Nixtamalization

We eat A LOT of corn tortillas and tamales. I finally got my lesson in tortilla-making from Maria Elena, Angel's cousin who has been helping with meals and cleaning since Gela got married. It was a much more involved process than I expected and lots of my torillas ended up on the ground. So I had to look it up on Wikipedia and figure out why it takes a whole day to prepare the corn and why it is that they cook the corn kernells in "cal" or limestone. I thought the summary on Wiki was super interesting so I thought I'd paste a slightly reduced version here:

Nixtamalization typically refers to a process for the preparation of maize (corn) in which the grain is soaked and cooked in an alkaline solution, usually limewater, and hulled. Maize subjected to the nixtamalization process has several benefits over unprocessed grain for food preparation: it is more easily ground; its nutritional value is increased; flavor and aroma are improved; and mycotoxins are reduced. These benefits make nixtamalization a crucial preliminary step for futher processing of maize into food products, and the process is employed, using both traditional and industrial methods, in the production of tortillas, tamales, corn chips, and many other items.

In the Aztec language Nahuatl, the word for the product of this procedure is nixtamalli(pronounced [neʃtaˈmalːi]; a compound of nextli "ashes" and tamalli "unformed corn dough, tamal), which in turn has yielded Mexican Spanish nixtamal ([nistaˈmal]).

The ancient process of nixtamalization was first developed in Mesoamerica, where maize was originally cultivated. The earliest evidence of nixtamalization is found in Guatemala's southern coast, with equipment dating from 1200–1500 BC. The ancient Aztec and Mayan civilizations developed nixtamalization using lime (calcium hydroxide) and ash (potassium hydroxide) to create alkaline solutions. The Chibcha people to the north of the ancient Inca also used calcium hydroxide (also known as "cal"), while the tribes of North America used natural-occurring sodium carbonate or ash.

The nixtamalization process was very important in the early Mesoamerican diet, as unprocessed maize is unbalanced in its essential amino acids and deficient in free niacin. A population depending on untreated maize as a staple food risks malnourishment, and is more likely to develop deficiency diseases such as pellagra and kwashiorkor. Maize cooked with lime provided essential amino acids and niacin in this diet.

In the United States, the nixtamalization process was not adopted by European settlers, though maize became a staple among the poor of the southern states. This led to endemic pellagra in poor populations throughout the southern US in the early twentieth century.

Maize was introduced to Europe by Christopher Columbus in the 15th century. Due to its high yields, it quickly spread through Europe, and later to Africa and India. Portuguese colonists grew maize in the Congo as early as 1560, and maize became, and remains, a major food crop in parts of Africa. Adoption of the nixtamalization process did not accompany the grain to Europe and beyond, perhaps because the Europeans already had more efficient milling processes for hulling grain mechanically. Without alkaline processing, maize is a much less beneficial foodstuff, and malnutrition struck many areas where it became a dominant food crop. In the nineteenth century, pellagra epidemics were recorded in France, Italy, and Egypt, and kwashiorkor hit parts of Africa where maize had become a dietary staple.

Health problems associated with maize-based diets have rarely, if ever, addressed adoption of nixtamalization, but rather have promoted vitamin supplements, the fortification of grains, and economic improvement leading to a broader diet. Though pellagra has vanished from Europe and the United States, it remains a major public health problem in lower Egypt, parts of of South Africa, and southwestern India.

The first step in nixtamalization, kernels of dried maize are cooked in an alkaline solution at or near its boiling point. After cooking, the maize is steeped in the cooking liquid for a period. The length of time for which the maize is boiled and soaked varies according to local traditions and the type of food being prepared, with cooking times ranging from a few minutes to an hour, and soaking times from a few minutes to about a day.

During cooking and soaking, a number of chemical changes take place in the grains of maize. Because plant cell wall components are highly soluble in alkaline solutions, the kernels soften and their hulls loosen. The grain hydrates and absorbs and calcium or potassium (depending on the alkali used) from the cooking solution. Starches swell and gelatinize, and some starches disperses into the liquid. Certain chemicals from the germ are released that allow the cooked grains to be ground more easily, yet make dough made from the grains less likely to tear and break down. Cooking changes the grain's protein matrix, which makes proteins and nutrients from the kernel more available to the human body.

After cooking, the alkaline liquid (known as nejayote), containing dissolved hull, starch, and other corn matter, is decanted and discarded. The kernels are washed thoroughly of remaining nejayote, which has an unpleasant flavor. The pericarp is then removed, leaving only the germ of the grain. This hulling is performed by hand, in traditional or very small-scale preparation, or mechanically, in larger scale or industrial production.

