The Country of Ecuador
Culture and Traditional Medicine
The culture of health and wellness in Ecuador rests on the values inherent in ancestral knowledge. According to Gopal, Ecuadoreans seek to lead an active, healthy lifestyle. They strongly believe in the continuity of the life processes and treat health as an equilibrium, a balanced state of being. Ecuadoreans adhere to the culture and philosophy of holism when it comes to health and healing. That is, they view every personality as a holistic being, who is intricately linked to the environment, to which he or she belongs. They also recognize the crucial role of the environment in understanding disease. The culture of health and wellness in Ecuador treats biological causes of disease as being secondary to economic and social ones. Even today when Ecuador has a well-developed health care system, ancestral knowledge and traditional medicine enjoy sustained popularity among country residents.
Traditional medicine remains an important component of health care provision in Ecuador. According to the World Health Organization, "there are associations of traditional medicine practitioners that work at regional and local levels." These organizations are run either by state authorities or indigenous organizations. Under the Ecuadorean Health Code of 1971, the scope of traditional medicine and legal practicing in this field were severely limited. Traditional healers could keep practicing, but their activities were outlawed. Since 1998, indigenous people have been struggling to recognize the legality and centrality of traditional medicine to healthcare provision in Ecuador. Ultimately, the State assumed legal responsibility for monitoring traditional medical practices, their safety and legal compliance. Unfortunately, there is still no formal association to cover traditional healers in Ecuador; nor is there any authority that would certify and assess indigenous providers of alternative and traditional medicine.
Healthcare System and Delivery
The healthcare system in Ecuador is riddled by controversy. According to Boslaugh, as of 2007, the country did not have any formal and accessible system for delivering emergency care. Under the current Constitution, the national Ministry of Public Health is the principal government entity responsible for delivering, monitoring, measuring, and regulating public health care. The Ministry of Health uses the National Health Council as a means for maintaining close policy contacts with other health care agencies. These agencies acknowledge the unequivocal power of the Ministry of Public Health in all aspects of public health care. The Ministry is further supported by a variety of social security institutions, which include Rural Social Security, the Ecuadorean Social Security Institute, the National Police Social Security Institute, and the Armed Forces Social Security Institute.
The Ministry of Public Health in Ecuador is the primary employer in the healthcare system, followed by the social security agencies. As of 2006, 55,578 professionals worked in Ecuadorean health care facilities. Of these, almost 20,000 were represented by physicians and almost 14,000 – by nurse assistants. At the same time, there were 5.6 nurses and 14.4 physicians per 100,000 Ecuadoreans.
The nursing education system in Ecuador is fairly well-developed. It has a total of 11 medical schools. Nurses graduating in Ecuador receive a degree of doctor of medicine. All graduates must spend one year following in a rural area or delivering government-financed medical services. All medical licenses are granted by the Ministry of Public Health, and only after one year of government services is completed. For physicians and nurses with degrees obtained in foreign universities, each degree must be subsequently validated by any Ecuadorean University.
As for professional nursing organizations, the Ecuadorean Federation of Nursing is officially recognized as the main body governing nurses' relationships with the state, clients, and other stakeholders. The organization is represented in 21 nursing colleges across Ecuador. Simultaneously, the Ecuadorean Association of Nursing Faculties and Schools governs all aspects of nursing education and career in Ecuador.
Despite the growing amount of investments in the healthcare system, numerous public health issues in Ecuador continue to persist. According to the World Health Organization, in 2008, diabetes was the primary cause of mortality in Ecuador, followed by hypertension, ischemic heart disease, pneumonia, as well as homicides and traffic accidents. Statistically, Ecuadoreans lose 45 percent of their life years to noncommunicable diseases, 30 percent to communicable diseases, and 25 percent to physical injuries. This being said, the top health priorities to be considered in this country are cancer, cardiovascular disease, and chronic respiratory disease. The issues of infant and maternal mortality also deserve attention. In the context of communicable diseases, Ecuador displays some of the highest rates of tuberculosis in South America. In 2008, 56 deaths every month were due to tuberculosis. Finally, Ecuador is known for being particularly susceptible to the risks of natural disasters. These pose a serious threat to individual and public health in the country. Some of the most prevalent natural risks include El Nino, high winds, earthquakes, heavy rainfalls, and volcanic eruptions. All these problems and risks have far-reaching implications for nurses, who come to Ecuador to provide high-quality care to its residents. Simultaneously, based on the information provided above, it is high time for nurses to assume a proactive leadership position and address the existing social and healthcare inconsistencies to achieve and sustain better public health outcomes.
Nurses are in a position to address the top health priorities listed earlier in this work. First, they can assume a leadership position in redesigning the existing healthcare system to deliver better quality of care and create favorable conditions for achieving the best health outcomes. According to USAID, since 1995, the country has not experienced any major or minor health reform. Consequently, many processes that take place within the healthcare system are either inadequately designed or obsolete. Nurses should consolidate around the need for a profound structural reform and lead positive change in the health care sector. They can accomplish their mission under the governing umbrella of the Ministry of Public Health and the Ecuadorean Federation of Nursing, which can engage in a concerted effort to improve public health in the country.
Second, nurses should advocate personnel and human resource changes in the healthcare system to increase the percentage of physicians and nurses per 100,000 Ecuadorean population. Boslaugh writes that, in 2000, Ecuador had 1.66 nurses and 1.48 physicians per 1,000 population. With more nurses working in hospitals, the accessibility and availability of primary care will gradually improve. Here, special emphasis should be made on emergency care. As mentioned earlier, the country has historically lacked any comprehensive system of primary care delivery. Yet, it is primary care that plays one of the fundamental roles in advancing the mission of public health and wellbeing among residents in Ecuador.
Finally, given the growing burden of communicable diseases in the country such as tuberculosis, nurses are expected to become more active in developing and implementing public health campaigns. Prevention of communicable diseases should become a measure of top priority for the national Ministry of Public Health and other government agencies involved in healthcare provision. Simultaneously, the system of nursing education should focus on preparing nurse practitioners, who specialize in community and public health. At present, only three universities in Ecuador have programs in epidemiology, and their number should be gradually increased. These are just some of the implications and recommendations that can be helpful at transforming the field of nursing in Ecuador.
To conclude, the system of health care in Ecuador is surrounded by structural, financial, and human resource controversies. Despite the growing amount of financial and infrastructural investments in health care, many health issues persist. Suffice is to say, Ecuador is home to some of the most difficult weather and environmental conditions, which put a heavy burden of public health threats on the government. Equally problematic are the high incidence and prevalence of communicable diseases such as tuberculosis. The number of people with diabetes and hypertension continues to increase. At the same time, the healthcare system lacks any focus on primary and emergency care. Alternative medicine is flourishing, even though under the Ecuadorean Constitution these healing activities lack any legal status. Nurses are uniquely positioned to address most, if not all, health controversies in Ecuador. They can assume a more active position promoting structural reforms in health care and initiating positive change within the healthcare system. They can organize health promotion campaigns to reduce the scope of preventable health conditions, including diabetes mellitus and tuberculosis. Simultaneously, nurse-to-patient ratios should also increase to ensure that all residents receive high-quality care without any delay. As of today, it is nurses who represent the hope and promise of the Ecuadorean healthcare system and its potential to make Ecuador a better place for living.