Preventing Adverse Childhood Experiences

From the field in Guatemala
By Ashley Fehringer

Ashley Fehringer is completing her Peace Corps service and will graduate from Tulane SPHTM in May 2018 as a Master’s International student with an MPH degree in maternal child health.

When I entered my MPH program at the Tulane School of Public Health and Tropical Medicine in 2014, I did not know exactly how I would focus my public health career. That changed in my first semester when I had the unique opportunity to hear Dr. Vincent Felitti (co-principal investigator of the Adverse Childhood Experiences (ACE) Study describe his study’s findings of the many bad health outcomes that could be correlated to an ACE. This blew me away.

Fehrninger800From that day on, I dedicated my public health work to the study, evaluation, implementation, and advocacy of early childhood development (ECD) programs and initiatives to ensure that all children have the opportunity to reach their full potential. My two years of Peace Corps Service as a maternal and child health (MCH) specialist with the Ministry of Health in Guatemala is coming to a close, and I am searching for work in ECD program implementation and advocacy in the US. This is the time to reflect on my experience in Guatemala and how it has added to my knowledge and skills in the field of ECD.

ashley_youngwoman_GuatemalaIn Guatemala, the family is the most important unit. Children live with their parents until they are married. The typical house complex consists of mom, dad, aunts and uncles, cousins, and grandparents, among other relatives. Everything is done for the sake of maintaining the family. This culture of “family first” creates a unique network for young children and provides them with a “village” of supportive caretakers. In their first years of life, this low-stress, safe environment allows for optimal brain development leading to more successful individuals later in life (CDC).

However, as Guatemala continues to develop and the need for better work breaks families apart, I have seen a breakdown of this supportive system that disproportionately affects low-income, rural, and indigenous families. As a MCH Specialist, I work with nurses, social workers, and other health professionals to help them deliver healthcare to families in rural Guatemala, including improving home healthcare delivery. In this work, I have witnessed families living in poverty where parents cannot afford to stay home to care for their children but instead work the coffee fields just to make ends meet; daycare or in-home care is not even an option.

In other families, the need for work has become so intense that one or both parents have been forced to migrate (usually to the US) to find work. They must then leave their children behind with whoever can care for them. These conditions leave young children unattended or neglected and without needed stimulation during the day, leading to stunted physical and psychosocial development (ACE Study). What’s more, they may not be getting the nutrition they need to develop. Guatemala has one of the highest rates of chronic malnutrition in the world, compounding the developmental delays brought on by neglect and adversity (World Food Programme).

Unfortunately, these children often fall through the cracks, due to a lack of programs designed to meet the needs of young children aged 0 to 3 throughout rural Guatemala. My service in Guatemala has focused on addressing this need in my community. In the past two years, my colleagues and I have implemented new house visiting protocols with the nursing staff to ensure that families with children under the age of 2 receive regular visits to measure development and improve education for families using a tool created in partnership with USAID and the Ministry of Health known as the Wheel of Practices for Living Better. We now have around 100 families receiving house visits with positive initial outcomes in development.

I have also had the opportunity to work with the teachers of pre-school and kindergarten students at local institutions to train them on RULER (a Yale-developed early childhood social emotional development program) methodologies to help their student’s social emotional development. With my guidance and feedback, the teachers have been able to implement these practices into the classroom to help their students learn to self-regulate and work well with their peers, ultimately allowing them to focus better and attain better success. I am also in the process of developing a training program for the parents of these students to help them understand the importance of their child’s brain development and what simple things they can do at home to help their child grow.

Ashley_Feringer_screen.pngI have learned so much from working in Guatemala that I will take into my next public health job. Although Guatemala and the United States have many differences, many of the trends I see in child development here are also affecting children in communities throughout the US. Unfortunately, poverty and race have a large impact on early childhood development in the US. In both countries, families living in poverty a stressful environment for their children under the age of two that affects brain development. And many impoverished communities lack access to basic support services that would help their children thrive (Webinar: Race, Place, Poverty and Our Youngest Children).

I know that I have learned so much from my experience in Guatemala, which has prepared me to work in advocating for and improving the lives of our most vulnerable citizens, our children.

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