Nutrition in Nicaragua: Access and Anxieties

“Can you tell me about your diet? What do you eat?” I ask the woman sitting on the exam table in front of me. “Food. I eat food. What do you eat?” This is a pretty standard question to ask patients in Portland, Oregon, where I attend school. The usual long, rambling answer is filled with talk of cereals and yogurts, fruits and vegetables, fast food and sushi, curries and quinoa – sometimes all eaten in a single day. There is sometimes talk of patients being gluten-free or lactose-intolerant, and words like “organic,” “grain-fed,” and “Atkins” are frequently peppered throughout the response. However, today I am not in my Pacific Northwest bubble. I am on the island of Omotepe in Nicaragua, and the woman sitting in front of me is staring at me like I am the gringa who just asked her the stupidest question she has ever heard.

This patient has presented to the free clinic where I am volunteering with gastritis, likely complicated by a diet of fried plantains, fried meats, and gallo pinto (a dish of beans and rice that is, you guessed it, fried), which has been the staple of nearly every meal of her 37-years of life. The frying in question probably involves rancid oil that is purchased from the pulperia down the street, where it is ladled out of a vat in the back of the shop and has been sitting and oxidizing for who knows how long.

In an ideal world, I would like to educate this woman on how to make more nutritious food choices that would both nourish her and be less irritating to her digestive system, but here, I feel that my hands are tied. Better nutrition means more money, and this woman has five mouths to feed on her husband’s meager seasonal farming salary. Not to mention the fact that vegetables are surprisingly hard to come by on this island. I have not eaten anything green in ten days, if you do not count the neon-green lime popsicle I picked up from the heladeria yesterday.

This is my first experience working in a clinic in a developing country, and it is opening my eyes to the realities of global health. It is also opening my eyes to the schizophrenic nature of our eating habits back home. While I am all for healthy, conscious eating and a believer that food can be as powerful a medicine as anything, there is something refreshing about being in this place where food is simply food. Any anxieties surrounding food involve worrying if there is enough of it, not whether we have selected the healthiest, most perfect ingredients to prepare the meal in front of us. There is no internal debate on whether to choose Italian or Pad Thai or Chinese food for dinner tonight; there is simply gallo pinto.

I recently heard of a newly identified eating disorder, orthorexia nervosa, which is characterized by obsession with avoiding foods perceived to be unhealthy. I saw more gastritis, parasites, and childhood malnutrition than I have ever seen before during my time in Nicaragua, but I saw no orthorexia, no anorexia, and no pathological fixation on food of any kind for that matter. This juxtaposition – between the particular anxieties that come with having unlimited resources to choose from and not enough – was something I thought about a lot during my trip. It stayed with me as I left the clinic, took the ferry off the island, and boarded the plane, all the while dreaming of the giant salad I was going to make myself the second I got home.

Niki Rarig is a candidate for ND/MSOM, class of 2015, National College of Natural Medicine in Portland, Oregon.