• Wikipedia
• Official Quito Site
• Ecuador: A country study
• Recommended Books on Ecuador

• For information about Ecuador's health indicators provided by the World Health Organization, please click on the following link: WHO-Ecuador

This program is open to participants who are 20 or over at the time of participation. We accept students of all nationalities with interest in international health and relevant educational background. Participants may be any of the following:

• Medical Residents, MD & DO
• Medical Students, MD & DO 1-2
• Medical Students, MD & DO 3-4
• Pre-Medical Students
• Post-bacc pre-medical students
• Gap year pre-medical students
• Graduate nursing students
• Nursing Students
• MPH Students
• Physicians Assistants Students
• Naturpathic students

If you do not fit into one of these categories, please contact us to see if you would be eligible to apply.

Language Ability

Please Note: Please use CFHI's language recommendations below as a guideline to assess your own language skills. Most important overall is your general ability to communicate with those around you, versus accuracy with grammatical tenses.

This program is open to those who speak:

• Minimal Spanish- You can express basic ideas in present and past tense. You can understand sentences and frequently used expressions related to basic everyday situations (e.g. basic personal and family information, shopping, local geography). You can also communicate about simple and routine tasks.
  
• Conversant Spanish- You can interact with a degree of comfort with locals. You can easily describe experiences and events in the present/past tense and have some knowledge of other tenses.
  
• Fluent Spanish- You can understand with ease virtually everything heard. In addition, you can use language flexibly and effectively for social and professional purposes. You can easily use a variety of grammar tenses.

The following hospitals and clinics are a sample of possible rotations during this program. Restrictions may apply for pre-clinical, pre-med, and those students with minimal Spanish skills.

CFHI's rotations are designed to offer you clinical and observational experiences relevant to your level of medical education. CFHI programs can be predominately observational depending on your previous clinical training, your level of Spanish, local laws that prevent foreigners from directly providing healthcare services, and whether the preceptors who will be supervising you trust your clinical skills. Rotation availability depends on local conditions. Please note that in Ecuador the doctors only receive pay for 4 hours per day and usually only in the mornings. The max number of hours that a student is guaranteed is 80 hours per month.

Maternidad Isidro Ayora
This public hospital located in the center of Quito is where the majority of the deliveries take place and where high-risk pregnancies are managed. It is a teaching hospital for medical students and residents. It has a capacity of 400 beds and is virtually always full. This site is open to 3rd and 4th year students only. The Medical Director of the program may consider other participants for this rotation if participant posses high-level Spanish skills. Students must have certification that they have completed a rotation in Ob/Gyn in the United States. (Please bring along relevant proof that coursework has been completed in Ob/Gyn rotations.)


Centro de Salud, Carcelen Alto and Carcelen Bajo

Centro de Salud Carcelen Alto  is a Pediatrics/Obstetrics clinic under the direction of wonderful family practice physicians. It is a small clinic in a very poor neighborhood in the northern part of Quito. Centro de Salud Carcelen Bajo is similar to Carcelen Alto but closer to downtown Quito. This facility also employs a midwife.

Hospital Militar
Hospital Militar is a facility with approximately 400 beds and provides healthcare services to military staff and families as well as civilians in the central part of Quito. This site includes internal medicine and surgery rotations. In the surgical rotations, students will be able to participate as observers and depending on their clinical and Spanish skills, may assist during surgeries. In the internal medicine rotations, students may rotate in the in-patient area of the hospital as well as out-patient offices throughout the Hospital. Participants will be able to observe many different types of pathologies due to the fact that citizens from all over Ecuador are referred to this hospital.

Hospital Tierra Nueva
Hospital Tierra Nueva, an NGO, serves the poorest citizens in the southern part of Quito, comprised of approximately 500,000 residents. All specialties can be found at this hospital, as well as other community health programs they offer, such as free cleft palate surgeries. Participants may rotate in different wards: surgery, pedatrics, ob/gyn, ambulatory care,  and family medicine.

Jambi Huasi Clinic, Otavalo*
This rotation is different from others in Quito. The clinic is called Jambi Huasi and specializes in combining `medicina naturalista` (traditional medicine) and western medicine in a town called Otavalo. They have a huge indigenous population. Students can come and observe the workings of the traditional doctors for a maximum of two days. The clinic charges a fee per day, which must be paid by the student directly to the clinic. Accommodations in Otavalo will be the responsibility of the individual student.

*This clinic is not included in the regular clinical rotation in the Quito program, but is a good opportunity to experience traditional healing in a nearby town.

All rotations are subject to change depending on local availability and general Ecuadorian holidays. Local coordinators will try and make alternate arrangements if a particular activity or facility is not available during the program month.

