Fellow Bio:
My lifelong goals are to make a positive difference in the lives of other people and to foster conservation of the natural world. As an undergraduate I studied tropical botany, and spent time in Latin and South America conducting research and travelling. Through these experiences I found that conservation was often secondary to a more immediate community need: access to quality health care. With this insight, the focus of my career path shifted to medicine. As a physician, I am interested in family medicine and international health with a rural community focus. It is my intent to serve as an activist for underserved areas as well. I joined LOCUS to continue developing leadership and organizing skills that will enhance my ability to be a culturally competent advocate at community, national, and international levels. In addition, I felt that LOCUS would provide a wonderful environment for meeting students and physicians who have a diverse breadth of experience, passion for service, and an interest in sharing relevant skills.

Situation: A recent study carried out by the World Bank, UNICEF, and the Ecuadorian Ministry of Public Health ranked the Napo Province last among Ecuador's 21 provinces in terms of health, education, and poverty. In the rural areas of the Napo Province:

• The infant mortality rate is 70 per 1,000 live births.
• The maternal mortality rate is between 120 and 140 per 100,000 births.
• There is no potable water or electricity in any communities.
• More than 95% of the inhabitants suffer from intestinal parasites.
• One in four children under the age of five suffer life-threatening diarrhea every two weeks.
• Only 32.9 percent of children receive all necessary immunizations (diphtheria, measles, polio, tetanus, and tuberculosis) before they reach the age of one.
• Just 24% of babies are born in hospitals and clinics and another 15% in the presence of health professionals working in the field.

In 1995, FUNEDESIN brought together 30 rainforest communities located along the Napo River and helped them organize their own organization, Amanecer Campesino. The communities determined healthcare was their most urgent need. Up until that time the nearest professional medical attention was in Tena, the provincial capital, more than three days from the most remote communities that the Mondana Health Clinic now serves.

FUNEDESIN uses the Mondana Health Clinic as a base for its community-based healthcare initiatives. The Clinic provides excellent, low-cost medical and dental care to over 10,000 Quichua indigenous and colonists living in impoverished communities that are accessible only by canoe.

The Foundation has identified an urgent need for (1) additional prenatal healthcare; (2) expanded sexual and reproductive health education for adolescents; and (3) gynecological exams to detect cervical cancer.

Inputs:
Mondana Health Clinic Leadership and Infrastructure. A board of directors comprised of three Amanecer Campesino members and three FUNEDESIN employees jointly manages the Clinic and its community-based healthcare programs. To effectively provide healthcare to communities spread across a wide geographic area marked by difficult terrain, the Clinic has developed an extensive community-based healthcare network comprised of community health promoters (CHPs), a two-way radio system, and fully equipped medical outposts. Through this network, 80% of the health issues in the communities are solved without transporting patients to the Clinic. Doctors are regularly on staff at the Clinic.

Mondana Health Clinic Coordinator. Christopher Sacco serves as the Volunteer Coordinator for the Clinic and arranges projects that meet the needs of the population and the students completing a medical rotation. He is enthusiastic about working with medical personnel to further serve this unique area.

Mondana Health Clinic Volunteers. Volunteers play a significant role in maintaining the efficacy of the Mondana Health Clinic. Medical students, nursing students, and other health professionals complete a 2-8 week rotation during which time they provide community health checks, administer vaccines and nutritional supplements, and facilitate educational family planning workshops in the Upper Napo River communities. Melissa Bachhuber, LOCUS fellow. As a practicing physician, it is my intent to spend a portion of time each year providing rural health care in Latin/South America, with a particular interest in the Amazon. A clinical rotation with FUNEDESIN would give me meaningful insight into the challenges of care in this remote setting, enhance my understanding of public health education, provide me with a wide spectrum of medical, environmental, and cultural teachers, give me greater Spanish practice, and allow an opportunity to engage in meaningful community service. I plan to invest 4 weeks at the Clinic, participating in all elements of the medical student rotation discussed in this proposal.

Outputs: What we doTo effectively provide healthcare to communities spread across a wide geographic area marked by difficult terrain, the Clinic has developed an extensive community-based healthcare network comprised of community health promoters (CHPs), a two-way radio system, and fully equipped medical outposts.

In addition to providing 24-hour attention on-site, the Clinic's medical personnel travel to each of the 30 communities every two months. Scheduled community visits are an integral part of the Clinic's effort to systematically administer prenatal care, vaccines, and nutritional supplements. The visits also provide important support for the CHPs.

