Guatemala; PI Manuel Ramirez-Zea, MD, PhD

Fellowship Site: Guatemala-Guatemala City

Details International Site: Institute of Nutrition of Central America and Panama Country: Guatemala Site Directors: Manuel Ramirez-Zea, MD, PhD murillos@incap.ops-oms.org Sandra Murillo, PhD murillos@incap.ops-oms.org Jose Adan Montes, MD amontes@incap.ops-oms.org

The Institute of Nutrition of Central America and Panama, INCAP, is a specialized center on nutrition of the Pan American Health Organization (PAHO) and the Central American Integration System (SICA). INCAP is headquartered in Guatemala and has representatives in each od its eight member countries: Belize, Guatemala, El Salvador, Honduras, Nicaragua, Costa Rica, Panama, and the Dominican Republic.

INCAP was founded in 1949 to contribute in the development of the nutrition science and promote its adequate application to strengthen the ability of Central American countries to solve their food and nutrition problems. The Institute carried out clinical and epidemiological research related to the nature, magnitude, distribution and determinants of the food and nutrition problems, particularly of the most vulnerable populations. INCAP also provides technical cooperation in the design, implementation and evaluation of public nutrition programs and policies, at the regional, national and local levels, in order to contribute to the solution of the existing problems and to guarantee food and nutrition security for the Central American population.

Since 1976, INCAP has been an associated institution of the United Nations University conducting several activities within the Advanced Training Program on Food and Nutrition. Additionally, during a Presidential Summit of Central American countries, held in Guatemala in October 1993, the Presidents agreed to support the Regional Initiative towards Food and Nutrition Security, instructing the Ministers of Health to monitor its implementation, with the technical and scientific support of INCAP, PAHO, and SICA.

INCAP´s member countries are increasingly facing a double burden of disease where obesity and under nutrition coexist. This double burden of disease affects all socioeconomic groups, and places excessive demands on governments, individuals and families due to high economic and social costs of disease and loss of quality of life and productivity. INCAP has several on-going research projects related to the analysis of the determinants of these epidemiological and nutritional transitions and the developemnt of intervention models to minimize the effects of these changes. In addition, INCAP has recently received a 5-year grant from United Health Group/NHLBI to strengthen research and capacity building on prevention and control of nutrition related chronic diseases in the region. This grant has contributed to refurbish INCAP's Laboratory of Physiology and Body Composition.

INCAP has active collaboration with several academic institutions in the US, including RAND Corporation, Emory University, Harvard University, University of California at Davis, Johns Hopkins University, University of Colorado, University of Pennsylvania, Cornell University, Tufts University, and the International Food Policy Research Institute (IFPRI), among others. In Latin America, strategic alliances and partnerships have been strengthened with recognized national and international centers, such as the Institute of Nutrition and Food Technology (INTA) in Chile, the National Institute of Public Health (INSP) in Mexico, the Institute of Research and Training in Nutrition and Health (INCIENSA) in Costa Rica, and the Antioquia University in Colombia, among others.

Research opportunities:

Main research areas available for fellow inclusion are:

• Dietary factors associated with non-communicable chronic diseases in Mesoamerica
• Intervention models for the prevention of childhood obesity and promotion of cardiovascular health
• Intervention models for the prevention and control of cardiovascular disease in patients with diabetes or hypertension.
• Evaluation of intervention programs for the reduction of childhood malnutrition in Latin America
• Evaluation and revision of National Dietary Guidelines in Central America
• Early nutrition and health and disease in adulthood
• Functional effects of micronutrient deficiencies, particularly zinc, vitamin B12, folic acid, and iron
• The consequence of trade liberalization and the Central American Free Trade Agreement (CAFTA) in food consumption in Central America
• Food and nutrition security with gender perspective at local level
• Impact of the involvement of women in productive projects with income generation in the nutritional status of their families
• Food fortification and bioavailability of different iron compounds, folic acid and other micronutrients and their effects on health
• Migration and its effects on food and nutrition security in Guatemala
• The impact of fishing and aquiculture on food and nutrition security at family and community level in Central America
• Budgetary analysis of food and nutrition public expenditures in El Salvador, Guatemala, Honduras and Nicaragua
• Assessment of vulnerable geographic areas and population groups to food and nutrition insecurity in Central America

Housing/Meals/Transportation:

INCAP can coordinate one month of housing upon arrival, and facilitate fellows with the logistics of securing housing for the rest of their stay in Guatemala. There are two residences (Claret and La Salle) that INCAP has recommended to different students and professionals that visit our Institute; and there are also Guatemalan families that can host students for the length of time required for their training. The accommodation facilities are within 10 kilometers of INCAP headquarters in Guatemala City. Rates :

• Residences: including cost of room, two meals per day (breakfast and dinner) and laundry service: US$450/month
• Guatemalan families housing, including cost of room and breakfast: US$375/month

Health Issues:

See the Centers for Disease Control website and The Yellow Book: Health Information for International Travel. NIH/ICRF trainees are required to see a physician before leaving for assignment abroad.

Safety Issues:

See the U.S. State Department website for more information.

Language requirement other than English:

If field work is required, fluency in Spanish is needed. For laboratory work or data analysis, understanding of Spanish is required. INCAP can coordinate the planning and implementation of Spanish courses. There are several recognized Spanish schools available in Guatemala City and Antigua Guatemala, where 8-week intensive courses are usually adequate to acquire enough skills to understand and speak Spanish.

What is it like to live in Guatemala?

Guatemala City is the economic, governmental, and cultural capital and also largest city in Guatemala. INCAP is situated in a health complex where several hospitals and the Ministry of Health are located; hence, opportunities to interact with these other health institutions are easy. Guatemala is characterized by wide economic disparities and its culture is highly influenced by the Maya civilization, particularly in the highlands. Guatemala is mountainous, except for the south costal area and the northern lowlands of Peten department. Daytime temperatures in the city and most popular tourist destinations (i.e. Antigua, Lake Atitlan) rarely exceed 85° F and nights are pleasantly cool. Seasons are defined by precipitation: rainy (mid-May to October) and dry. Unlike the Caribbean, Guatemala is rarely hit directly by a hurricane. Basic precautions are recommended to take due to crime, such as avoid traveling alone, after dark or in certain areas of the city.