This is a photo of Hospital Pedro Vicente Maldonado in rural Ecuador. It might look like kind of a boring building, but this hospital is in fact changing the face of health care in Latin America’s countryside.

The hospital is financially self-sustainable, which means it will be here for the long-term. Read an earlier post to learn about financing of the hospital and how it maintains ‘break-even’ status.  The hospital also houses a residency and nurse training program. This is another way this hospital lives on.

The quality is of the hospital care is the best in Ecuador and no one is turned away.

Learn more at www.andeanhealth.org

Andean Health  & Development has been a great experience! I always hoped to be part of an institution that really has a primary objective: to provide care to the neediest communities and in places where they really need health services.
I am growing every day with this program. I am learning medicine while reaching more needy people in a rural part of my country.

I’m single, I’m the third of four siblings, my parents and my family are very close and have always supported me.  I thank Andean Health for this opportunity to further my career while serving those in need.

His answer: early detection and early response. (and utilize web crawlers!)

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According to Kaiser’s survey, “More of the public prefers an emphasis on health infrastructure rather than fighting specific diseases. While the public continues to support U.S. spending on a variety of specific health-related programs in developing countries, when asked to rank the importance of two different approaches, 58 percent say it is more important to emphasize programs that help countries build their health system infrastructure, under the theory that stronger health systems can better handle a variety of problems. In contrast, 36 percent say it is more important to emphasize efforts to fight specific diseases like AIDS and malaria because efficient methods for treating such diseases already exist and can save large numbers of lives.”

This is evidence that Andean Health & Development is on track with US interests in global health since its mission is to build a new system of comprehensive health care in Ecuador rather than, say, eradicating a single disease.

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For the complete study, please visit: http://www.kff.org/globalhealth/posr111209pkg.cfm (pdf)

While hiking with a rural Ecuadorian medical team, I felt like I was a general practitioner from the late 1800s on his way to make a house call. Modern medicine is relatively new to this region of Ecuador, so I perceived that its unfamiliarity to the local community would make for an interesting encounter.

We arrived to a shelter that looked like an abandoned tree house and met with a 25 year-old pregnant mother of six children. Although we were complete strangers to Maricela and despite her extreme poverty, she kindly welcomed us into her home. She confided in us and let us examine her children. When I asked Maricela what her hopes were she quickly responded, “good health and a better future for my children”; the latter being clearly dependent on the former.

My experience with the EBAS team opened my eyes to some of the social, economic, political, and cultural barriers that prevent rural populations from receiving quality and equitable care. Working under the Ministry of Health was a beneficial experience, as it allowed me to integrate myself into the Ecuadorian system of law, government, and culture. More importantly, it provided me with a once in a lifetime opportunity to obtain a thorough and pragmatic introduction into policy strategies in Ecuador. Working for the MOH also introduced me to the challenges that exist because of the disconnect between health policy makers and those that make financial decisions in the country.

One question that was often brought up was whether the people living in the rural Ecuadorian communities were receptive to “modern” or “western” medicine. I found the people of Sarahuasi, Pilalo, and Guasaganda to be very open to whatever assistance that was available to them. However, I could notice that the EBAS teams are still in the process of establishing trust with some of the members of the community.

The most important lessons learned from my experience with AHD and EBAS are twofold. First, I learned that all of the theories and frameworks that I read in health policy textbooks will not be able to be successfully applied to the communities that I worked in this summer. Instead, these theories must be adapted to local customs and time tables.

Cultural, political, and socio-economic realities must all be taken into account when trying to successfully develop a viable model of health care in these regions. This is a very important lesson for someone interested in global health, as these are the pieces of the puzzle that one must fit together on a daily basis.

I believe that the success of AHD is largely derived from its ongoing responsiveness to the personal needs of the community. In both PVM and La Mana, I met physicians, nurses, and staff who are enthusiastic about the work of AHD and its dedication to serving the individual patient within the context of his or her cultural and socio-economic reality. Thus, AHD’s future success will not only be a result of its financial sustainability, but also its “personal” sustainability.

Second, I learned that my contribution to the people of Ecuador this summer was small compared to what they gave back to me. The patients, doctors, and friends that I came to know invited me into their lives. I had the privilege of learning about their hopes, joys, fears, and anxieties. More importantly, their life stories allowed me to reflect on my own life, to rearrange my priorities, and to develop a clearer understanding of the common human bond that we all share.

Learn more about Andean Health & Development at www.andeanhealth.org.