In 1999, FUNEDESIN launched the Ecuadorian Amazon Children's Health Initiative (EACH Initiative) to meet the immunization and nutritional needs of children and pregnant women living in the Upper Napo Region. Medical personnel from the Mondana Clinic travel to communities throughout the region administering critically needed vaccines and nutritional supplements to children and pregnant and breastfeeding women.

In 2002, with support from the United Nations Population Fund, the Mondana Clinic started providing family planning and reproductive health information and services to 35 rural communities in the Upper Napo River Region. FUNEDESIN sponsors training seminars for the network of 50 community health promoters it works with. After completing the seminars, the community health promoters will present a series of community conferences about reproductive health. This project also supplies at-cost contraceptives to the participating communities.

Volunteers: The Clinic treats routine ailments, as well as emergencies resulting from snakebites, complicated pregnancies, and traumatic injuries. At the Clinic, we attend to patients in the presence of a supervising doctor. In addition, community interventions discussed above involve travel to rainforest communities. The goals of community interventions vary, but typically they involve the administration of vaccinations, oral rehydration therapy, and micro-nutrient supplements, as well as health eduation and medical examinations of school children. We also collect information about one or more of the communities and the health problems that they face to enable the Clinic to serve the area more effectively.

Who we reach:
More than 10,000 people benefit from the Mondana Clinic and FUNEDESIN's other health care activities. Seventy percent of the Mondana Clinic beneficiaries are Amazon Quichua indigenous and 30% are colonists of Spanish or mestizo heritage. The beneficiaries come from 35 rural and impoverished communities located along the Napo River. These communities identified health care as their single greatest need.

Short term outcomes:

• Assist in meeting the health care needs of the underserved communities in the Upper Napo Region especially in areas of child and maternal health
• Empower women with reproductive health knowledge that may be used to make informed decisions about family planning
• Promote supportive interaction of an underserved population, the LOCUS program, medical students, and international health care professionals within the global community
• Gain Spanish and Quichua language experience
• Understand the complex web of political, economic, social, cultural, and spiritual forces which influence the health of people within the Ecuadorian Amazon
• Appreciate and experience the cultural practices of Amazon communities including traditional health care practices, natural resource use, artisan work, socioeconomic issues, and spiritual beliefs.
• Understand issues related to providing international health care in rural areas of Ecuador

Long term outcomes:

• Promote culturally-sensitive relationships of medical personnel from developed countries with an underserved population in a developing country
• Contribute to a long-term volunteer program which helps to enhance the overall health of an underserved population
• Complete engaging presentations to other medical students regarding issues in rural health care and underserved populations of the Ecuadorian Amazon in collaboration with a fellow medical student Leila Mittelfort, who will complete the rotation in June/July. The Cross Cultural Health Care Interest Group will sponsor this event.
• Enhance understanding of international health issues and shape my future career path in international public health initiatives
• Utilize Spanish skills during the LOCUS Mindfulness Meditation Program, during future clinical rotations, and in my future practice as well

My lifelong goal as a physician is to utilize medicine as a tool for fostering social justice and environmental protection. In light of this goal, providing health care to the underserved in an international capacity is one of my greatest priorities.

• 1) To gain meaningful insight into the issues underlying international health leadership and public health education programs in rural areas within developing countries through direct experience.
• 2) To assist in delivery of health care and womenís reproductive health workshops to the communities located near the MondaŇa Clinic on the Upper Napo River in the Ecuadorian Amazon.
• 3) To understand the political, socioeconomic, cultural, and spiritual forces which influence the health of the people the MondaŇa Clinic serves.
• 4) To appreciate and experience the cultural practices of communities living in the Upper Napo River region including traditional health care practices, natural resource use, artisan work, socioeconomic issues, and spiritual beliefs.
• 5) To enhance Spanish and Quichua language knowledge and experience to effectively communicate with individuals in Ecuador, and to utilize Spanish language in future medical situations and practice in Wisconsin. This Spanish experience would also enable me to better communicate with Latina women who will be involved in the LOCUS Mindfulness Meditation Program in fall 2003.

Last update:

August 22, 2003

A indicates the item has been completed.

Completed	When	What	On-line
	Year 1: Beginning of Semester 2	New Project Report	Submit Report
	Year 2: Beginning of Semester 1	Project Update	Submit Update
	Year 2: Beginning of Semester 2	Project Update	Submit Update
	Year 3: Beginning of third year	Project Update	Submit Update
	Year 4: August of fourth year	2-3 page final summary of project that includes a reflective evaluation of the project process	N/A
	Ongoing	Participate in program evaluation (written and/or focus group)	View Options
	By the end of fourth year	Select poster, presentation, paper, creative option or your own idea	View Options

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© 2003 University of Wisconsin-Madison Department of Family Medicine