The prepared grain is called nixtamal. Nixtamal has many uses, contemporary and historic. Whole nixtamal may be used fresh or dried for later use. Whole nixtamal is used in the preparation of pozole and menudo, and other foods. Ground fresh nixtamal is made into dough and used to make tortillas, tamales, and arepas. Dried and ground, it is called masa harina or instant masa flour, and is reconstituted and used like masa.

The term hominy may refer to whole, coarsely ground, or finely ground nixtamal, or to a cooked porridge prepared from any of these.

The primary nutritional benefits of nixtamalization arise from the alkaline processing involved. These conditions convert corn's bound niacin to free niacin, making it available for absorption into the body. Alkalinity also reduces the amount of the protein zein available to the body, which, though this reduces the overall amount of protein, improves the balance among essential amino acids. Secondary benefits can arise from the grain's absorption of minerals from the alkali used or from the vessels used in preparation. These effects can increase calcium (by 750%, with 85% available for absorption), iron, copper and zinc. Lastly, nixtamalization significantly reduces (by 90-94%) mycotoxins produced by Fusarium verticillioides and Fusarium proliferatum, molds that commonly infect maize and the toxins of which are putative carcinogens.

Oral Rehydration Solution

Back in January, we had a nutrition day in San Gregorio. Whenever we hold a nutrition day, the health promoters teach parents about some topic or skill. This day, Vicente and Dominga taught the moms to make a remarkably yummy ORS. I’ve tasted a few ORS’s and nearly all have made me cringe (dehydrated babies tend to be less picky but mom’s aren’t -- around here they have been pretty reluctant to make their own ORS). But this one: 1 liter water, 4 Tbsp sugar, ½ Tbsp salt, and ½ cup orange juice actually got the moms and kids coming back for more. Rotavirus hit Guatemala in late Dec, Jan, and Feb, resulting in several deaths and a lot of hospitalizations. Our clinic was out of ORS packets for almost all of February and most people from distant communities like San Gregorio don’t make it in to clinic anyway. It was wonderfully encouraging to watch the moms crowd around the pila (outdoor sink) and pepper the health promoters with questions and clarifications on the recipe and how to give the solution.

Practicing for Semana Santa

This is adorable: the little kids in the family have been playing "Procession" several times this week. What's "Procession"? Well, during Cuaresma, the forty days leading up to Semana Santa, every Friday afternoon there is a procession of townspeople carrying the figure of the Jesus that leaves from the Parrochia at 4pm and walks at a painfully slow (I suppose, reverent) pace throughout the town, pausing at some 10 or 15 "stations", and finally returning anywhere between 6 and 12 hours later (the time they stay out lengthens each week).

I got my first glimpse of the Procession game last week when I heard the kids chanting and solomnly singing hymns. I stepped out of my room to find them with a teddy bear dressed as Jesus and surrounded by flowers propped up on a plank that they were, also very reverently, carrying throughout the house and yard, pausing at the stations. They did a great job recreating the scene. The kids carrying the plank padded their shoulders against the pretend weight. Little "Canche" carried an urn of burning incense and let it pendulum back and forth as they do in Mass. Little David scurried ahead to each station, diligently laying out a reed mat and dusting its surface to prepare it for the Christ Bear and the bearers there-of to rest before continuing on. Jenny used a bath towel as her white shawl. There was an offering plate, candles, and an alter to boot. Prayers were held at each station.

Dia De Carino

For Valentine's Day we took the day off of health promoting (or so we thought until the school kids playing nearby presented Vicente with a wound to clean) and picnicked by the river in Vicente's community of Quixaya. It was such a great day of relaxing with Vicente (and his wife, Gloria), Dominga, and Abelino, one of the graduated promoters. Hanging out with Abelino is like hanging out with your wise, old grandfather. Gloria and Dominga treated us to a dish called chorizco which is basically BBQ, without the tangy sauce. They both laughed heartily when we explained that in the States men light the coals and roast the meat. The men were sunning themselves (and to be fair, the gringo women were too). We ate a salad of greens collected directly from the river. You can see the "crop" in the photos. The small, flavorful salad green is the signature crop of Quixaya. The food was delicious. We contributed soda and rice crispy treats. Hmmm. Well, they loved the rice crispy treats, made with pink marshmallows and topped with M&M hearts for Dia de Carino.

