This project used a national team of
Christian health care professionals and local resources to demonstrate
that very basic health infrastructures can significantly improve spiritual
and physical health.
How it began
For many years, the Onzole River area in the northern province of Esmeraldas,
Ecuador has, contained a very isolated and needy population of both blacks
and Chachi Indians. A community survey completed in the late 1980s revealed
that no effective medical/dental services were available within a two-day
canoe trip. There were no preventive services for children or pregnant
women; and malaria, parasites, wounds, skin infections, and back problems
were abundant. There was a very high incidence of dental caries in both
children and adults, resulting in too many totally decayed teeth. Approximately
50-55% of the adult population was involved in tobacco and/or alcohol use,
and there was a substantial incidence of drug abuse.
In terms of public health concerns, only 20% of the population used
a latrine regularly, and even less 10% treated water prior to use or used
safe drinking water. The average diet was lacking in iron, zinc, and B
vitamins. Only 30% of households had a small vegetable garden for supplementing
diet, and the communities had little expertise in dealing with governmental
or non-governmental organizations that could potentially benefit them.
Spiritually, while most professed to be Catholic, very few practiced
their religion; and only one or two active believers were identified. Thus,
children received only sporadic religious instruction, and sexual promiscuity
was rampant. Relational conflict was the norm.
Committed to an integrated bio-psycho-social-spiritual approach to medical
care, I wanted to develop a project in Ecuador that would reflect that
philosophy. I had been privileged for many years, to practice family medicine
in a group of four believers in Lakewood, Colorado. We sponsored one member
to take up to 3 months every 4 years for a short-term mission. Both my
wife and I had been committed to mission work for years, working in Guatemala,
Peru, and Zaire for short stays of 2-3 months. Thus, God had prepared me
to understand health care needs in cultural settings outside of the United
States.
People and Organizations Involved
This project used only national professionals in conjunction with two
non-profit organizations, National Evangelical Group of Help and Development
(CENAD) and Medical Assistance Programs/Ecuador (MAP/Ecuador). The initial
multidisciplinary team included a doctor, nurse, dentist, social worker,
and boatman. Our initial team consisted entirely of strong believers, especially
the doctor and nurse, who were very active from the start in discipling
and evangelistic work as well as the medical work. At the beginning of
the third year, the Ministry of Health requested that the project be expanded
from four to twelve communities. and it provided additional personnel for
the team.
The team collaborated in projects with UNICEF for construction of latrines,
with the Ecuadorian Ministry of Health to build a clinic in one of the
larger communities, and with the Ministry of Health to obtain a government-supported
rural doctor and nurse for another clinic. All the health promoters have
been included in the Ministry of Health program of continuing health education
and are receiving a small stipend from the government. These strategies
have made the projects self-sustainable, without reliance on outside sources.
Methods
The project completed a community survey to introduce members of the
team to the area. A family chart was drawn up for every household, leading
to the creation of an area diagnostic profile and planning for the following
goals:
Improve the general standard of health by the prevention and early detection
of serious and common medical/dental problems.
Train local community workers (supported by community and government funding)
in detection and management of problems.
Help develop economic self-sufficiency and a more healthy style of living.
Present the gospel of Jesus Christ in a natural manner to build up believers
and form a strong, self-sustaining Christian community.
The base of operations was in Santo Domingo, where the community built
a clinic and living quarters for the team. The project team worked on the
river 15 days each month visiting the other communities. Approximately
25% of visits were for preventive activities:
bimonthly immunizations of children and pregnant women;
an intensive and comprehensive malaria control program;
control of onchocerciasis, tuberculosis and cholera;
an intensive campaign to promote chlorination of water; and
dental care, e.g. filling of caries and restoration of damaged teeth.
Research provided data for evaluation. There was one study of nutritional
status. Treatment for parasitic infections was analyzed by comparing the
efficacy of two local herbal remedies to standard anti-parasitic medication.
There was an investigation into types of malaria manifested in river areas
and clinical resistance to standard treatment. IUD use, acceptance and
complications in women were a subject of inquiry. A demographic study of
prevalence of dental disease in the upper river area was published. Data
were utilized to improve the health care delivered through the project.
