The small country situated in the Andes crossed by the equator has beautiful beaches, snow-capped mountains, rain forests, colonial cities, and most notably friendly and warm-hearted inhabitants.
The government’s efforts for improving the population’s situation are hindered by instability of the political systems, mismanagement and corruption. The economic situation in the country depends intensely on foreign countries because Ecuador gets its foreign currencies and money for the national budget from exporting oil and oil-related products as well as few agricultural goods.
At the moment, the country’s economy is weak due to low oil prices. These gains are also used for repaying foreign debts. Or these debts and interest are not paid as in 2009 – resulting in a lack of trust of possible external investors.
Furthermore, there is no certainty that improvements and offers stated by the government reach populations in need. This does not only refer to the health sector, but also to education. Many well-intentioned approaches fail from the beginning and improvement is not in sight as long as the majority of the population does not have continuous access to these existential parts of life.
The project region: El Páramo
“La Y de la Laguna” (pronounced “La Yeh”) and the thirty village communities are situated in the Region “El Páramo” in the national ecological reserve entitled “Mache Chindul”, a national park with natural tropical rain forest and a lagoon in the province Esmeraldas. The capital city of the region, Quinindé, with approximately 30.000 inhabitants and a local hospital is situated 40 kilometres from La Y. From Quinindé, “camionetas” (pick-up-trucks) and “rancheras” (old motor trucks with wooden benches on the load floor) make their way through country roads, which are hard to drive. It may take about four hours to reach La Y, especially during rainy season.
The name of the central village “La Y de la Laguna“ means “the y-parting of the ways“ because this is the place where the road diverges to reach the small village communities in the region, mostly only accessible by foot or horse/mule. Such a path may lead to a ten or twelve hours walk with extreme conditions, especially in rainy reason.
The inhabitants of the province Manabí settled in this region decades ago. Nowadays, the population counts approximately 6.000 inhabitants, belonging to the ethnic groups of mestizos, Afro-Americans and native inhabitants (“indígenas”). Due to a lack of data, more exact information about the population is not available. (Due to a lack of data, the precise composition of the population is not known.)
As the settlement of El Páramo was only disapprovingly accepted by the government, there has been little government support.
The people living in the area do not have access to fresh water pipes, garbage disposal, electricity (in La Y it is available intermittently)). Too few village schools are available for people’s education. Earnings from poorly-paid jobs within agriculture lead to low family incomes. Nature – people’s biggest treasure in the Region – is affected and destroyed by agricultural practices.
Before the establishment of the primary healthcare centre, high costs and difficult travel conditions to Quinindé (especially in the rainy season) hampered access to healthcare.
The health project
Foundation Human Nature (FHN) supports a
sustainable development program in the region “El Páramo” in the Northwest of
Ecuador. The focus is on primary health care backed by a health centre in the
main village La Y de la Laguna.
The health centre was officially opened on 15 December 2001. Offering long-term sustainability and steadiness, FHN signed a contract for cooperation with the Ministry of Health, the local hospital in Quinindé, and the voluntary local health committee. Based on this contract, health care is supported by doctors, dentists, nurses, midwives and laboratory assistants. Monthly deliveries of medications – the amount and components of which are limited – vaccinations and materials are provided by the hospital in Quinindé. FHN provides funding for additional medications (amount and components), materials, repairs and purchase of medical equipment.
The local health committee consists of local community members who were involved in constructing the health centre and are now engaged in administering it. The health committee is represented by its board and approved by the governmental authorities. Administrative tasks such as the purchase of medications, accounting and budgeting is done by an administrator who is paid for by FHN, but employed by the local health committee.
For the first time in August 2002, every community elected two persons being educated as community health workers who since then participate in regular capacity building activities, e.g. on first aid, family planning, vaccination programs, hygiene and medicinal plants. Local doctors and international volunteers lead these capacity building activities. The acquired knowledge is shared with neighbours and other community members.
As paths within the region re hardly accessible especially during the rainy seasons, it is hardly possible for families with kids to regularly visit the health centre for check-ups or vaccinations. Therefore, the local health committee together with community health workers organizes so-called health brigades (“brigadas medicas”) rounds. During a health brigade round, a medical team visits the villages around La Y to do examinations, treat patients and vaccinate children. Health brigades bring along medication to be able to offer direct help.
A laboratory was set up in the health centre to aid in the accurate diagnosis of uncommon illnesse. The Laboratory which is staffed by an FHN trained local laboratory assistant spares patients long and costly journeys to Quinindé for examinations. Here different tests can be done, i.e. malaria or dengue related laboratory analyses of patient samples.
Besides primary health care, Foundation Human Nature (FHN) engages in health promotion and disease prevention in the areas of non-communicable diseases, clean drinking water and capacity building of community health workers.
Currently, there is a group of patients with non-communicable diseases such hypertension and diabetes that regularly meets at the health centre. The initiative started off with approximately 15 individuals, while there are now up to 40 people between the ages of 45-85 years who participate. During these meet-ups, the group discusses different topics, e.g. related to a non-communicable disease such as its symptoms and prevention. Moreover, the group engages in gymnastic exercises (do you mean cardiovascular or aerobic gymnastics sounds quite extreme). Afterwards, measures of weight, blood pressure or blood sugar are offered by the health centre and consultations with health professionals are possible.
A rainwater reservoir containing 50.000 litre provides the health centre with water. Before consumption the water needs to be boiled to be germfree. Many households in the region also boil their water, which, however, leads to further deforestation (as electricity is often unavailable, the water is boiled over an open fire).
Since 2010, FHN is running a water filter project to facilitate access to clean drinking water, and preventing further deforestation. So far, more than 100 families are using these water filters (2016). Even some schools are using them. In the health centre and the neighbouring “Casa Multiple” where doctors, nurses and other local and international staff members live, the water filters are used as well.
Since the initiation for the health centre, there have been recruitment drives for community health workers who are the link between the health centre in La Y and the villages in the surrounding areas. Community health workers arrange appointments for the health brigades, for example, and support their organization.
Waste management projects help counteract contamination in La Y. At the same time, the health local committee and the inhabitants agreed on staking all horses and mules in two places near the main road reducing the contamination of the village by their excrement.
In 2009, a cooperation for micro finance was founded in the region called “caja de inversion social para la region del Páramo“(CIS). Members of the CISmay request a credit of USD 50 after making a minimum deposit, e.g. to buy fertilizer or seedlings. In some cases, school fees were financed – until returns from the next harvest would allow for the loan repayment. In this way, the family income can be increased and lead to improved living conditions.