Intercultural health in Ecuador: an asymmetrical and incomplete project.

Intimate connections between culture and health are complicated by various understandings of the human body, divergent beliefs about reality and place-bound theories about healing. Health care systems in various countries are modified with a goal of creating 'hybrid' structures that make room for traditional practices within a dominant Western model. But genuine intercultural health care is elusive. In Ecuador, a country with great cultural and geographic diversity, the culture-health spectrum is broad and bumpy. This is especially evident in health care politics, education and administration. A constitution adopted in 2008 aims for inclusivity and equality by incorporating indigenous concepts of the 'good life' and ideals of an intercultural society. These new values and perspectives should be reflected in economics, law, education and health care. But these concepts confront a racial, political and economic history that has delegitimized indigenous systems of knowledge and belief. This paper contrasts 'ideal' and 'real' intercultural health care using case studies of the Tsáchila, an indigenous group in coastal Ecuador. The conclusion is that 'ideal' intercultural health care, as reflected in medical school education and clinical practice, is a superficial attempt at dialogue and understanding between indigenous and western medicine. 'Real' intercultural health care involves a more profound level of mutual respect and cross-cultural understanding that aims for symmetry in patient-doctor relationships. Insights from medical anthropology guide the authors through a critical analysis that addresses interculturality as a political issue and a political struggle that the Tsáchilas - like other indigenous groups - are losing.

Brucellosis in dairy cattle and goats in northern Ecuador.

The purpose of this study was to conduct a convenience study for brucellosis prevalence in dairy-producing animals in northern Ecuador. In total, 2,561 cows and 301 goats were tested. Cattle sera were tested using the Rose Bengal card antigen test (RBCT), yielding an overall apparent prevalence of 5.5% (95% confidence interval [95% CI] = 4.7-6.5%) and true prevalence of 7.2% (95% CI = 6.0-8.5%). Prevalence varied by herd size and was highest in larger commercial herds. Polymerase chain reaction was used to test goat milk and lymph nodes, resulting in 9% and 8% positivity, respectively. The RBCTs from goat sera yielded an adjusted true prevalence of 17.8% (95% CI = 6.2-44.2%). Our findings are similar to other overall prevalence estimates for dairy herds but show higher prevalence in commercial herds compared with small groups (less than five animals). We also identify urban milking goats living in metropolitan Quito as a potential source of zoonosis.

An anthropological approach to teaching health sciences students cultural competency in a field school program.

International immersion experiences do not, in themselves, provide students with the opportunity to develop cultural competence. However, using an anthropological lens to educate students allows them to learn how to negotiate cultural differences by removing their own cultural filters and seeing events through the eyes of those who are culturally different. Faculty at the University of Wisconsin-Madison's Global Health Institute believed that an embedded experience, in which students engaged with local communities, would encourage them to adopt this Cultural Competency 2.0 position. With this goal in mind, they started the Field School for the Study of Language, Culture, and Community Health in Ecuador in 2003 to teach cultural competency to medical, veterinary, pharmacy, and nursing students. The program was rooted in medical anthropology and embraced the One Health initiative, which is a collaborative effort of multiple disciplines working locally, nationally, and globally to obtain optimal health for people, animals, and the environment. In this article, the authors identify effective practices and challenges for using a biocultural approach to educating students. In a semester-long preparatory class, students study the Spanish language, region-specific topics, and community engagement principles. While in Ecuador for five weeks, students apply their knowledge during community visits that involve homestays and service learning projects, for which they partner with local communities to meet their health needs. This combination of language and anthropological course work and community-based service learning has led to positive outcomes for the local communities as well as professional development for students and faculty.