Community Medicine: From Rainforest to Coast
Experience Ecuador's diverse cultures and geography, from Ecuador's most populated, vibrant and modern tropical coastal city to a small city in the Amazon basin, considered a frontier town before entering the vast Amazon, the world's largest tropical rainforest with unparalleled biodiversity, containing 1 of every 10 species on earth.
This program offers a unique opportunity to explore community-based medicine in a variety of settings, from the public hospital in a big urban setting to a small public primary healthcare clinic at the edge of the rainforest. Learn how communities in Guayaquil, Ecuador’s most vibrant and populated city, and Puyo, a small city on the Amazon rainforest, are addressing their most pressing health challenges including chronic, infectious, and vector-borne diseases, all while improving your Spanish and gaining insights into public health realities in Ecuador, indigenous cultures, and community medicine.
Begin your trip in Guayaquil, and spend two weeks attending Spanish language classes while taking part in clinical rotations in government primary healthcare clinics in an urban environment. This will allow you to strengthen your Spanish skills and become familiar with the main tenets and structure of the healthcare system in Ecuador.
Next, journey to the Amazon basin to learn about health issues facing rural and indigenous communities in the town of Puyo, Ecuador. In Puyo geography, resources and culture affect healthcare access, as the area is home to 7 of Ecuador’s 13 indigenous groups. Join local healthcare practitioners and take part in clinical interventions, public health outreach and initiatives and jungle community visits.
In the city of Puyo, focus on rural and community medicine and gain exposure to infectious and tropical disease. Interact with the community through rotations in rural and suburban primary healthcare clinics. Go on home visits with local clinic staff who follow up on patients with diabetes, hypertension, tuberculosis, etc. Join brigades with public health personnel that are working to eradicate and prevent vector-borne diseases like malaria and dengue. Also learn about conservation and indigenous health issues by visiting local nonprofits working to preserve fragile ecosystems and rotate in rural primary healthcare clinics.
Unique to this program is the opportunity to live with an indigenous tribe for several days, providing an anthropological insight into indigenous communities. Hike with a local guide 6 hours into the Amazon jungle to reach a Shuar indigenous community along the banks of the Amazon River. Eat traditional meals with the Shuar and learn about medicinal plants.
To add to the cultural language immersion, participants live with local families in Guayaquil and Puyo. CFHI participants may also organize weekend trips from Guayaquil to various islands in the delta or visit some of the beach towns close to Guayaquil, such as "Playas. From Puyo, travel to Baños or Tena, home to numerous waterfalls and adventure sports like kayaking and zip lining.
Clinical Rotations & Public Health Placements
This program is divided up between multiple geographic areas within Ecuador.
Primary Healthcare Clinics- Located in the downtown area offering free or low cost services to patients without health insurance. Services include detection and treatment of chronic diseases and acute ones like hypertension, diabetes, asthma and arthritis. Basic maternal and child health services are also provided as well as family planning services. Join local physicians and partake in physical exams, patient histories and treatment for uninsured populations.
Malaria Eradication Center- This under-funded public center is responsible for combating malaria and other vector-borne disease in Guayaquil, covering a vast area of the la provincial del Guayas. This institutions compiles malaria, dengue and chagas statistics, research outbreaks, and educate the community on the various vector-borne diseases.
Rural Primary Healthcare Center- This small public primary healthcare clinic, about 40 minutes outside of Puyo by bus, is located at the mouth of the Amazon jungle. It serves a largely indigenous population that travel 4-6 hours from deep within the jungle to seek care. Local practitioners provide primary care, obstetrics, immunizations, and treat emergencies such as snakebites and machete wounds. Professionals also conduct community visits and provide preventative care, vaccinations, and well child check-ups.
Indigenous Community Visits- Hike into the Amazon jungle to visit an indigenous community and learn about the Shuar tribe. Unlike tribes that regularly receive tourists, this community works exclusively with CFHI participants and thus provides an authentic perspective of Shuar culture and daily family life. Learn about the unique worldview of the Shuar, their uses for traditional medicinal plants and important spiritual practices. Spend time with village children, sharing personal skills or knowledge such as art, music, or sports. Experience a traditional welcoming ceremony for guests and hike to a sacred waterfall. Click here to view video footage taken by a CFHI student during a visit to an indigenous community.
