A Rural Visit by an Aspiring Doctor

The following reflection is from Notre Dame graduate, Mark Sullivan. Mark volunteered with Andean Health in Ecuador during the summer of ’08. He is now in his first year of medical school at the University of Rochester.

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.

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Posted by laura in Global Health TopicsStories | 1 Comment  

One Response to “A Rural Visit by an Aspiring Doctor”

  1. Ricardo says:

    Congratulations on your effort, the experience that you will gain from this kind of adventure will be very valuable in your future. I am very familiar with rural medicine in Ecuador, until 1994 I operated an air ambulance company there and I could tell you some stories. Keep the good work and study hard.
    Ricardo Isacovici

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