Part of our Needed team Margaret Peus, recently spoke with Karlie Ruiter, co-founder of Ordinary Nurses: Casa Tabito. Their conversation shed light on the incredible work Karlie and her team are doing in Rosario, Guatemala, where they partner with mothers to address severe infant malnutrition through a deeply holistic and compassionate approach. As part of this care, every pregnant and breastfeeding woman in their program receives Needed’s Prenatal Multi Essentials.
Ordinary Nurses takes a holistic approach and works alongside mothers to restore their babies’ health. In their conversation, Karlie shared powerful stories of restoration and the incredible tenacity of these mothers. Her heart and deep respect for them shine through everything she says and does—including in her own approach to being a mother.
Needed: Could you please share a bit about Ordinary Nurses and what you all do?
Karlie: About ten years ago, my husband and I were on a trip to rural Guatemala. I was an ER nurse, and we went to help some friends who were living there at the time. They asked me to stop by a house where a child was severely malnourished. When we arrived, the mother was distraught—she shared that the child had just been removed from the home. Government officials in blue vests had come and taken him because of how malnourished he was.
We asked where they were going and traveled with her two hours away to a government clinic, which turned out to be a nutrition center. We learned he would stay there until he gained enough weight. It was overcrowded and under-resourced. The government was doing the best it could with what they had, but there were so many children, and it was a bleak outlook for Eden. We prayed and prayed, and eventually, he gained enough weight and was discharged.
When we saw that place and the mother's situation, we decided that no baby in the villages we work with should ever have to go somewhere like that.
We bought some land and moved to Rosario, Guatemala. Alongside 25 local men, we built a malnutrition center dedicated to the revival of starving babies. Today, we're partnered with ten villages—more than 50,000 people—and work with the government in each of them. Now, when there’s a severely malnourished infant, she’s not sent far away. She comes to Casa Tobito instead.
We exist for babies on the edge of life—babies with just days to live—as over 80% of children in this area are malnourished. We exist for the worst cases.
Those babies are sent to us by government-run clinics. Then we work with the mother and the baby to restore the child to health.
Over 190 babies have been sent to us in the last eight years—and every single one of them is now thriving. I still remember the first fifteen.
Karlie: We're so grateful to be a part of it. We’re friends with and partner with those people who wore the blue vests. They keep an eye on the children in all the villages. Instead of sending them to an under-resourced, far-away place, the government now trusts us.
Our center is fully run by Guatemalans. That’s something we’re really proud of.
When a mama knocks on the door, it’s likely a face she knows. We’ve sent local women to nursing school to help run the clinic. It’s familiar. Most women can walk to our center.
Unlike most malnutrition centers, which are inpatient—where the mother has to admit the baby and only sees them during visiting hours—ours is outpatient and intensive. The mother is the primary caregiver. She gets to revive her own baby. We just empower her with the tools, resources, and education she needs.
We love that because when her baby returns to health, so does her self-worth. In rural Guatemala, many women’s identity is rooted in motherhood. If their baby is starving, they often arrive feeling like failures. We'd be doing a huge disservice if we only provided medical care.
We make sure the mama is the one to give that first bottle. She’s part of medical care. She keeps her baby at home—maybe she comes daily to see pediatricians—but she’s part of every step. So when her baby is healthy, she can say, “I did that.” And she can remember she’s the best mother for that child. We're so grateful.
NEEDED: I love that you really focus on empowering the moms.
Karlie: They’re truly the best mamas for their children. So much of the global orphan crisis is related to poverty and malnutrition. Mothers are leaving their children at orphanages because the child is starving. We want to prevent that. We want mamas to stay with their babies—to know they're the best mothers for their children. They just need a little help.
NEEDED: Could you describe Rosario, Guatemala? What are some of the unique advantages and challenges?
Karlie: Guatemala is one of the few countries where more people live in rural areas than in cities. These rural, Indigenous villages are primarily made up of Mayan people. El Rosario is one of them.
