Christina HanRWJMS Class of 2019Global Health

This past summer for the month of July, I participated in the Interhealth South America program in Ecuador under the direction of Dr. Don Wedemeyer. To say the least, this program fulfilled all of my expectations and more. Not only was I able to accomplish my goal of helping underserved communities in Ecuador, I was also able to partake in Ecuadorian culture first-hand, experience traditional Ecuadorian medicine, learn medical Spanish, visit both tourist and local attractions, and travel to various urban, rural, and Amazonian parts of Ecuador.

We stayed in Otavalo for the first two weeks, which is a town in the Andean highlands surrounded by volcanoes. We went into the indigenous community and visited various local craftsmen who still maintain traditional skills and arts that have been passed down through generations in their families. After we came to understand more about the indigenous community in Otavalo, we visited Jambi Huasi, which is a community health clinic that provides conventional and indigenous practices in equilibrium. Most of the local townspeople prefer traditional medicine, so Jambi Huasi aims to provide a place where people can come to get the care they desire, but still have the option of getting treated with Western medicine. The clinic’s belief is that not one medical practice can cure all diseases, so different practices must work together. For instance, indigenous women prefer to give birth at home so that they can give birth traditionally in the vertical position. However, there are high mortality rates associated with these practices. So, Jambi Huasi offers vertical birth services, which encourages indigenous women to give birth under professional medical care. At the clinic, we met a partera (midwife) who specializes in breached baby massage and curing emotional afflictions with herbs and chants. There was also a yachac, who specializes in Ecuadorian herbs and plants. We were also able to see an elderly woman in the community treat espanto (fright) in a baby by massaging the baby with an egg and chants. The idea was that the egg should absorb undesirable spirits.

We visited the Pakarinka Sisari Ancestral Wisdom Center, which is located in an indigenous complex high up on Imbabura Mountain, overseeing the city. Its purpose is to restore the cultural and medical traditions that were lost during the Spanish Conquest and be a spiritual center for the indigenous population of Ecuador. There is an ancient prophecy that says, one day the eagle and condor will fly together. They have come to realize that it means that traditional and modern medicine complements each other, either one cannot heal all and therefore must work in tandem. With our team as patients, they demonstrated various healing processes. For instance, the cuy (guinea pig) is as used as a diagnostic test in traditional medicine by rubbing it on a patient and skinning it, with the belief that the guinea pig will show what diseases the patient has. They also demonstrated healing processes involving herb bundles and smoke.

During our health brigades in villages outside of Otavalo, we were able to care for many indigenous people who do not have nearby clinics or the means to travel to clinics further away. Our health brigades were set up in places such as farm stables, schools, and churches. We conversed with them in Spanish to gain an understanding of their chief complaint and history, though with some difficulty sometimes since many of the elderly indigenous townspeople spoke the Kichwa dialect rather than Spanish. We performed general physical exams and then

presented our findings to the attending, who evaluated the patient as well and prescribed the appropriate medications. Parasitic infection was a common concern for most people, so albendazole was frequently prescribed to children and adults. It was very gratifying in that even though there were so many people waiting to be seen and the waiting times were very long, each patient I saw was very thankful for our services. It was striking for me to see that many of the presenting illnesses were very preventable, and that it was simply the lack of access to medications, healthcare, and education that precipitated these diseases. For instance, many patients presented with pterygiums of the eye, which is often due to inadequate knowledge about sun exposure.

We spent our third week in urban Quito. Our main community health partner there was Cenit, which is an organization and school that aims to help underserved families and keep children from becoming street workers like their parents. During our health brigades here, we performed physical exams and wellness checks for the students. We also went into the marketplaces to set up health brigades so that we can care for children who follow their parents to work. Being under height was a prevalent problem during our brigades, which indicated chronic malnutrition. Our patients here were all children, and it was surprising to me that even the youngest were receptive to being examined and swallowing medications.

During our last week in Ecuador, we traveled to the Napo River, a tributary of the Amazon. The rainforest was an incredible experience where we were able to ride canoes to visit local jungle communities, eat and prepare Amazonian food, make chocolate from scratch, and experience the rainforest wildlife. As a team, we performed vision checks for the local communities, and also partook in their local basketball competition.

Besides the medical brigades, we also participated in events such as the famous Otavalo market, a sweat lodge, and a local summer solstice celebration. Interspersed between these activities in Otavalo, Quito, and the Amazon, we had regular medical Spanish lessons with instructors based on our baseline Spanish ability. Though I started off with very little proficiency, I was able to complete a general physical exam in Spanish by the end of the program. Besides the scheduled activities of the program, there was also enough free time for us to schedule our own activities, during which we visited Mindo, Baños, and Mitad del Mundo.

Overall, my experience with the Interhealth South American in Ecuador was well rounded. Besides experiencing cultural experiences that I probably will never have the chance to see again and gaining technical skills such as taking histories and performing physical exams in Spanish, the experience also affirmed my desire to become a physician who is well-versed in global health and committed to eliminating health disparities in underserved communities worldwide.