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Rough Cut: Ecuador: Country Doctors
Background Facts and Related Links
Learn more about the political and economic challenges facing Ecuador and efforts to provide healthcare to its poorest citizens.

Ecuador Profile

The South American nation of 13 million is bordered by Colombia to the north, Peru to the south, and the Pacific Ocean to the west. The equator crosses just north of Ecuador's capital, Quito, and the country gets its name from this hemispheric crossroads.

According to recent census figures, 95 percent of Ecuador is Roman Catholic, though the country's ethnic diversity has deep roots in its Incan heritage. The World Health Organization (WHO) reports that more than 70 percent of the population above the age of 15 considers itself "mestizo" -- a mix of European descent and pre-Columbian Native American, known as "Amerindian."

Andes Mountains

The Andes Mountains.

Geographically, the country is divided into three different climatic regions: the Pacific coast, Andes Mountains, and inland Amazonian rainforest. With such sharp contrasts and mix of land use, Ecuador enjoys a number of valuable natural resources, including, oil, bananas and shrimp. Petroleum production makes up about one third of Ecuador's $32.57 billion annual GDP, and the country is the world's largest exporter of bananas. Yet, more than 40 percent of the population lives below the poverty line, a number that has doubled in the last decade.

Politics and the Economy

Although Ecuador has a representative government, in which the large indigenous population has taken an active role since 1996, coups and revolts have turned over leadership at the top 13 times in the last 11 years.

Some believe political instability is at the heart of Ecuador's persistent poverty. While economic observers say government control of the country's main industries has caused 30 years of economic stagnation and lost Ecuador crucial international investment.

River House

The country's president, Rafael Correa, who served as economic and finance minister in 2005, took office after a typical run-off election in January 2007. During his brief four-month run as finance minister, Correa called for economic independence and the eradication of poverty. With 50 cents of every dollar in the national treasury going toward payment of international debt, Correa, like other current Latin American leaders, has put national pride and economic independence at the base of his leadership. During the first few months of his presidency, he threatened to default on Ecuador's international debt repayment, and eventually expelled one of the World Bank's envoys from the country. While agreeing to settle loans, Correa asserted that critical domestic restructuring should come first.

Poverty and Healthcare

With a per capita income of only $5,820, Ecuador is one of the poorest nations in Latin America, ranking 99 in the world. Its healthcare system reflects this, as the general mortality rate, according to the Pan American Health Organization (PAHO), is 4.1 per 1,000 inhabitants.

Some of the greatest health problems in Ecuador today include malnutrition, diabetes and heart disease, which is the leading cause of death. Other common problems include acute respiratory infections and diarrheic diseases, which have risen dramatically since 1990. With the country's large agribusiness industry, the PAHO has found a profound increase in the number of illnesses caused by the use of pesticides and other agricultural chemicals.

Dr. Edgar Rodas.

Dr. Edgar Rodas and his nonprofit organization has helped bring healthcare to more than 50,000 of Ecuador's poorest rural citizens.

Ecuador has improved its healthcare over the past decade by centralizing and attempting to organize its system into regional units. Ecuador's Ministry of Public Health is said to cover approximately 30 percent of the population, and in total, there are more than 17,000 physicians and 5,200 nurses working in the public system. Since the Free Maternal Child Health Law was passed in September 1994, free reproductive health services have been guaranteed for all.

But there are many factors that have made across-the-board medical service nearly impossible. Although Ecuador's rural population has dropped from around 70 percent in 1950 to half that by 2002, the combination of 40-plus indigenous groups, numerous languages and populations in remote areas, all contribute to the difficulty in setting up an equitable healthcare system.

Many of Ecuador's poorest, who live in the central provinces, Amazonia and urban shantytowns, receive no medical treatment from the two main public sources -- the Public Health Ministry and the Social Security Institute. Estimates suggest that as much as 20 to 30 percent of Ecuador's population lack immediate access to health services, and 70 percent are without health insurance and do not have the means to pay for care. These marginalized groups often rely on traditional medicine and aid from volunteers and NGOs.

Sources: CIA World Factbook, BBC, CBC, PAHO and WHO.

Related Links

Cinterandes Foundation
This nonprofit started in 1995, specializes in mobile surgery, family health and medical development programs, primarily serving the poorest citizens in rural and urban areas of Ecuador. One of the foundation's goals is to increase access to telemedicine, or medical outreach, to areas where people are typically cut off from the main healthcare services. Cinterandes has recruited international medical students and volunteers to help the operation.

The International Trauma System Development Program (ITSDP)

This education and support program, based at Virginia Commonwealth University Medical Center in Richmond, Virginia, works with health ministries on several continents to help improve medical care on the ground. The program has worked with doctors from the Cinterandes group in Ecuador, particularly in the area of telemedicine, or remote surgery.

Ecuador at the Pan American Health Organization
The PAHO, a division of the WHO, provides a comprehensive resource about Ecuador's health statistics, concerns and healthcare projects.

Ecuador Timeline
This BBC timeline provides a brief chronology of events in Ecuador, from the Incan empire in the 1450s to President Correa's April 2007 referendum that will revamp the constitution. It emphasizes the economic and political instability that has complicated Ecuador's turbulent 20th and early 21st century history.

Ecuador's New Leader
This CBC coverage of the January 2007 election of President Correa reports on his promises to rewrite Ecuador's constitution and his calls to reject the "Washington consensus" and U.S. economic involvement in his country, a theme echoed by other Latin American leaders, including Venezuela's Hugo Chavez and Bolivia's Evo Morales.

The Skoll Foundation
The Skoll Foundation fund was set up by former eBay president, Jeff Skoll, in 1999 to invest in social entrepreneurs who are using innovative ways to bring about systemic change in underserved communities around the world.

Social Entrepreneurs
Check out other FRONTLINE/World stories focusing on the work of social entrepreneurs, from India to Uganda and South Africa.

Ecuador's Bittersweet Pill
In this FRONTLINE/World dispatch from October 2006, reporter Rick Young writes about his return to Ecuador after 22 years and the mixed blessing of the country's decision to adopt the U.S. dollar as its currency six years ago.

--Rob Krieger