Statistics show that 70–80% of children here suffer from chronic malnutrition and stunting. Over 90% of the water is contaminated by fecal matter. It’s customary to cook on open fires inside poorly ventilated kitchens. Mothers often have a baby tied to their back while cooking over an open flame.
National Geographic did an air quality study here in 2016 and said these fires produce smoke equivalent to 400 cigarettes an hour. Between the smoke, contaminated water, and malnutrition, these children become very susceptible. Lung disease and waterborne illnesses are now the leading cause of death in these villages for children under five.
The people in Rosario and the surrounding villages are incredibly hospitable, kind, and hardworking. There’s a rhythm of perseverance and a drive not to give up on their families.
That’s why this model works—because the mamas are the most motivated, hardworking women I’ve ever met. Just coming alongside them is often all it takes for their babies to survive.
NEEDED: Could you talk more about your intervention tactics? How do they work together to holistically support the women and babies?
Karlie: Absolutely. It’s a holistic care model. Like I said, these babies are already immunocompromised. If we’re going to offer outpatient care, we need to ensure their homes are healthy. We also want to prevent regression. So the family must graduate into a healthy home.
The program lasts five years, with the first year being the most intensive. When a child enters the program, the mother commits to coming at least twice a week—sometimes more initially. One of those days is for medical care. We have two pediatricians, two nurses, and other health professionals who provide tailored care. Many babies arrive with electrolyte imbalances and severe depletion. It takes a detailed plan to get them healthy.Often we need to supplement breastfeeding with formula. In some cases, the baby is so weak we begin feeding with an eyedropper, then progress to bottles.
The mother also comes another day for classes taught by our nurses—local women who’ve gone through nursing school. These classes cover nutrition, hygiene, water safety, how to handle fever, and more. We explain that the water is contaminated, even if it looks clean, and how to prevent illness.We believe in a home of dignity. That means a foundation, footers, floor to ceiling block walls, and locks on the door and windows. We talk about the hierarchy of needs and how important it is to feel safe.On the first day of the program, every family receives clean water in their home. Then we reinforce that with education. Within a few months, they also receive a clean-air stove with a chimney to vent the smoke out of the house. These stoves also use less firewood and heat up faster, which provides buy-in beyond just health benefits.We also assess their home. We have two local construction crews and a Guatemalan man who oversees them, along with a nurse. They visit every home to determine what’s needed for that baby to thrive. While it always includes a water filter and stove, it might also mean fixing a leaky roof, replacing dirt floors—whatever it takes.There’s a study from the World Health Organization that shows a 70% reduction in parasitic disease if a home doesn’t have dirt floors. So we often cement the floors—or even build an entirely new house.Whatever it takes for this home to be healthy and for the family to thrive–it’s all part of the program. We’re simultaneously providing education and the medical care.
NEEDED: How do you find these mothers? Primarily word of mouth?
Karlie: Right now, the only way a mother joins our program is through a formal referral from a government clinic. Every village has a clinic called Centro de Salud, and these clinics are responsible for weighing and overseeing the health of all the children in the village. If a child is extremely malnourished and under the age of one, the clinic writes a letter, stamps it, and sends the mother to Casa Tobito.
We speak with the nurse at the government clinic to make sure we're aligned, and we stay in constant communication so the mother can continue receiving care for the rest of her family through the clinic. We're just a supplement to the work the clinic is already doing.
We used to do community-wide screenings and other outreach, but now we have such a strong partnership with the government clinics that everything goes through formal referral.
NEEDED: It’s really incredible to see how you work with the government, too, because I know that's a key part of your mission — to empower the local communities and their organizations.
Karlie: Yes, we don’t want to duplicate what’s already being done. We love the government clinic nurses — we know them all well. We even have someone on staff whose entire job is communicating with these nurses. We want to support the work they’re already doing, not take it over.