Gloria and Dominga preparing lunchVicente with Jose Eduardo, 2 years old

Jose Eduardo and his cousin, IrisVicente and Abelino to the rescueVicente cleaning a cut

Washing dishes Dominga and Iris

First Aid Health Promoter Training

Today was the second day of our primeros auxilios (First Aid) course with the second year health promoters Domitila, Ingrid, Samuel, Mariela, Benita, Delma, Clara, Magali, and Veronica. We taught Evaluate, Call for Help, and Treat; Cuts, Injuries, and Fractures; Animal Bites; Hemorrhage; Burns; Choking; Drowning; and Shock. This is a relatively shy goup (compared with the two graduated classes) but they did a very good job getting involved in the scenarios this time. One of the fun challenges of this year -- and a really nice learning opportunity for me -- has been experimenting with how to teach to health promoters. There is a book published by the Hesperian Foundation entitled "Helping Health Workers Learn." It is full of great ideas for teaching including models for explaining complicated concepts in simpler ways (many people have not even had a health course before), adapting information so that it's appropriate for the setting, soliciting important contributions from the learners as the people who know the patients and the setting best, etc. Planning for the courses takes a few days between the two lead health promoters and three of us volunteers. We've learned some important lessons along the way. One being that the learning has to be active and breaks for games are a must. Something new I learned today is that magic tricks don't get quite the response they get in the States. They seem to be disturbing to people. I think I'll save those for kids! Dominga teaching about wound cleansing Shom with a great fracture face Veronica stabilizing the fracture with Clara's help Magali cleaning a dog bite Clara responding to a snake bite Taking a break for hot potato ("patada caliente") Shom suffers a bloody nose mid-lecture

Clara gives Shom a handDomitila saves Ingrid with the Heimlich maneuverDomitila gives back blows to a choking baby

Delma choses a donated watch for taking pulses and resp rates

Copan, Honduras

This weekend I traveled to the Mayan ruins of Copan (Honduras) with Elena, Shom, Dick, Jen, Jim, and J&J's two adorable girls Emma and Abby. It was such a nice trip. Before we headed out from Guate City, Elena, Shom, Dick and I ran a bunch of errands in the City (fluoride, supplies for making shampoo and anti-itch lotions, formula, etc). Running errands in Guate is nothing like running errands back home. The car exhaust turns your stomach (I try to time my breathing between belches of black smoke from the truck in front), you can’t park so our ride just had to circle, and it’s so dangerous you are constantly on edge (or at least I am). We spent that night at Jen and Jim’s and enjoyed some wine, the memory of which had to last me through the trip since I had to start another course of metronidazole that night. That makes for 5 bouts of amoebas in as many months. TMI.

We caught the bus for Honduras at 5am the next morning and had an easy trip. Copan is beautiful. Jen described it well as “Antigua but a little rough around the edges”. The streets are all cobblestoned and the houses/stores are white-washed with Spanish roof tiles. The hillsides are lush green and the views are spectacular and relatively undisturbed. We spent the first afternoon at a “waterpark” though it ended up being closer to a collection of pools with some questionable water. The girls were in heaven and, well, so were we!

The next day we toured the Copan ruins. We had a great guide who shared a little of his story with us. He had worked some 15 or so years excavating the sites (wow!). He got involved one day when a visiting archeologist from Harvard found him on the roadside and asked if he wanted some work for the week. There after he has studied quite extensively and was incredibly knowledgable. It seemed sad to me that such a well-educated and experienced man was only giving tours as his living. Anyway, compared with Tikal the ruin site was less extensive and most temples smaller but the carvings were more interesting. There were stelae (historical records that look something like stone totem poles), a stone staircase that was also a historical record of the prior 300 years, a ball field, a human sacrifice “altar”, and a series of tunnels that allowed you to view the temples that were covered over as the Maya built bigger temples atop earlier ones. The story of the ball field and sacrifice alter was interesting. The game involved keeping a ball from falling to the ground. It was played only by nobles. The captain of the winning team was sacrificed as an honor. He was first given a liquor drink then laid over a large stone with a groove for his head. A neck vessel was cut and he slowly bled to death. The loser had a worse fate: he became a slave.

That night we watched some of the primaries action on cable TV (what fun!) and played cards at a cute rooftop café. The next day we holed-up at the same café and planned out our course for the health promoters on hypertension. We returned to the City on Sunday and savored our last moments of sheer comfort and luxury with Jen and Jim over sushi.