From the Ground Up: Community Based Integration of Indigenous Perspectives on Health in Ecuador

Adviser: Vania Smith-Oka

Final Report:

When I first arrived in Ecuador, I was greeted with a smiling face and an enthusiastic introduction. This was my first insight into what living in Ecuador would be like. If I were to choose one word to describe the people there, it would be kind. Nearly everyone I encountered was excited to get to know me, patient with my Spanish language abilities, and enthusiastically willing to help me learn more about their community. This made it really easy for me to ask questions, find ways to explore, and learn more about life in Ecuador. One thing I found is that people in Ecuador really care about their neighbors and communities. Ecuador’s religious identity was also extremely prevalent - whether through the number of churches I was able to explore, the mass-goers I frequently encountered while walking around the cities, or the way that the streets of downtown Riobamba became a ghost town on Sundays. I was able to learn more about the distinct ethnic communities within Ecuador: the indigenous and mestizo (of both indigenous and Spanish descent) people. Much of my time in Ecuador was overshadowed by some of the political discussions following large protests by indigenous organizations in response to an increase in the cost of living. Coming from a country with a much higher cost of living, it was humbling to learn just how difficult increasing costs could be for some of the people I met, especially those who lived further away from the city center.

While I was in Ecuador, I spent the majority of my time working with Fundación Omar Mosquera. This is an organization based in Riobamba that works with the government of the Chimborazo province and volunteers from around the world to bring healthcare to the community with a van full of doctors and nurses. We drove all over Chimborazo to meet with patients about anything they may have needed. I spent most of my time helping take vital signs and observing the doctors as they worked, which allowed me to gain exposure to a variety of medical conditions, practice my Spanish speaking skills, learn more about the different ways in which doctors interact with their patients, and understand the complexity of the Ecuadorian healthcare system. While I was sometimes frustrated that I was not able to contribute more because I do not have formal medical training, the new understanding and perspectives I was able to gain made my fieldwork an extremely rewarding experience.

 One of the biggest realizations that I had is that free healthcare does not inevitably mean accessible healthcare. I was surprised to find that even though people in Ecuador can always go to a “Centro de Salud,” (healthcare center) we encountered many conditions that had long gone untreated. The Ecuadorian people seemed hesitant to go to the Centro de Salud because they did not actually feel cared for there. I found out from other doctors that it is not uncommon for doctors in the center to have less than ten minutes with each patient, which could make it easy to miss certain details or not hear the full story. Additionally, patients are not able to see specialists right away through the public healthcare system, but instead must be referred through several rounds of appointments to different health centers and hospitals, which could end up costing the patient a lot in both time and transportation expenses. If an operation is necessary, it is not always covered through public healthcare which could mean even more costly trips and health expenses for people who do not always have time or money to spare. There is also private healthcare, which not only becomes more personalized and thorough but also costs more for the patient and in many cases is not an option due to the price. In the end, it became clear that while free public healthcare is a way to mitigate costs, it is also important to make investments to ensure that healthcare is accessible and available for those who need it.

I also found some differences in public perceptions of health. First of all, many people still use more traditional forms of medicine. Whether this is different herbs, foods, juices, or religious “cleansings,” it is not uncommon for Ecuadorians to believe that they can manage their own health without ever seeing a doctor. Some of our patients had never had their blood drawn for a blood test or taken pills before. While some types of traditional medicine were welcomed by the medical community (such as certain teas to help deal with a sore throat), it was clear that this mindset at times became a barrier to people getting the care that they needed. Patients also seemed to possess less public health knowledge about issues such as the importance of a balanced diet, sexually transmitted diseases, and good hygiene. The issue of hygiene in particular was extremely prevalent through common health issues including fungi on the feet or hands or parasites acquired through eating unwashed fruit and vegetables or food prepared with unwashed hands. The parasites in particular were a major problem for children and often led to anemia and a lack of appetite, resulting in widespread malnutrition. This helped me realize how important public health initiatives are when it comes to improving global health outcomes. Finally, there was a big difference in Ecuadorian perspectives when it comes to mental health concerns. Mental health was not widely talked about, and when patients were told that their conditions may be mental rather than physical the response was often shock or confusion. This helped me realize the importance of normalizing conversations around mental health so that people are able to get the care they need.

Ultimately, spending time in Ecuador allowed me to learn a lot about their culture and healthcare system and led me to reflect more on healthcare within the United States, leading me to gain a broader perspective of global public health. But perhaps more importantly, I was able to increase my confidence in interacting with patients and navigating a different culture, which will be extremely important as I continue to explore the world.