II. Project Description

A.  Background and Justification

The communities of Altos del Valle and El Valle Abajo (collectively referred to as Los Valles) are located in the District of Kinkintu, which is part of the region of Buri, situated in the Province of Bocas del Toro.  These two communities are part of Comarca Ngöbe-Buglé and therefore operate according to the laws of this political system (a more detailed explanation of this system can be found in the “Beneficiaries” Section).

In general, the indigenous population lacks access to basic health services due to geographic, economic, and cultural barriers, which has resulted in high levels of poverty and extreme poverty among this group.  A 2001 study published in La Prensa found that in the indigenous areas of Panama 94.5% of the population lives in poverty, with 86.45% falling into the category of extreme poverty.   The study also found that in general the incidence of malnutrition has a tendency to reflect the ethnic and geographic patterns of poverty, with approximately 66% of children in indigenous areas suffering from malnutrition, and with the highest incidence found among the Ngöbe-Buglés.

In reality, the presence of malnutrition within a community projects its influence on a number of social and economic factors, all of which cannot exist independently of one another.   Agriculture, climate, cultural patterns, transportation, education, and religion all influence and are influenced by the presence of malnutrition within the community.  Within those factors most strongly influencing the nutritional status of Altos del Valle, and El Valle Abajo the following can be found:

§ Lack of education (basic education and environmental education)

§ Difficulties in physically accessing the community of El Valle Abajo

§ Limited access to drinkable water

§ Remote geographic location and resulting limited access to services

   (i.e. employment and education)

§ Limited access to food

§ Lack of sources to generate income

§ Very limited access to health services

§ High levels of parasitic and bacterial infections

§ Insufficient Diet

MOCELVA volunteers completed an in-depth analysis of both communities in April of 2004 in which the members of both communities were weighed and measured.  An analysis of these statistics found a strong presence of malnutrition, and concluded that children under the age to be most effected.   In Altos del Valle, 62% of the children under the age of five suffer from degree of malnutrition. 38% falling under the category of Mild Malnutrition (Level 1), 20% within Moderate Malnutrition (Level 2), and 4% suffering from Severe Malnutrition (Level 3).   In El Valle Abajo the situation is worse with 81% of the children under five afflicted.  Of these 29% are afflicted by Mild Malnutrition, 33% by Moderate, and 19% suffer from Severe Malnutrition.

Table 1: Nutritional Status, Altos del Valle, April 2004*

Table 2: Nutritional Status, El Valle Abajo, April 2004*

*Source:  MOCELVA Survey and Analysis

These findings are alarming for several reasons, the primary being that indigenous communities in Panama are experiencing a rapid increase in growth, resulting in an augmented number of children under the age of five, and it is this segment of the population that suffers the most when afflicted by malnutrition.  Numerous studies have found that malnutrition within the first few years of life can lead to irreversible physical defects and permanent brain damage.  The combined effects of malnutrition, intestinal infections, diarrhea, and respiratory infections lead to a high percentage of illness and death among young children and infants in these communities.

Due to these alarming statistics as well as the general nutritional status of the communities, MOCELVA is prosing the following project to assist the communities of Altos del Valle and El Valle Abajo to lower the level of malnutrition among those children under five.   Furthermore, this project proposes to take a preventative approach by providing basic health education to the women and children in the communities which will in turn lead to an improvement in the status of health and well-being among the community members.

Possible Solutions

1.      Strategies that could be used to improve the nutritional status of the communities include the following:

a.       Establishment of educational programs on health and nutrition utilizing government resources and those of various NGOs (i.e. MOCELVA)

b.      Establishment of dietary guidelines adjusted to accommodate available food sources in the communities

c.       Participation of other social organizations and NGOs (Patronato de la Infancia, Nutre Hogar)

d.      Skills-Based learning approach (executed through classroom instruction and one-on-one intervention through home visits)

e.       Case Management and ongoing monitoring of those most severely affected by malnutrition

f.        Curative and preventative assistance from MINSA with:

                                                               i.      Vaccinations

                                                              ii.      Medical Emergencies

                                                            iii.      First Aid education

                                                            iv.      Assistance with control and prevention of intestinal parasites and skin infections

It is in the opinion of this organization that when taking into account environmental influences, historical and structural factors, and the social organization of the community, the ideal manner in which to work with the communities is to utilize a participatory program focusing on nutritional education and sustainable solutions.   Additionally, the primary focus of the project should be placed upon improving the nutritional status of those children less than five years of age, as this group is that most strongly affected and harmed by the presence of malnutrition.