Health Committees were established to coordinate health activities for
the area, such as two village pharmacies, two village libraries, a tool
bank for village projects and local handicrafts, and construction of family
and multi-family latrines in conjunction with UNICEF.
An agronomist helped introduce new vegetables and seeds with improved
agricultural techniques. A small tree farm was established for reforestation.
Household vegetable gardens were promoted. Assistance was provided in draining
a swamp and building a permanent drainage ditch.
Teaching and training were major priorities to enhance knowledge and
skills and increase self-sufficiency:
seminars and training in community organization, accounting,
and leadership skills for community leaders;
regular teaching in the schools related to brushing teeth;
meetings with local village midwives focusing on an exchange of ideas
and teaching about prenatal and postpartum care;
training mothers to improve hygiene skills, food protection, and recognition
and management of common childhood illnesses;
training village health workers in health education, prevention and
management of common illnesses, use of medicines and natural remedies,
and emergency treatment of dental problems.
Spiritual care included regular Bible studies for interested young
people and adults, and weekly Bible classes for school-age children. Spiritual
mentoring of the team was a top priority for me, both during team meetings
and while on site in the villages. Team members thus were enabled to counsel
patients regarding personal problems from a Bible-centered perspective.
There were special village-wide seminars on topics of interest such
as family life, marriage, and child-rearing according to biblical principles;
and by the final year of the project, quarterly spiritual retreats were
held. Two young men were sponsored by the project to attend Bible School
in Argentina, and approximately six young people per year received scholarships
to attend Bible conferences or camps. Sports clubs were a means of reaching
out to young people.
Results
Within five years, the incidence of malaria was reduced by 75% in the
upper river area. In the last year, there were no cases of cholera, despite
its existence along other jungle rivers. The incidence of symptomatic parasitic
infections decreased by 50%. There was significant improvement in acceptance
of preventive health care, especially for well-child and prenatal care
and family planning.
Preventive care visits increased by 54% during the five years. Approximately
80% of all children were fully immunized when the project concluded. There
was also an increased awareness of the need for regular brushing of teeth
and dental prophylaxis.
There are now government-paid health auxiliaries and health promoters
in every major village along the river and two functioning pharmacies supplied
by governmental sources. Regular health education classes for young mothers
and schoolchildren were taken over by health promoters and the nurse practitioner.
By the fifth year household gardens in Santo Domingo had increased from
30% to 70%. There was increased awareness of outside markets and a strategy
for marketing handicrafts.
In relation to the spiritual needs, the project saw the development
of two active evangelical churches in the lower river areas of San Francisco
and Anchayacu, both led by capable local pastors. These pastors also helped
periodically with the up-river work. As a result of the evangelistic and
discipling outreach, two new groups meet regularly in Colon and Santo Domingo.
Each group has at least one man who is well grounded in biblical truths
and following programmed seminary studies by correspondence. Each village
has also constructed a church and continues to develop local leadership.
The Challenge of Handing Over
The most difficult part of handing over the project was the break in
close relationships which had been forged. An entire week was devoted to
farewell dinners, meetings, and ceremonies in the various associated communities.
Assets also had to be carefully distributed. Most medical and dental
equipment was donated to the Ministry of Health with the stipulation that
it not be used outside of the area. The canoe and functioning outboard
motor were given to the community of Santo Domingo, under the supervision
of the trained auxiliary health worker, primarily to be used for medically
related purposes.
Lessons Learned
1. The collaboration with governmental and other agencies has
made it possible for this comprehensive project to be self-sustainable,
rather than dependent on outside funding.
2. Using an entire working team composed of Ecuadorian professionals
allowed them to serve as models to their own peers of an integrated, team-oriented
and spiritually focused approach to meeting complex community needs in
an isolated setting.
3. The total cost of the five-year project was $212,883 and 58,000
man-hours of work. Although the cost may be seen as high, it showed that
a time limited project can be started in an isolated area lacking any basic
services and difficult to access, and it can be handed over with a good
sense that the work will be carried on by the communities of those who
will ultimately benefit.
Editors Note: This article was excerpted from an article
published
by Health Development International at www.healthdevelopment.org