thus recognized later by multilateral organizations such as the United Nations. In 2015, inflation shot up to 180.9 percent, which was just a prelude to the astronomical leap that later became the worst hyperinflation on the continent in remembrance. The shortage had also been unleashed in an unexpected way. There were long lines in supermarkets to buy what little was supplied, including basic supplies such as diapers, baby milk or meat.
Settled in Cuenca, I witnessed two transformations. The one in Venezuela that I followed from a distance and the one in Ecuador that I saw in front of my own eyes. In my country things got worse. A piece of news that shook me to the core helps me explain it. It was an event that occurred in 2020 in Cagua, Aragua state, a town near Santa Cruz, where I grew up. Reed beds were being burned and a group of children decided to go into them to hunt rabbits and iguanas, that were fleeing the fire, to bring food to the table. The little ones suffocated and lost their lives. It all happened in a place where I had enjoyed part of my childhood in a completely different way.
While that was happening there, in Cuenca and in Ecuador, waves of people came from Venezuela. Lenín Moreno’s government established in 2019 that for those who want to set foot on Ecuadorian territory the mandatory requirement was the so-called VERHU visa. Its establishment sought to stop the migratory flow and open a temporary regularization process for those who were in Ecuadorian territory with irregular status. The costs and the requirement of documents, which were not always at hand, became obstacles that were increased in the case of boys and girls.
One fact illustrates it. In the entire province of Azuay, for example, only 125 visas had been issued to minors between January and September 2021, as confirmed to me by Ingrid Ordoñez, zonal director 6 of the Ministry of Foreign Affairs and Human Mobility. “The reason for this low number is that their fathers and mothers are not together. Most of the boys and girls are only with the mother and do not have a power of attorney from the father to have taken them out of the country or to apply for a visa in Ecuador”.
Families remain awaiting the implementation of new policies which were announced by President Guillermo Lasso on June 17, 2021 within the framework of his participation in the International Conference of Donors in Solidarity with Venezuelan Refugees and Migrants. At that meeting he said a new regularization process would be carried out that would be complemented with economic inclusion strategies that can impact child welfare.
The migrant population has had special vulnerabilities. Many pregnant women have suffered from malnutrition and have suffered complications due to lack of prenatal check-ups, which has affected their children. Others, due to lack of employment, have even ended up in informal street vendors or having been victims of organized groups that, according to the authorities, have turned begging into a business.
Fabián León, executive secretary of the Cuenca Rights Protection Council, affirms that from this institution they want to promote a policy to reverse the situation of children exposed to begging. The protocol includes referring the little ones to childcare centers while mothers and fathers work on the streets and training responsible adults so that they can improve their sources of income. In cases that the situation persists, complaints will be filed against the parents to establish whether there is negligence and eventually refer the affected minor to foster care temporarily. "What is sought is that the boys and girls are well," he says, although the attempts to separate them have created some situations of tension in the streets of Cuenca.
I was also an immigrant who carried her son on her back while she worked. Without major contacts or knowledge of the city, my first job was to walk the dogs of US citizens living in Cuenca, a city preferred by many of them for retirement. I dedicated myself to that precisely because it was the only job having my little one with me wherever I went.
Deinessix’s Round Trip
“I am Venezuelan, from Valles del Tuy, but my son was born in Ecuador. He is two years old and underweight” says 23-year-old Deinessix Pitre. “In Venezuela she worked as a waitress in a restaurant in Caracas, but I left my country because of how ugly the situation got and to start a new life. I came with my son's father. The first time, it was for two years. I returned to Venezuela, but decided to go back. This second time, I have only been here for months: I came back in August 2021. I clean a pizzeria a few days a week, but they can't hire me full time because I don't have papers. The rest of the time I sell lollipops on the street and ask for aid.
“I always carry my son with me. He was born underweight. I did all the pregnancy checks here in Cuenca and thank God they helped me a lot. However, I had a very bad diet because I did not have a job. He ate only rice, egg, pasta, and cheese. The cheapest. In December 2020 I returned to Venezuela. In the months that I was there my son got sick several times and on one occasion he had a fever of 40 degrees. He was already convulsing and at the Santa Teresa del Tuy hospital and they had nothing to give him. They didn't even have a thermometer. I took one from here in Cuenca.
“That's why I came back. Here we sometimes make an arepita (typical Venezuelan food) with cheese. In the afternoon, we make rice with chicken or eggs. At the foundation they told me that he is malnourished, that I should give him soup, meat, but I cannot buy this not only because I lack money sometimes but because I do not have a place to store food, in a refrigerator. What I do is buy food daily. Now I live with several Venezuelans. We slept on a mattress that they lent me and the kitchen belongs to the owner of the house, but she also lends it to me. I have to help with the rental but I have not been able to. Today I have made a dollar and I already bought bread and fruit for my baby. I have not eaten".
Photography: Xavier Cavinagua
Deinessix Pitre works cleaning a pizzeria and selling sweets on the street to feed her son.
An Enlightening Crisis
I was not only a dog walker carrying my son in Cuenca. While he was growing up, I worked in a rose exporting company as a salesperson to florist shops in the United States. In addition, I wrote for various media outlets aimed at Americans in the city. On weekends, I took a job as a waitress in a bar and on Sundays I cleaned the houses of several friends. Sometimes, I would eat up to one egg a day, to save the chicken and meat for my mother and my son. By then I had separated from my partner and I asked my mother to come from Venezuela not only to help me with my son’s upbringing but to be able to treat her for a kidney condition that required dialysis that was not possible in our country.
