Thank you so much for taking time to look at our blog! We are a group of edical students who are passionate about training and in underserved areas. This January and February, we are in Peru, the Dominican Republic and Costa Rica internationally as well as locally in Flint and Lansing completing volunteer service, rotating in hospitals and clinics, and learning about international medicine and local underserved health care. We appreciate any time you take to read our reflections and any donations you might offer.

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Monday, February 20

Anconcito, Ecuador

Bienvenidos a Ecudaor!  The time has flown by, and my wife Lauren and I have had our share of hard work, new experiences, and excitement!

Anconcito, Ecuador
We are working with the Foundation for International Medical Relief of Children (FIMRC) on a project to assess childhood malnutrition and anemia in the rural fishing town of Anconcito.  There is a great deal of need in the community, with widespread poverty, overcrowding, and limited access to healthcare being among its chief problems.  Some statistics: the majority of families in Anconcito survive on $200 or less per month, and while the cost of living is substantially less here than in the U.S., it is still hard to make ends meet. For reference, the minimum wage here in Ecuador is $366 per month, but since so much of Anconcito depends on the fishing industry, and some times/seasons are profitable while others are not, families here are often making far less than minimum wage.  Indeed, less than 6% of families make more than $400 per month!

Additionally, while diseases such as parasites and diarrhea are common, often owing to contaminated tap water, there is little in the way of medical care for the community.  The Ecuadorian Ministry of Health (MoH) runs a small clinic here in town where people can receive free health care, but there are only three doctors for a town of nearly 20,000 people, and, while private clinics do exist, the poverty of the residents here makes cost a daunting obstacle to using these services.  The MoH clinic is understandably overwhelmed with its impossible task of trying to provide care to the town, so patients often must wait weeks or months to be seen.  And even when they do get in for a visit, the MoH clinic has so few resources at their disposal that the level of care provided often falls well below what we would expect in the U.S.  Cases of even low complexity must be referred to a hospital in the nearby town of Salinas (I once saw a child with an earache referred to a pediatrician in Salinas because the MoH clinic didn’t have an otoscope to perform a proper ear exam).  I do not blame the doctors at the MoH clinic; they are good people doing the very best that they can.  The task before them is simply far, far greater than the manpower and resources they have available to them.

It is in this context that my wife and I are conducting our research.  To our knowledge, there is very little data about malnutrition in this community, so we are hoping to help fill that void of knowledge.  Our study involves collecting height and weight measurements of children aged 0-59 months, as well as collecting hemoglobin samples from kids aged 6-59 months.  From these data, we will estimate the prevalence of manifestations of malnutrition such as underweight or stunting, as well as estimate the prevalence of anemia in the community.

We are nearly done with data collection at this point, and while we have yet to sit down and analyze the data, we can already see that malnutrition and anemia are both very significant problems in children here.  Stunting is very common, and even the children that check out as “normal” on the growth charts are nearly all below average for height-for-age.  Additionally, mild-to-moderate anemia seems to be almost the rule rather than the exception, and our screening has even detected a handful of cases of severe anemia that required urgent medical attention.

We hope that our work here will be much more than an academic exercise.  We are collaborating with the MoH clinic to conduct the study (they are very kindly lending us their hemoglobin analyzer to perform our tests), and we will share the information we collect with the doctors there so that they can hopefully follow up with the children most in need of medical intervention.  We also hope that our results will be useful to FIMRC as they continue to work to develop interventions to promote health and nutrition here in Anconcito.

But it hasn’t been all work and no play for Lauren and me.  We have taken advantage of our weekends to do a little sight-seeing in this beautiful country.  One of our trips took us hiking and snorkeling at Isla de la Plata (Sliver Island), also known as the “Poor Man’s Galapagos,” where we saw blue-footed boobies, a whale, a shark, sea turtles, and a huge variety of fish.  This past weekend, we visited the city of Cuenca, a sprawling historical city surrounded by beautiful mountains.  And this weekend, we hope to journey to Riobamba and see the famous volcano, Chimborazo.  Ecuador truly is a land of immense natural beauty, and I wish we had more time to see it all!
Chris and Lauren in Cuenca, Ecuador

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