In 2001, Andean Health & Development (AHD, Milwaukee, Wisconsin), also known as Salud y Desarrollo Andino (Saludesa, Quito, Pichincha, Ecuador), a non-governmental organization (NGO), opened a 17-bed rural hospital, built jointly with the local municipality and the Ministry of Health (MOH) of Ecuador. The hospital serves a rural community of 50 000 that had no prior secondary care services. AHD/Saludesa’s efforts to develop a quality, primary/secondary care, selfsustaining public/private health network have led to important experiences in the administration of a rural hospital. In this article, AHD shares some of
these experiences through a discussion of rural hospitals in Ecuador.

Rural communities in Ecuador continue to experience unprecedented urban and international migration (1), resulting in shrinking rural infrastructures as political forces increasingly respond to the demands of growing urban populations. Ecuador’s public spending on health is 2.1% of its national budget, among the lowest in the Western Hemisphere (2). Furthermore, the high turnover rate among top-level MOH personnel—31 ministers in 37 years (3)—has made it exceedingly difficult for Ecuador to implement a long-term strategic health plan or define the role of the MOH in the health care landscape.

The MOH, Social Security Institute (Instituto Ecuatoriano de Seguridad Social, IESS), private sector physicians, and NGOs form a network of more than 4,000 primary care centers throughout the country (4). However, the secondary and tertiary care facilities, available in the larger urban areas, have extremely limited access for rural populations. Poor, rural patients requiring transfer for secondary or tertiary care encounter almost insurmountable obstacles.

A three-hour transfer to the capital city for a high-risk patient in labor can turn into nine hours when there is no receiving facility. In a situation such as this, the birth may occur en route, in the back of a pickup truck. Common obstacles to transporting patients to urban hospitals are:
• Patient unfamiliarity with large cities and their transportation systems
• Costly transportation for transfer
• Lack of in-town family support and lodging for family members of ill patients
• Bed unavailability due to severely congested tertiary care hospitals
• Insensitive medical personnel at receiving urban hospitals

Despite the obstacles however, technically, administratively, and financially well-maintained RSCHs, situated in appropriately-sized communities, offer many advantages over their urban tertiary counterparts. Specifically, the well-run RSCH:
• Keeps patients close to families
• Prevents traumatic long distance journeys
• Provides continuing medical education to an oftentimes relatively abandoned group of primary care providers in the community
• Decongests overburdened tertiary care city hospitals
• Delivers important curative services more economically due to lower fixed overhead costs
• Provides important leadership in developing local
capacity in the public and private health sector

For the complete PAHO Article, please click here:

http://www.andeanhealth.com/html/PAHO%20Making%20Secondary%20Care%20a%20Primary%20Concern.pdf

REFERENCES
Rev Panam Salud Publica/Pan Am J Public Health 23(3), 2008 217
Gaus et al. • Making secondary care a primary concern

By David Gaus, Diego Herrera, Michael Heisler, Barnett L. Cline, and Julius Richmond, University of Wisconsin, School of Medicine and Public Health,
Madison, Wisconsin, United States of America and Andean Health & Development, Emory University School of Medicine, Atlanta, GA, Department of Tropical Medicine, Tulane University, New Orleans, LO, Harvard Medical School, Boston, MA, Former U.S. Surgeon General, Former U.S. Assistant Secretary of Health.

Please click HERE to continue reading.

“My name is Amanda Elizabeth Tene Rueda. I am 26 years old. I was born in Quito, but my family is originally from Loja. I studied in Universidad Central del Ecuador. I was interested in family medicine when I was working as a rural physician in San Gabriel.  I liked my first rotation in Hospital PVM.  It was very hard and I learn very much about rational medicine, even though I never had enough time to study!!

I think family medicine is very important in order to improve the health conditions in my country, especially in rural areas. Fortunately, I can dedicate more time to my career because I don’t have children or any other huge responsibility. I am single, my family is big – 8 members, I am the second, but I am the only physician.

Mi nombre es Amanda Elizabeth Tene Rueda.  Tengo 26 años.  Naci en Quito, pero mi familia es de  Loja.  Estudié en La Universidad Central del Ecuador. Hice el año de medicatura rural en San Gabriel provincia del Carchi.  Ahí me nació la el interés por la medicina familiar. Me interesó mucho desde el principio la idea de hacer un postgrado en hospital rural. La primera rotación ha cumplido con las espectativas, aunque siempre hace falta mas tiempo para estudiar. Estoy contenta de haber escogido la carrera.

Pienso que la medicina familiar será un pilar importante para el mejoramiento de la salud sobre todo en las comunidades rurales.  Afortunadamente, puedo entregar mucho más tiempo al postgrado porque no tengo hijos, ni otra responsabilidad mayor. Mi familia es un poco grande somos 8 personas, soy la segunda, la única médico de la familia.“

Learn more about Andean Health & Development at www.andeanhealth.org.