My son, in that difficult time, was admitted on one occasion to a regional hospital with an asthma attack. There they told me that he had acute or temporary malnutrition. Learning this shook me. While he was confined in the health center, I received help from women who lent me clothes every morning to change.
Also, I ate thanks to a civil society initiative called “Cuenca Soup Kitchen”, which maintains a soup kitchen for migrants in the city and currently supports 150 families per month. The project was born in the hospital where my son was staying precisely to help parents who could not afford a lunch at the establishment. That help I received to overcome the crisis made me convince myself that I had to do the same for other people, especially other women.
Everything was improving when my son started his first grade classes. Through schools, the Ministry of Education grants each student a snack consisting of 18 liquids and 14 solids that serve to cover the 18-day diet. The package includes among others whole milk, flavored fruit nectar and cereal bars. As time goes by, more children of Venezuelan origin go to school. According to data from the Ministry of Education, 1,638 were enrolled for the 2021-2022 school period in Azuay: 91.33 percent are in Cuenca. However, there is a large number of young migrants or children of migrants who remain out of school and without access to snacks that save many from malnutrition.
I was able to overcome the situation I experienced with my son with help. But since then I have been trying to better understand how CCM can be avoided. Unicef points out that medical check-ups are key in the first thousand days of life for boys and girls. The organization, however, warns that the problem is not exclusively related to the lack of food, but can occur when mothers do not receive adequate prenatal controls or when infants do not have access to appropriate water sanitation services or live in inadequate conditions.
“My daughter has never been the correct height or weight for her age,” says 27-year-old Wilna Cedeño. “She was born just 660 grams and she spent eight months in the neonatology service before she could take her home. It had a lot to do with a brain tumor that I was diagnosed with and faced in the middle of my pregnancy. They discovered it here, in Cuenca. I am from Apure, Venezuela and I arrived in Ecuador on July 8, 2017. In Venezuela I was studying systems engineering while working as manager of two legal gambling establishments. When I was in the seventh semester of my degree, there came a time when I stopped studying. I had two salaries and lived with my daughter's father. But I didn't have enough money for us. We didn't even have enough to eat. That is why I came to Ecuador.
“My partner came first and it was my brothers-in-law who paid for my bus ticket. As soon as I arrived, I got on my phone, looked for a job on the weekends and within two days I started working in a restaurant. A year later I got pregnant. Two months later, in the middle of a pregnancy check, I passed out. That was when the doctors discovered the tumor. She lived with him without knowing it. It fed on the placenta. I had been to the hospital the day before, because I had headaches. A doctor saw me and told my whole family that I was crazy, that the pain was due to pregnancy. The next day, however, I went into the emergency room where they placed a valve that to this day helps my drain encapsulated fluid from my brain. I had surgery while pregnant. They told me it was my life or my daughter's. I didn't let them take her from me. The doctors thought that I was going to die and they even asked my relatives to carry out the procedures with the embassy to transfer my body to Venezuela if I did not survive.
“A couple of hours after the operation, against the most optimistic forecasts, I woke up. A few weeks later, I was referred to the Cuenca Cancer Institute where they told me that the tumor was encapsulated and that I could continue with the pregnancy if I could bear the headaches. I said yes. I can. Three months later, when and echo was made, the doctors discovered that the tumor had grown but my daughter had not and that her heart rate was also dropping. It was then that they decided to perform a cesarean section after which I went back to the operating room to have the tumor that I had in my head removed, which by then was not just one but two. After the operation, I received chemotherapy, radiotherapy and I am still here.
"I separated from her father, but he has a stable job that pays for the therapies for her development. I now work as a kitchen assistant in another restaurant. Luckily I have a VERHU visa that allows me to work legally. I don't earn much, but with that salary, I have to pay rent, food, clothes, medicine for my daughter. I spend practically everything I make on her. What worries me the most is her health, I don't think about anything else. I don't think about going back to Venezuela. I can’t. My daughter and I need medical attention and we will not get it there."
Photography: Xavier Cavinagua
Wilna Cedeño's daughter was born with low weight and height and requires multidisciplinary care to maintain her health.
This is how I came to GRACE
In Wilna, I have seen an example of resilience. Perhaps, I would not have met her if I had not worked at the foundation. I arrived at the institution by chance. After receiving help from the Cuenca Soup Kitchen, I wanted to give back by helping them in their dining room in the city center. As I was putting silverware on the tables one day, an American came up to me and started helping me. His name is Saxon Gotfried, the founder of Grace. He was recruiting people to join the project that he had created. At that time, he asked me to work with him at the institution. I did not accept. But it wasn't until a year later that I saw clearly what my mission should be.mi misión.
I was in the office where I worked as a sales executive. I heard a noise that took me out of concentration. I learned later that a boy had committed suicide by jumping off the bridge into the river just ahead. Those present commented that he had been a Venezuelan, with three children who had lost his job at the beginning of the pandemic. That week I resigned and turned to Saxon to accept his offer. My first position was as a public relations officer, but later I became the executive director. Dedicating myself to supporting migrants and refugees derives from the fact that I am part of them and went through similar harassment to those they have gone through. It also motivates me to have received support from other organizations and how much it meant to me and my family. This encourages me.
The foundation offers free or low-cost general medicine, pediatric, dental and psychology consultations. It also provides clothing donations and pedagogical support to refugee children with online classes. The little or much help that the beneficiaries receive represents either a significant change for them or at least a safe space to rest before continuing.
Dorina, Deinessix and Wilna wanted to escape from a country where the only possible future for them and their children was malnutrition. Without knowing it, they arrived in a country where this is the existing outcome for many children. Although none of them are over 35 years of age, they all have something in common, they work every day to save their children.