Health Development in Ecuador: An MPH Perspective


As a Master of Public Health practicum student for The Foundation of International Medical Relief of Children (FIMRC)- Project Anconcito, located in Anconcito, Ecuador- I participated in a wide
range of the foundation's ongoing projects in the community as well as focus on a specific long-term project during my time with them. Chicos Superman y Chicas Marivellous is the weekly children's clubs where each week a different health lesson is given. During my time we discussed self-esteem, drug and alcohol prevention, future planning, and physical activity. We also spent time surveying out in the community to continue to develop the FIMRC programming according to the population's needs. This year FIMRC has started a gardening program in two of the community's schools. We assisted a class at each school in building and planting the garden, as well as providing a lesson on gardening or the environment each week. I personally helped deliver a lesson on nutrition and a food demo one week. As an ongoing program, FIMRC has developed a young child nutrition class for mothers of children below age 5 that are severely
malnourished, identified as a weight or height for age z-score below –2. My personal project this
summer was to re-evaluate the programs 8-week curriculum, as well as assist in developing
monitoring and evaluation for the class and a follow-up portion of the program.


The experience of working in rural Ecuador was one that helped me grow both personally
and professionally. The most important lesson I learned was looking at public health in context of a community-through the lens of their needs, wants, strengths, weaknesses, and culture. A strength of FIMRC is how integrated they are into the community. We worked in the local health clinic, the local government building, and in people's homes every day. We continued to assess the community's health status as well as individual's views and opinions on the most important problems that needed to be addressed. It was also an important lesson learning where FIMRC was limited as an organization in their power, especially in their case in limitations under the Ecuador Ministry of Health. This experience caused me to continue to evaluate the importance of policy in health care, in Ecuador and at home in the United States.


The learning objectives outlined for this practicum experience included reviewing
previous as well as continuing assessment of the community nutrition status. This objective was met by reviewing the child nutrition campaign Project Anconcito staff completed earlier this year. After this assessment the Child Nutrition Program was developed. This summer we continued to screen children to enroll them in the program and collect their anthropometric data. This objective met the competencies under biostatistics and epidemiology, specifically the third competency of epidemiology.

The second learning objective outlined was to review community health assessment and highlight community areas to target programming. Meeting this objective was done through a similar means as the previous objective, as well as participating in community surveying and discussions with the project site staff about current and future directions of programming.


The third objective set, to work with FIMRC and the local government to address community needs, was fulfilled by being fully immersed in the daily on-goings of FIMRC in the Anconcito community. We worked with the governments Peace Corp volunteer in our school gardening projects, attended the governments health events as well as they supported our health-led efforts. We often provided education in the health clinic waiting areas, provided donations of medical supplies, and had ongoing conversations with the President of Anconcito and his staff about the focus of public health efforts.


The final objective of developing the nutrition education program, under the competency of health policy and management, was met with my main project work of reviewing the 8-week course and designing a monitoring and evaluation for the course and follow up program. I did this in partnership with my preceptors and the local nutritionist who works part-time with the foundation in Anconcito. I reviewed the course material and strengthened its content. Monitoring and Evaluation put into place included a pre/post-test, and recording anthropometric data of the children screened as well as enrolled from the time of enrollment through graduation of the follow-up. We designed a follow-up program after graduation from the course in which the nutritionist and FIMRC staff will visit the children once a month to get their weight and height, as well as an algorithm to follow for re-education and problem solving if necessary based on these results. A system for effective data tracking was implemented as well, including individual growth charts for each child and the use of a software program to analyze the data as a population group.

Project Anconcito was a unique international public health experience because it is a very
new site, in operation for just over one year, and is still in the very early stages of community
assessment and program development in comparison to other FIMRC project locations.


*This blog was written by University of Missouri MPH student, Rachel Pankau.