International staff: 9
National staff: 16
In Ecuador, difficult economic conditions and a move toward privatizing the health sector have pushed health care beyond the reach of many.
MSF has concentrated its work in northeast Ecuador, where the Putumayo River forms the border with Colombia. In a program that got underway in January 2000, MSF provides basic health care services for Ecuadorians largely excluded from the Ecuadorian medical system and Colombians either fleeing violence in their own country or traveling to Ecuador for economic reasons.
The MSF project has two bases, one in the town of Puerto del Carmen, on the river, and the other in Nueva Loja, a small town a few hours south. The entire area is a place the authorities are unable to reach, and where travel for the population - and access to health services - is difficult. From these towns, MSF provides care for Ecuadorians and Colombians on both sides of the border.
A 200-kilometer boat trip
Each month, the team based in Puerto del Carmen makes a 200km circuit by boat along the Putumayo River, traveling eight days northeast to Cuenbi and Puerto Asis, and another eight days to the southwest to Tres Fronteras and Puerto Leguizamo. On the Ecuadorian side of the border, MSF supports a health center, a health post and a "hogar materno," a place for women with difficult pregnancies or births.
On the Colombian side of the river, MSF provides care at eight health posts. Common medical problems in the region include acute respiratory and diarrhea infections, malaria, parasitosis, and yellow fever (MSF carried out vaccinations for this disease in early 2000). The program serves about 8,000 people on the Ecuadorian side of the border and 32,000 on the Colombian side. Another 10,000 Colombians (refugees and others travelling through the region) also benefit.
The other part of the project is based in Nueva Loja and reaches about 50,000 people - primarily from the Secoya, Quichua, Suares and Cofane indigenous groups - as well as settlers. MSF supports the basic health care activities the government has set out in its national health plan but for which there are limited public resources. The organization also trains local health care staff and assists with the rehabilitation and equipment of health facilities. Early on in the project, MSF lobbied successfully for the authorities to assign a Quichua-speaking nurse to the area.
The need for cheaper medicines
As the Ecuadorian public health system has become more decentralized, private health services and pharmacies have flourished. But the country's economic difficulties mean that most people cannot afford the expensive commercial drugs that are the mainstay of the market. In addition, health centers frequently run out of medicine. MSF is trying to make more low-cost drugs available at the pharmacies linked to the health posts it supports. The organization donated the first stock of medicine and set up a cost recovery system to help make the pharmacies self-sustaining.
MSF has been working in Ecuador since 1996.