We strongly suggest you read the "Rotations" section of the FAQ for more information about "Hands on vs. Observational" experiences during your rotations. Please take the time to download and read the "Rethinking your elective" document in that section, particularly the paragraph "Getting hands-on experience".

• CFHI Arrival and Departure Dates
• Clinical Rotations
• Academic Credit Assistance
• Language Training Component
• Accommodations
• Communication
• Program Months

CFHI participants should schedule their flight to arrive at any time on the designated "arrival day" (see right side bulleted menu for exact arrival dates). Program activities and arrival orientation generally start the following day, thus arriving on the arrival day ensures all participants are present to take part in these activities. The departure date of each program occurs on the Saturday four (4) weeks following the arrival date. Participants not planning on doing extra traveling outside of the program should be sure to schedule their flight to depart at any time on this day.

Clinical Rotations

• Pre-trip orientation materials & web conference opportunities
• Orientation upon arrival, including cultural adjustment exercises
• Weekly meetings with Medical Director and Local Coordinator
• Clinical rotations Monday-Friday, excepting holidays or work stoppages, working with a local physician who has opted to participate in CFHI as a teaching preceptor
• Information sessions that highlight the health care system in that country, common cases you will encounter and other site-specific information
• Post-trip debrief materials & other on-going alumni activities/services

Academic Credit Assistance
If you expect that you will need academic credit for your CFHI program, you will be responsible for getting your university's approval. CFHI can help you and provide you with the appropriate material (printing out this website information generally is not sufficient), however we are not an accredited institution and cannot award credit ourselves. Please click here to read more about ways in which CFHI can help you obtain academic credit from your university.

Language Training Component
We recommend you study as much Spanish as possible before you go, as it will greatly decrease personal frustration you  may experience during the CFHI experience. Most activities listed above will be conducted in Spanish, except for the orientations and alumni services.

Click here for a general overview of Spanish-language course learning objectives.

CFHI students will take Spanish language classes at the Amazing Andes Language School, located in the same area as most of the host families. They are responsible for arranging all host families and offering 35 hours of language classes in the first three weeks of the program. You are welcome to design these classes as you wish, for basic grammar and conversational Spanish, or in order to practice your Medical Spanish vocabulary and interviewing skills. Some classes may be taught in small groups, and others individually.

If you would like to continue with additional language classes beyond the 35 hours that are included in the CFHI program, you are welcome to schedule these by the week so they do not interfere with your scheduled clinical rotations. If you set up extra hours of Spanish class, please note that they are not included in the program fee, so you will have to pay the local coordinator of the program directly for the extra hours of Spanish class.

The language school also provides coordination for other activities such as salsa dancing classes, cooking classes, and tours of the city and important landmarks. They are available to arrange weekend trips for the students if there are enough interested, and are always available to give suggestions and guidance for things to do and see.

Accommodations
Homestay families are chosen and screened by Amazing Andes language school. Most host families live in close proximity to the school, allowing for participants to walk to and from their language classes and meetings with ease. In some cases, students may stay with one other student in the homestay, but in all cases, students will have their own room.

If you decide to arrive early or stay with the homestay family after your program has ended, you will need to pay around $14.00 USD per night for the time spent outside of the CFHI program. These fees should be paid directly to the local coordinator of the program.

Communication
You will be assigned a mobile phone for the duration of your stay. All-important phone numbers will have been pre-programmed  along with a limited amount of airtime for emergencies. To  make calls over and above the airtime included, you can purchase pre-paid phone cards at various locations locally.

You will be required to sign a $100 release form in order to receive the cell phone. You will not be charged the $100 fee if the phone is returned in good working order to your program coordinator. To learn more about how to make phone calls to and from your program country, click here

(*CFHI does not endorse any services provided by these sites nor does it guarantee the accuracy of their information).

Program Months
All CFHI groups of participants fluctuate in size through out the year. The summer months tend to be the busiest time of year, so please plan ahead and apply early if you want to secure a space in a specific program during the summer months. During the rest of the year, the group size in a program can be small, especially during the fall months. However, we will NEVER cancel a program due to the size of the group, even if there is only one participant.

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CFHI is a nonprofit organization committed to providing students a unique opportunity to experience another culture and healthcare system in a responsible way. Though we work closely with our global partners to provide you the best possible trip, the nature of international travel means that we cannot anticipate all challenges that may occur. It is important that participants realize they must remain flexible in the face of situations that may be difficult to understand. Participating in a CFHI program means that you are an informal ambassador to the community you visit and your professional behavior is of the utmost importance.

