Navigating the Public Health System

When I’m not with my host family or in Spanish class, the majority of my time during the week is spent as a public health volunteer through the Tandana Foundation*. This foundation coordinates a variety of local service projects, hosts groups of American volunteers, and also provides scholarships to rural Ecuadorian students to continue their education past the primary level. In the public health sector, their mission is to improve rural community members’ access to basic health care. Although this care is provided at no cost by the government, there remain many unmet needs in the system. Having been sick here myself quite a few times, it is apparent to me that patients do not get the privacy or attention they deserve. Everyone could listen in and witness my appointment, and the doctor simply prescribed me pain medicine, which did not treat the underlying issue. Tandana seeks to fill in these gaps; they support local health professionals with added supplies, set up free one-day clinics in the most rural of communities with groups of doctors serving as medical brigades, and follow up with patients regarding treatment and health improvement.

My official position with Tandana is a Coordinador de Actividades de Salud (sounds fancier than it is). As the title would suggest, depending on the week, I coordinate different activities surrounding public health. When the group of American doctors came for our first medical brigade (the next one is in March), I took vitals for incoming patients. I learned not only how to take blood pressure and pulse, but also witnessed how necessary these rural clinics were. Since there is little transportation to these communities, the patients would need to walk hours just to schedule an appointment, often for a different day. Here the mission of Tandana became clear, as each patient that came through intake was full of not just gratitude, but trust in the organization. As part of the medical brigades, Tandana also conducts patient follow-up, as many patients are referred to specialists for advanced care. My current project is to help children referred by our clinics to the ophthalmologist receive the necessary further treatment, which will be provided by a foundation called Vista Para Todos.

Another project of mine is to find an ENT doctor, also known as an otorrinolaringologo, in the area, and then set up volunteer positions for a group of doctors coming in January. While this may sound easy, I can’t just do a quick Google search or call a phone number, as neither of those will get me any information. Though there isn’t one in Otavalo, when I asked my Spanish teacher if she knew of a doctor for orejas, nariz y garganta, she responded that she thought there was one at the Clinica Metropolitana, and from there I started my search. After giving my spiel about the qualifications of our volunteers, I was informed that they did not need anyone, but that I should try at the hospital. The following week I headed over to the large Hospital San Vicente de Paul, where after a series of secretaries and explanations in mediocre Spanish, I landed at the desk of the director. She first asked for my documentation (I am foreign and 18, I had nothing) and then informed me that in their hospital they also did not need volunteers, despite the crowded rooms and seemingly constant flow of patients. After talking about the values of a volunteer experience, discussing the excellence of our volunteers (despite having never met them) and basically pleading with the director, she said that she would discuss the opportunity with the ENT doctor and get back to me next week. Though I will be talking further with the hospital, I definitely considered this a small victory.

Through Tandana, I have access to the schools in the communities outside of Otavalo. Here we give charlas, or health talks, to promote well being. The first one I ever gave was on the importance of handwashing and the proper technique. I explained to a class of 5 year olds that they had millions of microbes on their hands; I think that blew some minds, and in retrospect probably should have started off with the activity. The activity consisted of using glitter to express germs and having them wash their hands until they got it all off, demonstrating the time and force needed to actually clean one’s hands. I think they got the point, and despite a dog and chicken walking in the classroom, the kids were mostly on task and focused. My next charla was given to a 6th grade class at the Gualsaqui School. While speaking to the crowded 47-kid class about being nice to one another, they were passing notes and a small fight even broke out. I hope that the kids got something out of it, but maybe it would be better to give this talk to younger kids in order to stop this behavior in the future. It also made me appreciate the smaller classes and caring teachers I had access to during my school experience. My most recent talk was about proper teeth brushing. This was never really taught to kids since they don’t really go to the dentist frequently. With delicious 10c ice cream available outside the school, it is no wonder to me that many have to get teeth pulled before they are 18.

That particular line of work has given me quite a few fun stories, whether I am being chased by a bull through the mountains in a rainstorm for crossing through a farm, or taking vitals of a 90 year old indigenous woman speaking to me only in kichwa. All of this contributes to me having a rather hectic schedule, but it keeps things interesting. Believe it or not, even with all of this going on, I find 3 days a week to work at a Subcentro! Subcentro is a medical clinic that is run by the government. When deciding where to spend the rest of my time volunteering I knew I was really enjoying my work through the Tandana Foundation and I knew that I wanted to find another aspect of public health to explore.

More about Subcentro in my next blog post.

*For more information, visit