Current Programs and Projects

At this time there are various NGOs and government groups working periodically with the communities of Altos del Valle and El Valle Abajo including:

§         MINSA (Ministry of Health)

§         MIDA/Rural Health

§         Nutre Hogar

§         Patronato de Nutricion

Of these groups, Patronato de Nutrition is the only that works consistently with El Valle Abajo and in a manner that will have more long term effects as they are constructing a sustainable farming project in the community that will be managed by the organization for a term of 10 years.    MOCELVA however, is currently the only organization that places a volunteer in the area on a full-time basis and this integration into the community is a strength in the ability of our organization to both recognize the needs of the community, and respond in a manner that will lead to sustainable changes in the communities.

A.  Desired Results

Final Results

Using the methods outlined in this proposal it is hoped that at the conclusion of one year the following will have been achieved:

§         That the members of the communities will have a better understanding of the human body, the importance of good nutrition, and illness and disease (including forms of prevention), with special emphasis on the needs of pregnant and lactating women, and those children under the age of 5.

§         Increased levels of food and water safety through education on food handling and water purification techniques

§         Development of a preventative focus on health both through the educational seminars and the establishment of Health Resource Center.

In all activities and projects a focus will be placed on encouraging and consistently increasing community involvement and participation in order to achieve more sustainable results.

For those children under the age of five suffering from malnutrition it is hoped that at the completion of the project the nutritional levels of these children will have seen the following improvements:

     CURRENT                                            AFTER ONE YEAR

Altos del Valle

  38% Normal                                       50% Normal

48% Level 1 (Mild)                                 40% Level 1 (Mild)

  14% Level 2 (Moderate)                   10% Level 2 (Moderate)

El Valle Abajo

 19% Normal                         35% Normal

29% Level 1 (Mild)                 25-30% Level 1 (Mild)

33% Level 2 (Moderate)           25-30% Level 2 (Moderate)

 19% Level 3 (Severe)              5-10% Level 3 (Severe)

 In addition to the general objectives of this project it is hoped the following quantifiable measurements will be obtained at the end of one year:

§         A rate of 40-50% community participation in organized classes and activities regarding health and nutrition as well as with the development and maintenance of the sustainable farming project in the community.

§         70% positive evaluation by students at completion of courses in regards to quality and satisfaction with material produced and presented

§         Informational report reflecting activities and results every three months

§         Existence and operation of a Resource Center

C. Beneficiaries

General Characteristics of the Ngöbe-Buglé

The Ngobe group is the largest indigenous group in Panama with about 180,000 members, and together with the Bugle inhabits the majority of the Comarca Ngöbe-Buglé, an autonomous region that covers part of the provinces of Chiriqui, Veraguas, and Bocas del Toro.  The Comarca Ngöbe-Buglé is the result of a 40-year struggle by the Ngöbe-Buglé people to attain the right to govern their own territory.

The Comarca Ngöbe-Buglé is one of five Indigenous Comarcas that currently exist in the Republic of Panama.  The Comarca was established by the 10^th Law of March 1997, and is governed through it’s own carta organica, or regional constitution by parallel traditional authorities and representatives of the Panamanian government.  The guiding principles of the Comarca aim to maintain cultural homogeneity, the traditional cultures and traditions of the people.

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On small farms, Ngöbe-Buglé men practice a style of sustainable farming that utilizes slash and burn techniques and through this produce: corn, yucca, rice, bananas, pixbae, and other fruits.   During harvest season more than half of the population migrates to coffee, banana, and sugar plantations where they are able to earn a salary (about 3-4 months of each year).  The administration of the home and the production of traditional crafts are performed primarily by the Ngöbe-Buglé women.  They also support the men strongly in agricultural tasks and replace them in their absence from the farms.

The National Census conducted in the year 2000 registered a population of 110,080 persons in the Comarca.  Within the last 10 years the growth rate for this population has been 4.27%, compared to a national rate of 2%.  This equates to a youth population (under the age of 18 of age) consisting of almost 60% of the total population.

The population in Altos del Valle and El Valle Abajo is comprised of approximately 400 people, distributed by sex and age as follows:

Table 3:  Community of Altos del Valle.  Population by Sex and Age (April 2004)

Table 4:  Community of El Valle Abajo.  Population by Sex and Age (April 2004)