Child Family Health International (CFHI) offers service-learning programs around the world. CFHI would like to stress to prospective applicants and institutional partners, that service-learning is not an episodic volunteer experience, and our student programs are not designed to provide service to those who would otherwise not have healthcare. The main objectives are to broaden your public health knowledge, experience a different culture, and develop creativity in problem-solving. CFHI has assembled a global family of outstanding local healthcare professionals who are at the forefront of healthcare delivery in their countries. You will have the rare opportunity to shadow these unique women and men observing and learning to work in a clinical and public health environment with limited diagnostic and therapeutic resources.

1. What problem do we address?

2. How do we address the problem?

3. How does the community benefit?

4. How do participants help in the clinic?

5. What kind of educational experience is the CFHI global health elective?

6. What are the objectives of the program?

7. Where do CFHI students come from (past participants' universities/colleges)?

8. What role can domestic Institutional Partners (universities, collaboratives, et. al.) play?

9. What is Service-Learning?

1. What problem do we address?

In today’s world we often see the uneven distribution of healthcare that leaves many impoverished communities underserved. Economic, political, and social factors all contribute to people’s access to healthcare, both internationally and at home. Increasingly, we need culturally and linguistically competent healthcare providers around the world to address these inequities.

2. How do we address the problem?

Child Family Health International’s (CFHI) Global Health Service-Learning Programs combine instruction, experience, service, and reflection to create a model that supports physicians and clinical sites abroad, addresses the healthcare needs of the underserved, and adds an unforgettable experiential element to each program participant’s education.

CFHI programs bring service-learning to hospitals and clinics around the world, allowing participants to gain insight on the contextual constructs of illness and healing in foreign settings. Program Alumni return from the host country with new perspectives on healthcare systems and delivery in places where resources and supplies are extremely limited. To read further on the potential benefits of international experiences for health students, we recommend the paper “The Effect of a Global Multiculturalism Track on Cultural Competence of Preclinical Medical Students” by Godkin and Savageau (2001).

Since 1992, CFHI has arranged for nearly 4,000 pre-medical, medical and other students of the health professions, from over 400 top universities in the and the world, to work and study in Bolivia, Ecuador, India, Mexico, and South Africa

3. How does the community benefit?

While a student’s ability to practice medicine may be limited by clinical knowledge or language skills, the participant’s contribution to the community is not an illusion. For example, we provide each participant with a box of donated medical supplies to carry with them for distribution among partner facilities. In addition, our partner physicians at each program site are compensated for their willingness to mentor CFHI students. This supplementary income promotes job retention in countries where physicians are paid small salaries, often by financially strapped governments. Furthermore, the exchange of information between students and their preceptors provides an invaluable experience for participants, the patients, and the physicians.

4. How do participants help in the clinic?

Each of our program sites has many locally qualified and experienced healthcare providers, so the participant’s primary motivation for participation should not focus on a concept of humanitarian aid, in which one expects to provide medical care to people that would otherwise not receive it. The participant’s main objective should be to actively observe, according to current language abilities, level of training, and local laws, in order to develop a high level of community health awareness. While abroad, this happens in the social and cultural context of the program site.  Child Family Health International (CFHI) would like to stress to prospective applicants and institutional partners, that service-learning is not an episodic volunteer experience, and our student programs are not designed to provide service to those who would otherwise not have healthcare.

5. What kind of educational experience is the CFHI global health elective?

CFHI's rotations are designed to offer you hands-on  or observational clinical experience (depending on your clinical and language skills as well as local laws), much like what you would experience during a rotation in the . The program includes the following educational aspects:

• Pre-trip orientation materials & web conference opportunities
• Orientation upon arrival, including cultural adjustment exercises
• Weekly meetings with Medical Director and Local Coordinator
• Clinical rotations Monday-Friday, excepting holidays or work stoppages, working with a local physician who has opted to participate in CFHI as a teaching preceptor.
• Information sessions that highlight the health care system in that country, common cases you will encounter and other site-specific information.
• Post-trip debrief materials & other on-going alumni activities/services

If you are attending a program in a Spanish-speaking country, we recommend you study as much Spanish as possible before you go, as it will greatly decrease your personal frustration during the CFHI experience. Most activities listed above will be conducted in Spanish, except for the orientations and alumni services.

MD Consult and FIRST Consult bring the leading medical resources together into one integrated online service to help physicians efficiently find answers to clinical questions, make better treatment decisions, and stay abreast of recent developments. MD Consult has been adopted by over 90% of North American medical schools and by over 1,700 health care organizations in 46 countries worldwide. FIRST Consult offers an evidence-based resource for the Point of Care, peer-reviewed content and a differential diagnosis tool.

