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the Community
The rural and tranquil Valle de los Chillos is one hour south
of the capital city of Quito, Ecuador. The majority of its inhabitants
continue to earn their living much as their ancestors for generations
before them, relying on the rich soil and abundant rains of the
valley to produce subsistence crops and livestock.
Escalating economic pressures beginning in the 1990’s
led to a sharp increase in numbers of commuters from El Valle
de los Chillos attracted to service and manufacturing jobs in
neighboring cities such as San Golquil and Quito. Runaway inflation
and adoption of the U.S. dollar as the official national currency
in the late 1990’s also initiated a wave of immigration
abroad. Citizens of the parroquia can now be found living and
working abroad in countries including the United States, Norway,
Italy and Spain. |
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| Despite the natural blessings of climate
and location favoring agriculture, the rural character and economy
of Cotogchoa contribute to many problems affecting the health of
its citizens. These problems are closely related to a historical
lack of infrastructure, organization, and the political influence
necessary to command sufficient government resources. |
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| Such problems are common in Ecuador
and can be found throughout the world. However, people in developing
countries tend to be affected disproportionately by deteriorating
economic conditions and an ineffective government response to them.
Of people in these countries, certain groups, such as the rural
poor, in places like Cotogchoa, frequently are among the most underserved
of populations when it comes to all services, including healthcare.
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|  These
problems have been well identified, and illustrated, in the Parroquia
of Cotogchoa’s official 10
year development plan for the years 2002 – 2012.
Specific issues identified in this well-documented
study affecting the health of the community fall into several
categories:
- Education:
One third of adults are functionally illiterate. Nursery
school space is 70% under capacity. There are no screening programs
in the schools to detect hearing or vision loss, orthopedic
deformities, or developmental problems. There is no secondary
school in the community. The parroquial library is closed.
- Water, Sewage, Basic Services:
20% of residences lack running water. 40% of residences lack
any type of septic, or sewage system. 40% of households and
businesses have no type of garbage removal. None of the water
is treated, resulting in widespread parasitic disease. 30% of
houses lack electricity, 40% are without a working telephone.
- Security: Police staffing
and equipment are inadequate. Alcohol abuse is widespread, leading
to domestic violence and neglect in many families.
- Public Health: Currently
a government sponsored Subcentro de salud exists in Cotogchoa
Central, but its ability to serve patients is limited. Current
issues with the Subcentro de salud include:
- Limited and irregular staffing hours of the Subcentro
de salud.
- Limited ability to see patients during first come, first
serve, morning hours that the Subcentro de salud is open.
- No medicines are available through the Subcentro de salud,
and there is no local pharmacy. With average household income
of less that 100 dollars per month,*
the majority of people cannot afford to have their prescriptions
filled.
*according to a recently
conducted HealtheClinc survey. Click here
to read this survey.
- The Subcentro de salud is staffed by newly graduated
physicians, fulfilling their government required "Rural
Year" of public service. The result of this annual
rotation policy is to deprive the Subcentro of an experienced
physician, and continuity of care.
- No dental service, no access to specialty services.
- No outreach programs in preventative healthcare, such
as prenatal care, prevention of water born illnesses, domestic
violence, etc.
- Insufficient access to the Subcentro de salud by many
of the members of outlying communities. People in many parts
of the parroquia need to take three buses to get to the
Centro, and then another 1 or 2 buses to reach a pharmacy
if they are trying to fill a prescription.
For more on problems with the official, state-sponsored healthcare
in Ecuador click here.
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| With on ongoing economic stagnation,
continued government instability, and little hope of an infusion
of money, equipment or personnel to the existing Subcentro de
salud, the community decided to take action.
- First, they adopted a new version
of the official Vision Statement for the Parroquia of Cotogchoa
to prioritize concrete healthcare needs:
“Healthcare services shall be permanent, preventative
and curative; offering specialist services, rehabilitation,
modern equipment and a pharmacy.”
- Second, they began to talk.
Among neighbors, among community leaders, were there other options
that to address the gap in healthcare? If they organized and
enlisted broad support in the community, could they find technical
help and alternative sources of support for healthcare in Cotogchoa?
- Third, after officially organizing,
they decided to enlist the support of HealtheClinic.org to provide
assistance in planning, funding and managing Cotogchoa’s
own, self-sustaining, community-based healthcare project.
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