Guayaquil and Puyo Ecuador: Diverse and Interesting experience

I spent a month is Ecuador in April 2017

I’m a physician with a great deal of clinical and administrative experience and am also a graduate of the Michigan School of Public Health. Because of this, I’m probably not very typical of the majority of folks who are reading this but for a few, my comments may be helpful. I was most interested in population health, delivery systems and vector control. I also hoped to do something that might contribute to the place I was visiting. Finally, I wanted the opportunity to have meaningful conversations with people in Spanish.

The month I spent in Ecuador was more than I could have hoped for. This was in large measure due to the programmatic flexibility of the sponsor and my assigned preceptor.

My first two weeks were spent in Guayaquil. The first week was weighted toward language classes with a couple of mornings visiting a local clinic. The next week was spent with vector control with some afternoon language classes. This was a good balance of time. I would say that the language school was more conversational and less structured than the school I attended in Oaxaca on a different trip.

My time with vector control was terrific. I was able to observe a highly organized and effective program on the ground. Wilfrido (my preceptor) is the vector control officer of a program that is responsible for diminishing the threat posed by mosquito bone illness (dengue, zika and chikungunya) in a huge, economically depressed area of Guayaquil that includes 500,000 people. I went out with the home visiting crew who charmed their way into most homes and provided personal and high quality education. I also spent time with the fumigation team and had the opportunity to see many different barrios, some of which don’t have basic water and electrical services.

Before going, I read a good deal about how tough Guayaquil can be and I had some anxiety. My preceptor who also hosted me not only kept me secure but also made me feel comfortable in that environment. They often provided transportation and gave careful advice on how and where we should go.

The second two weeks were spent in Puyo, a much smaller town on the edge of Amazonia. Because Puyo is at about 3000 ft above sea level, the weather was very comfortable with thundershowers almost every day and just a bit of heat for a couple of hours in the afternoon. Folks told me that there really isn’t a dry season in Puyo. It is about the same all year around. (Guayaquil does have a wet season and a dry season with May being variable.)

During my two weeks in Puyo, I was able to work on a project in which the local medical care community and hospital are trying to implement a major program advancing the care of type 2 diabetes. The Ecuadorian Ministry of Health has recently released a set of guidelines and I happened to arrive during a time of intense planning. My fellow participant and I were able to develop a set of recommendations that we discussed and modified with the help of community members and medical personal. I believe that this work will contribute to the eventual success of the program. This was more than I hoped for and we were supported fully by Child Family Health International.

Additionally, I was able to visit San Virgilio for a couple of days. This was an experience of a lifetime. I stayed in a comfortable bungalow that was in close proximity to members of an extended family. My host, Rodgrigo kept in almost constant contact with me and thought of everything, including providing a walking stick to help with stream crossings and slippery slopes. You are actually driven to the main village and do a bit of walking to get to the family compound (you cross the stream twice). You do need to purchase rubber boots but that is easy to do at the Mercado in Puyo and it costs about $10.00. I was introduced to Kichwa culture and tradition in a genuine way. By the way, the meals I had in San Virgilio were the most interesting I had on my trip. Amazingly enough, there were no mosquitoes! (Because I am older than 58, I chose not to be vaccinated for yellow fever). Rodrigo told me that there are mosquitoes during the “drier” months of July and August.

I feel particularly fortunate to have stayed with my preceptor, his wife and their two children during my two weeks in Guayaquil. They were more than generous hosts. It felt like I was actually part of the family. Guayaquil was warm and humid and it was comfortable to be able to sleep in an air-conditioned room. My hosts for the second two weeks were also very generous and provided a very comfortable home during my two weeks in Puyo.

I had given no thought to weekends before leaving but this turned out to be an important part of the trip. I feel very fortunate that my companion during this month was a young woman who is just graduating from the University of Oregon. She was a courteous, flexible and interesting working/educational partner and traveling companion. We had the opportunity to visit Cuenca and Caja National Park, Latacunga and the crater lake called Quilotoa and of course Banos and the waterfalls (only an hour and one-half away). By the way, at this moment, Ecuador is a great travel bargain.

Thank you and CFHI for helping me have a remarkable experience.

A few additional thoughts:

1. I think a person with at least basic conversational Spanish competence will be able to take best advantage of the opportunities presented in Guayaquil and Puyo. I think a person wishing to be introduced to an “intensive” Spanish instructional experience might be better served at a different site.

2. I think a person interested in population and public health might find this experience exceptional, as I did.

3. This program demonstrated flexibility.

4. I studied almost all the materials provided and I suggest that participants take the time to do this as well. I had realistic expectations going in and this was important.