Suburban Primary Healthcare Center- This small public primary healthcare clinic located 15 minutes by bus from Puyo, in the small hamlet of Mera. The clinic offers free services to patients without health insurance, including detection and treatment of chronic and acute disease like hypertension, diabetes, asthma and arthritis. Basic maternal and child health care services, such as family planning and vaccinations, are also provided.
Farmworkers Clinic- This small rural facility is located in one of the smallest cities in Ecuador. It is one of ten clinics in the Pastaza province specifically serving farmworkers. Join local clinic staff providing primary care, dental services, and treating farming related injuries. The clinic also does community education workshops focusing on education and prevention of common health issues.
Environmental NGO- On the site of a former cow pasture now lays a reforested botanical garden. Visit this project that has been in existence over 20 years. See local insect, plant and reptile species, many of which are threatened and facing extinction. Learn from local experts about environmental health, botany, animal husbandry, forestry, entomology, and the sociocultural and political aspects of preserving the jungle ecosystem in this community.
Open-air Cultural Center- Located in downtown Puyo on the banks of a river this center promotes conservation of tropical wetlands and increases visibility and awareness about indigenous Amazonian cultures. Indigenous guides provide important cultural and medicinal information about the seven different ethnic groups that inhabit the Pastaza province. Learn about indigenous beliefs related to health. Opportunities may be available to assist with projects such as the medicinal plant garden, building of eco-friendly latrines, native huts, etc.
CFHI is considered a global health ethics leader therefore CFHI programs uphold strict standards and comply with all local laws regarding student involvement in health settings. Your experience on the program depends on your previous clinical training (if applicable), Spanish level, and the relationship you build with your supervising preceptor. Above all, YOU are the most important factor in making the CFHI experience as fulfilling as possible by being respectful, inquisitive, and open to the wide variety of learning experiences which you will encounter.
The first portion of this program is based in Guayaquil, known as the "Pearl of the Pacific." This tropical, colorful and vibrant city is the most populous in Ecuador and has become the main trading and economic capital of the country. Located along the Guayas River in the Gulf of Guayaquil, it is an important trading center with influence at the regional level in the areas of trade, finance, politics, culture and entertainment .
For the remaining weeks of the program, students will be based in the tropical city of Puyo, about 6 hours by bus from Quito bordering the Amazon jungle. Surrounded by green hills Puyo is a modern city home to about 60,000 inhabitants. It the largest city in the region and the main economic and commercial hub of the province. Because of its location, Puyo is a common jumping off point for trips into the Amazon. In and around Puyo there are large indigenous populations and this influence is seen in the food and culture of the region.
Things to Do
CFHI participants have free time during most evenings and weekends and may choose to organize weekend trips to nearby destinations and take part in cultural activities offered within the cities of Guayaquil and Puyo.
Within Guayaquil, popular activities include the old city center, know as Barrio Las Peñas and taking a stroll down the "Malecon", a renovated riverwalk. During the weekends, participants can visit various islands in the delta or visit some of the beach towns close to Guayaquil such as "Playas."
In Puyo stroll around downtown and sample local delicacies like fish wrapped in banana leaf or chicha, made from fermented yucca. Pay a visit to the Water Park, wildlife sanctuary, or local museums. Take a short trip from Puyo to Baños, known for its waterfalls and adventure sports like kayaking and zip lining. A short ways away visit waterfalls, caves, or jungle regions to learn more about indigenous cultures and what is being done to preserve threatened ecosystems.
Accommodations & Homestays
In Guayauquil, participants stay with homestay families, chosen and screened by the CFHI Local Coordinator. Homestays are located in a middle class residential neighborhood. In Puyo homestays are generally located near the main square with easy bus access to clinical rotations. In some cases CFHI participants may be housed with others in the same homestay, but will always have their own room.
Homestays provide a unique opportunity to learn about local culture and practice Spanish skills on a daily basis in an informal setting. Accommodation includes two meals a day and laundry once a week. At the welcome orientation participants will be instructed on recommended transportation from homestays to clinical rotations and getting around the city.
Eligibility: Who Can Apply?
This CFHI program is ideal for students of all levels with an interest in fields related to hospital medicine and care, as well as understanding the benefits and limitations of free universal healthcare coverage. Non-students are also eligible. This program will provide an in-depth overview of hospital medicine in Latin America through visits and experiences within hospitals in the city of Cordoba. To confirm your eligibility, please read CFHI’s general eligibility requirements.
Minimum Language Required: Beginner 2 Spanish or Above
Beginner 2 Spanish: “I can communicate simply when I am in familiar, everyday situations.”