We’ve been able to remodel a number of these government clinics. One of them used to leak when it rained, so we put on a new roof. We also provided all of them with scales and any other equipment they needed to properly assess the babies.
NEEDED: When you think about nutrition specifically, especially intervening when a mom is pregnant or in those early stages, how do you see that impacting long-term outcomes?
Karlie: Nutrition begins in utero. Because of a lack of resources, it’s hard for a mother to consistently get prenatals or folate during pregnancy. In one of our villages, women can only get one folic acid supplement every eight days from the government clinic — and that’s about it.
We see cases of spina bifida. Right now, we’re working with a 10-year-old who has chronic sores and cannot feel his feet, because of a closed meningocele on his back from spina bifida. This likely resulted from a lack of folate during his mother’s pregnancy.
When mothers are drinking contaminated water, they’re constantly fighting waterborne illnesses, which depletes them during pregnancy.
Malnutrition can set in immediately. In general, children in this area are just born small for gestational age. That’s why we exist for babies under one year-old.
We work with children up to age five, but we really try to reach them early. Once chronic malnutrition sets in, it’s very difficult to reverse.
NEEDED: Is there one particular child’s story that has been especially impactful over the years?
Karlie: One of the first babies to ever come to us was three months old and weighed less than five pounds. He had been discharged from a national hospital, even though he still wasn’t expected to survive.
His mother heard about us and wanted to come see us, but many actually suggested she just let her baby die at home. She had already lost other babies to starvation, so she hadn’t even named him — it was her way of coping, knowing this one might not survive either.
I remember her knocking on our gate. I peeled back layers of textiles to see this tiny three-month-old. You could see every bone in his body, including the bones in his face. He was so weak, he couldn’t even cry — his mouth opened, but no sound came out.
We ran labs and immediately started feeding him with an eyedropper because that’s all he had the strength for. We fed him through the night, and at one point, he looked up and smiled. He locked eyes with us, and it was this moment of realizing: this is a life fighting to live.
We told his mom, “We need to pick a name for your baby, because he’s going to live.” She said she wanted to pick a name from the Bible. Our neighbor mentioned the story of Peter raising Tabitha from the dead. She wanted to name him after someone risen from the dead because she felt that’s how close he had been. We told her Tabitha was a girl’s name, and in Spanish that’s Tabita. So she said, “Let’s name him Tabito” for a boy.
Tabito is now a thriving seven-year-old boy who loves soccer. We just celebrated his birthday— he’s borderline chubby!
That’s also how Casa Tabito got its name.
NEEDED: That’s incredible. How has being a mom yourself impacted your experience?
Karlie: I became a mom while living above the clinic during the eight years we spent full-time in Guatemala. It was the women of Guatemala who really shaped my motherhood because I was with them every day while raising Lucy.
In Guatemalan culture, women bring their children everywhere — whether they’re collecting firewood, washing clothes, or going to church. Their babies are on their backs no matter where they’re going.
I love the culture of just bringing your children along — making them a part of life. They’re not seen as inconvenient or noisy. In Guatemala, if you go to a restaurant and kids are running around, the waitresses might be holding someone’s baby while they eat. It’s just amazing to see the love for children. There’s a customs line for families with children, bank lines for them, and even parking spots for pregnant women. The value placed on life and new life is really incredible.
That’s shaped me. So many of the things I do as a mom, I’ve learned from Guatemalan women. I always tell them, “Your baby might have been starving — that wasn’t you.” I really look up to them. Most of these women have had many children, and they have so much wisdom and experience to pass on.
Karlie’s work with Ordinary Nurses is more than a medical mission—it’s a movement of dignity, empowerment, and relentless hope. By walking alongside mothers in rural Guatemala, providing critical care and education, and working hand-in-hand with local clinics and leaders, Casa Tabito is not only saving lives—it’s rewriting generational stories. Every healthy child is a testimony to a mother’s strength and a community’s resilience. At Needed, we’re honored to support this sacred work—because every mother deserves to thrive, and every baby deserves a chance.
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