Delivering Interventions, Aid to Family’s Door

Zamanta Huarcaya Tamani was not a typical toddler. Unlike other one-year-olds born without a developmental disability, she didn’t babble or wander haphazardly around the house, leaving little disasters in her wake. She simply sat statue-like on her mother’s knee, her round face staring up at the stranger who came to visit her family in the remote hillside community of Miraflores in the impoverished Carabayllo district north of Lima, Peru.

The visitor, Inela Espinoza Cadenas, immediately noticed how calm and quiet Zamanta was. Cadenas is one of six community health workers employed by Socios En Salud, Partners In Health’s sister organization based in Lima, and was visiting Zamanta’s family as part of Project CASITA, a program that identifies Carabayllo children ages 6 months to 24 months at risk of developmental delays and trains caretakers in activities that encourage age-appropriate behavior. Since launching the program in November 2013, community health workers have enrolled 138 children and mothers, whom they visit at least a dozen times and provide access to social services.

Project CASITA is supported by a $250,000 Canadian (roughly U.S. $199,000) grant through Grand Challenges Canada, and is administered in partnership with Peru’s Ministry of Health and local government and health centers. Community health workers undergo a comprehensive training and certification process before they begin rounds in Carabayllo.

Cadenas began visiting Zamanta last June and found a humble family lacking basic needs. Eight people lived in a 130-square-foot house divided by a curtain into a kitchen and bedroom, where the entire family shared two beds. The tight quarters were particularly worrisome, considering Zamanta’s aunt and cousin—who were living with them at the time—had both been diagnosed with tuberculosis, a disease that spreads through coughs and sneezes.

Although she always planned her visits close to lunch time, Cadenas never saw the family preparing a meal or heard any of the four children begging for a snack. She later learned that food was scarce, and that the family’s sole breadwinner was Zamanta’s 15-year-old sister, Milagros, who sang in a cumbia band on weekends. Her earnings helped the family skate by each week. Zamanta’s father was recovering from a botched surgery and hadn’t worked in months. Health insurance or basic medicines like aspirin were luxuries the family simply couldn’t afford.

Cadenas took this all in while working with Zamanta’s mother, Karina Tamani Manihuari, teaching her activities that would encourage Zamanta’s mobility and language development. Meanwhile, she connected the family with food vouchers, federally-subsidized health insurance, and contractors who could remodel their cramped living quarters.

”Everything they learn with the girl they should try to apply to their other children,” Cadenas remembered telling Zamanta’s parents. “In CASITA, we really look for interaction between mothers and children, that the mother makes a special connection with the child, that she looks into her baby’s eyes, that she responds also to what the child does, that she gives her all her love and care, that she shares games with her daughter, and also includes the whole family [in these activities]. This will give her child more confidence and security.”

Zamanta’s Transformation

Manihuari said she typically carried Zamanta everywhere she went. She knew her daughter should have been babbling by seven months, sitting on her own, and preparing to walk (although the prospect possibly made her nervous considering the house perches at the edge of a steep hill). Still, she had her doubts about Project CASITA.

“The first time that Mrs. Inela came and did the activities with us, I thought that my daughter wasn’t going to do them,” Manihuari said.

Her husband, Carlos River Huarcaya Java, was equally skeptical. He’d had a bad experience with another nongovernmental organization, which offered his family help that never materialized. Even so, he witnessed his daughter’s gradual improvement following each session with Cadenas and slowly gained faith in the program. Soon he was sitting in on Zamanta’s sessions and participating in her daily exercises.

To advance Zamanta’s language development, Cadenas had the girl’s parents create toys she could blow through to exercise her tongue and a picture album of animals they could use as a vocabulary tool. She also coached the parents to speak to their daughter often and have her repeat their words.

Following Cadenas’ advice, Manihuari made a rolling pin-like device from recycled materials over which she rocked Zamanta and often stood her child on her lap to strengthen the girl’s abdominal and leg muscles in preparation for walking. She collected small objects like bottle tops and had her daughter pick them up and place them into containers to build her fine motor skills. And she and her daughter played peek-a-boo with a bed sheet, a game that encourages cognitive development by reassuring children that objects exist even when they can’t be seen.

Cadenas demonstrated each new activity to Manihuari and left her with “homework” to practice with her daughter throughout the week. “At first, I thought the activities were difficult,” Manihuari said, “but they became easier by the third week.”

By the end of 12 sessions, Zamanta was talking and taking her first steps around the house, much to her parents’ surprise. “I even saw changes in Zamanta’s mother’s attitude,” Cadenas said. “Karina herself confessed at the last session that she initially hadn’t put much importance in the intervention, but as the weeks passed she saw changes in Zamanta. She realized how important it was to do the activities with her daughter.”

“Mrs. Inela told me that everything I do, my daughter will repeat,” Manihuari said. “Now she seems like such a big girl. I was very happy and my husband was as well. He says Mrs. Inela has a real knack with children.”