- I can understand sentences and frequently used expressions related to areas of immediate relevance (e.g. very basic personal and family information, shopping, local geography, employment).
- I can communicate simple and routine tasks requiring a basic and direct exchange of information. Examples include discussing weekend plans, asking for directions, planning social outings or going grocery shopping.
Leading this program on-site are our on-site partners (see Local Team tab), all natives of Ecuador who speak Spanish as their primarily language, but do know English as well. To provide authentic learning experiences translators are not provided. Daily interactions will be in Spanish, but CFHI’s local team is able to support and help you through your experience.
All CFHI participants applying to programs in Latin America will evaluate their Spanish language skills as part of their application. Most important is your general ability to communicate verbally with those around you, versus accuracy with grammatical tenses. All CFHI Latin America programs include Spanish language instruction on-site.
Not sure about your Spanish level? View a full list of CFHI’s language levels for all Latin America programs on our Spanish Level Guidelines page.
Participants should arrive in Guayaquil, Ecuador on the program start date and will be picked up from the airport by a CFHI representative and taken to their homestay. A welcome orientation will take place the Sunday or Monday after arrival.
Visas are not required for U.S. citizens staying less than 3 months in Ecuador. More information on travel and logistics will be provided by CFHI after acceptance into the program.
- Guidance from CFHI staff in San Francisco before departure
- Program-specific materials with information on making travel arrangements, visa requirements, recommended immunizations, etc.
- Airport pick-up upon arrival and transportation to homestay in Guayaquil with local CFHI representative
- Welcome orientation with other participants covering safety, transportation, and other logistics
- Spanish Classes: 20 hours/month of Spanish classes during the first two weeks of the program (in Guayaquil only), includes medical Spanish instruction
- Welcome dinner, city tour and cultural activities
- CFHI Local Team: providing instruction, logistical support, and 24/7 emergency response
- Weekly meetings and lectures on local healthcare system and socio-economic determinants of health
- Placement and coordination of clinical/public health activities in Guayaquil and Puyo
- Accommodation, two meals a day, and laundry services once a week in Guayaquil and Puyo
- Ground transportation to/from Guayaquil and Puyo
- Indigenous community visit: local guide and activities
- Local cell phone
- International emergency medical and evacuation insurance
- Access to CFHI alumni-only LinkedIn group featuring news and career opportunities related to Global Health
- CFHI alumni newsletter highlighting events, resources, and ways to stay involved
Uniquely CFHI, 50% or more of student program fees go directly to the communities they will be visiting, benefiting the local economy at large and specifically underserved health systems. Read more.
Meet the Local Team
Dr. Wilfrido Torres – CFHI Puyo Medical Director: The role of the Medical Director is to arrange clinical rotations and public health placements, supervise the participant experience at these sites, and provide instruction on healthcare topics during weekly meetings. Dr. Torres serves in this role during both the Quito and Puyo portion of the program. He has extensive clinical and public health experience with local populations.
Dr. Torres has worked with CFHI since 1999 in the Amazon region of Ecuador. He completed his degree in Medicine and General Surgery at the State University of Guayaquil, where he also completed his Master’s in Clinical Investigation and Epidemiology. Currently he is the Program Coordinator of the Vector Control Program with the Ministry of Public Health. He previously served as a primary care provider and ran a CFHI training program for health promoters in Indigenous villages outside of Puyo. He enjoys guiding CFHI students as they learn about global health and taking part in experiences that shape their future careers. His hobbies include listening to music (especially songs his kids play on the keyboard), as well as traveling to nearby mountains and beaches.
Viviana Torres – CFHI Puyo Local Coordinator: Viviana has served CFHI since 2004. She is the wife of Dr. Torres and is the main student contact for cultural and travel matters while in Puyo. Viviana is originally from Guayaquil, Ecuador and is currently finishing her degree in Psychology and Human Resources from the University of San Francisco. She enjoys spending time with her family, listening to music, cooking, and since moving to Puyo she has gained a big appreciation for nature and spending time outdoors. She has a positive energy and is very approachable.
What Alumni Say
Please note that the program structure has recently changed. Participants will spend the first two weeks in the city of Guayaquil and not Quito.
“I just returned from our wonderful trip deep into the jungle of the Amazon and let me just say, it. was. not. real. I can’t even begin to tell you how incredible this journey was. Words definitely will not do it any justice..” read more on Jessica’s blog.
-- Jessica Valdez (Amazon Community and Indigenous Health Participant, October 2013)