Day 4: Ministry of Health

Buenas noches,

We had a very productive and thought-provoking day today! We drove to Guatemala City and met with Dr. Miriam Bethancourt, the current director and Dr. Antonio Petzey, the incoming director of Reproductive Health at the Ministry of Health. The first portion of our meeting focused around Miriam telling us about the current guidelines for folic acid standardization and distribution. She informed us that currently they recommend 5 mg of folic acid once per week during pregnancy. There are 2 ways that women can get folic acid:

1. Directly from the Ministry of Health, free of charge 
2. Through pharmacies, no prescription needed

She also stated that although not in the Ministry guidelines, they do recommend that physicians tell women of reproductive age to take folic acid 3 months before pregnancy.

Since this is all consistent with international guidelines, we asked her why she thought the prevalence of neural tube defects remained so high. She stated a number of reasons:

1. Women are skeptical of free medication
2. They do not know of folic acid or its benefits and therefore, they do not know to go and ask for it
3. Women present late, if at all, to prenatal care and have not been taking folic acid

To combat malnutrition (maternal malnutrition included) in Guatemala, the Ministry has partnered with an organization called Prosan. We met today with Ivette Lemus, a head honcho of this organization. Prosan sets the guidelines for how the Ministry should distribute folic acid, iron, and micronutrient 'sprinkles'. Their program, the Program of Nutritional Health, will be starting in April. This program is focused on 83 towns/villages that have the highest rate of malnutrition and poverty in the country. They aim to give children micronutrient sprinkles every 6 months for the first five years of life. For females aged 10-49, they plan to give 60 mg of iron and 5 mg of folic acid per week, if not pregnant. If pregnant, women will get 120 mg of iron and 5 mg of folic per week. To evaluate the effectiveness of the program, they plan to record the height and weight of children until age five years. 

It seemed to us that all of the pieces to reduce the incidence of neural tube defects are in place, however, the people are not aware of them. Miriam suggested that one way to inform Guatemalan women about folic acid would be through a national advertising campaign. We immediately loved this idea. We discussed this for a while to figure out what mediums would be most effective. Pamphlets seemed to be the most practical option as they can reach the largest number of people. There were many organizations mentioned that would be able to assist in distributing these pamphlets to villages around the country. We also discussed including the pamphlets with folic acid packets so women can learn about what they are taking. Pamphlets would be in Spanish, but translated into the 3 most common indigenous languages. They also would be mostly pictures, as many cannot read (in any language). The ministry is going to collaborate with us to create this pamphlet. Isn't this great?! We're so excited to get started :)

GenetAssist with Dr. Bethancourt, Dr. Petzey and Dr. Ruiz

GenetAssist with Ivette and Dr. Ruiz