(Please view the FAQs on the right had panel for more information)

6. What are the objectives of the CFHI Service-Learning program?

CFHI’s International Health Service-Learning Programs help participants:

• Develop a larger sense of cultural competency
• Observe and develop existing clinical skills
• Broaden public health knowledge
• Develop creativity in problem-solving
• Deepen their commitment to service
• Promote medical supply conservation

Prospective participants may apply online. Our participants are 21 years of age and over, come from around the globe, and are dedicated to a diverse array of professions in health.

7. Where do your students come from (past participants' colleges/universities)?

CFHI has provided global health education programs to nearly 4,000 health science students since 1992.  Our participants come from over 35 countries and 400+ of the most prestigious universities in the world, and represent a huge variety of the medical profession’s student population.

8. What role do domestic institutional partners (i.e. universities, collaboratives) play?

In addition to providing quality programs for individual students, CFHI is dedicated to building relationships with institutions of higher learning for relevant international programs. Creating and sustaining international programs is a long-term and labor-intensive process. Our international partnerships with physicians and clinic sites are established and reliable, and CFHI can offer the expertise needed to administer an international program to match institutional needs. Some of our current partnerships include:

• Princeton University—Health Professions Advising Office and the Pace Center for Service-Learning: CFHI developed a domestic and international health service-learning program that combined 5 weeks of international work in Quito, Ecuador with 40 hours of service in Spanish-speaking health centers in urban New Jersey.

• Oregon University System—IE3 Global Internship program: CFHI designed 11-week clinical internships in and that focus on cultural competency and valuable clinical experience within the structure of an internship. The internship promotes planning and goal-setting for students in the clinic setting.

• College Corps—CFHI currently working with College Corps, a project started several years ago by Harvard University undergraduate students, to offer 8-week programs in Bolivia, Ecuador, India, Mexico or South Africa, for pre-med students.

• University of California Davis—has teamed up with CFHI to offer a quarter-long study abroad program in Oaxaca, that highlights Latino/a Health Internship Program for undergraduate students. This course is certified by the university as a 20-unit course entitled "Bi-National Health".

If you are an administrator and would like to discuss partnership possibilities we would be excited to hear from you! Please contact Program Staff at CFHI at students@cfhi.org or by phone at (415) 957-9000 x304 and ask for Rea (pronounced Ray).

9. What is service-learning?

Child Family Health International (CFHI) would like to stress to prospective applicants and institutional partners, that service-learning is not an episodic volunteer experience, and our student programs are not designed to provide service to those who would otherwise not have healthcare.

The following is an excerpt from the Campus Community Partnerships in Health (CCPH) website (http://depts.washington.edu/ccph/):

Service-learning is a structured learning experience that combines community service with preparation and reflection. Students engaged in service-learning provide community service in response to community-identified concerns and learn about the context in which service is provided, the connection between their service and their academic coursework, and their roles as citizens.

Service-learning differs from traditional clinical education in the health professions in that:

• Service-learning strives to achieve a balance between service and learning objectives - in service-learning, partners must negotiate the differences in their needs and expectations.

• Service-learning places an emphasis on addressing community concerns and broad determinants of health .

• In service-learning, there is the integral involvement of community partners - service-learning involves a principle-centered partnership between communities and health professions schools.

• Service-learning emphasizes reciprocal learning - In service-learning, traditional definitions of "faculty," "teacher" and "learner" are intentionally blurred. We all learn from each other.

• Service-learning emphasizes reflective practice - In service-learning, reflection facilitates the connection between practice and theory and fosters critical thinking.

• Service-learning places an emphasis on developing citizenship skills and achieving social change- many factors influence health and quality of life. The provision of health services is not often the most important factor. In service-learning, students place their roles as health professionals and citizens in a larger societal context.
  
  

Citation: Seifer SD. (1998). Service-learning: Community-campus partnerships for health professions education. Academic Medicine, 73(3):273-277.  

Medical Director
Dra. Susana Alvear is your medical director for the Andean Health program. Dra. Alvear is an accomplished family physician that obtained her MD and specialty certificates in Ecuador and has since traveled and completed clinical education courses at the University of New Mexico as well as other workshops at McGill University in Montreal, Canada. She has mentored hundreds of CFHI students since 1996 and also teaches at Pontificia Universidad Catolica del Peru, where she manages their residency program.


Local Coordinators
Amazing Andes Language School is where your Spanish classes and weekly meetings are held. Ms. Rosa Tamayo and Ms. Francia Ducos run the school together. The women were interested in creating a responsible small business that would support the local economy and generate employment. Rosa Tamayo has been hosting visiting students from the U.S. and Europe in her home for several years. She is the homestay coordinator for the Quito program. Lorena Bermeo Rivera recruits and trains Spanish teachers, and develops Spanish language curriculum for CFHI students, and those students with special needs.