Urban & Rural Comparative Health
Join a program spanning two distinct regions of one of the most bio-diverse countries in the world. Quito, located in the Andes Mountain Range and home to a more cosmopolitan and educated population is a stark contrast to Nanegalito, a small city in the tropical lowlands of Manabi province – about an hour from the Pacific coast. Visit both of these cities during the program and learn how resources, diseases, and access to care differ vastly within this diverse country. Come away from an understanding of how lifestyle, behavior, and environment influence urban and rural health outcomes.
In Quito, experience a range of clinical sites and services including government hospitals delivering higher-level diagnostic, specialized, and emergency care that is free of charge and accessible to all, as well as community level clinics on the outskirts of the city serving low-income populations. Other rotations include a public maternity hospital where high-risk pregnancies are managed, and a military hospital focusing on internal medicine and surgery.
Next, travel to the small rural town of Nanegalito, about 1.5 hours west of Quito. Although not far from Ecuador’s capital, students will experiece first hand the health challenges in clinical settings that represent the rural and urban divide in Ecuador. At the main local hospital, participants will join physicians in the the diagnosis and treatment of the most common diseases that are treated in a hospital: respiratory infections, parasitic infections, as well as tropical disease like dengue. Additionally, participante may also have the opportunity to join local health brigades to visit outlying communities, offering health advice and assisting with workshops.
Become immersed in Ecuadorian culture and language while living with local families in Quito and Nanegalito. CFHI participants may also organize weekend trips from Quito to destinations such as Tena in the Amazon region, known for its waterfalls and adventure sports like kayaking and zip lining, the town of Mindo and its subtropical forest, and Otovalo, an indigenous community with a bustling weekly market. From Nanegalito, travel to the popular coastal surfing towns of Montañita and Canoa.
Clinical Rotations & Public Health Placements
This program is divided up between multiple geographic areas within Ecuador.
Public Maternity Hospital- Located in the center of Quito, this public hospital of over 400 beds serves pregnant women of all ages from some of the poorest areas in the city. It is also a referral center for high-risk pregnancies and deliveries, and all services provided are free of charge. It is a teaching hospital for medical students and residents, with labor and delivery, emergency, outpatient, and inpatient ward for more complicated cases and post-partum care. Join healthcare teams for morning rounds, followed by rotations at one of the wards mentioned above. While rotating at the outpatient ward, take part in pre and postnatal check ups. This hospital is one of the busiest in the country, thus opportunities to witness C-sections as well as labor and delivery abound.
Government Primary Health Clinic- This small clinic serves low-income populations and is managed by a family medicine physician in a poor neighborhood in northern Quito. This public facility has a small emergency room, a dentist and a psychologist. Patients come to receive free services such as pediatrics and obstetrics care, preventative medicine and vaccinations. Clinic staff also conducts home visits for patients that cannot travel to the clinic.
Outpatient Obstetrics Rotation- A community clinic in northern Quito offering primary care, pediatric and obstetrics and gynecological services. This rotation focuses solely on obstetrics – join a local obstetrician providing free services to low and middle class patients. Take part in activities guided by preceptors such as prenatal check ups and general obstetrics consults which may include focused physical exams, differential diagnosis and discussing treatment options with patients. In addition, participate in home visits providing care to women on bed rest due to complications such as placenta previa.
Tertiary Care Hospital- With approximately 400 beds this facility provides services to military staff and families as well as civilians in the central part of Quito. Patients from all over Ecuador, are referred to this hospital to receive specialty care. Rotate alongside hospital staff within two of the busiest and most dynamic areas of the facility, the internal medicine and surgical wards.
Nonprofit Hospital- Founded by an Italian priest as a social services center for Quito’s poorest citizens, this outpatient hospital houses approximately 150 beds and over 25 specialties. Rotate within wards including surgery, pediatrics, OB/GYN, ambulatory care, and family medicine. In addition, the hospital runs a mobile medical unit, a school for developmentally disabled youth, two daycare centers, a legal services center, a microcredit institution, and social work department.
Indigenous Medicine Clinic- (This rotation is optional and must be requested.) This clinic is located in an indigenous town about an hour and a half outside of Quito. It serves patients from all over Ecuador and specializes in combining medicina naturalista or traditional medicine alongside western modalities. Witness Andean healers using herbal medicine and curanderos or spiritual healers who employ traditional diagnostic techniques.
Secondary Government Hospital - Hospital Nanegalito serves the town and surrounding areas. The hospital includes 15 hospital beds. The hospital also has a psychologist and a social worker on staff to deal with a wide variety of mental health and social problems. The hospital does not have an operating room; therefore, all serious emergencies usually have to be referred to Quito. Quito.serves as a referral hospital for 7 small primary healthcare clinics in more remote areas. Because the town sits right on the main highway between Quito and the coastal region, hospital staff are usually the first responders to traffic accidents. The hospital also has a community health program through which they run preventive health education campaigns such as; sexual and reproductive health, basic check ups at local schools and even vaccination programs.
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.
Quito is the capital of Ecuador, one of the most bio-diverse countries in the world. It was founded in the 16th century atop the ruins of an Incan city. Today, this modern metropolis boasts a diverse population of about two million people. As the capital and economic hub of the country it attracts migrants from rural areas - mostly indigenous groups, as well as immigrants from neighboring countries.
Quito is nestled in a valley within the Andes Mountain Range, surrounded by volcanoes and impressive peaks. At an elevation of 9,000 feet above sea level, it is considered one of the highest capitals in the world. Due to its close proximity to the equator, the climate is spring-like all year long, with warm days and cool nights. Quito’s historic center is one of the largest and least altered in the Americas and one of the first world cultural heritage sites declared by UNESCO in the 1970’s. As the nation’s capital, it is a lively urban center with dancing, dining, historical sites, shopping and museums.
Nanegalito is a stark contrast from Quito’s headlands, both culturally and ethically. Politically, Nanegalito is part of Mindo, a collection of rural parishes (Gualea, Nanegal, Nanegalito, Pacto). These rural parishes make up the Noroccidental Administrative Zone of Quito Canton, within Pichincha Province in the northern sierra region of Ecuador. Nanegalito is an extremely small town, consisting of just around 3000 inhabitants. Nanegalito has a rather pleasant climate, with temperatures never surpassing 70 degrees Fahrenheit, as well as high humidity and frequent rains.
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 Quito itself.
Within Quito, popular activities include visiting the “middle of the world” or the equatorial line, the famous Guayasamin art museum and home, and the historic city center. Quito is also served by various bus lines thus is an ideal jumping off point to see the rest of the country. Travel to the Amazon to hike, nature watch, and visit jungle communities. Closer to Quito and ideal for a day or weekend trip is Otavalo, a primarily indigenous town that has maintained its traditional way of life and is renown for its weekly market.
In Nanegalito, relax and take advantage of the slower pace of life. Enjoy yourself at the Hosteria Sumak Pakari, a down-to-earth hideaway featuring an informal restaurant, an outdoor pool & volleyball court. Or destress at the Yumbo Spa and Resort, a luxurious retreat in the heart of the evergreen cloud forest just a 90 minute drive from Quito and 1 hour from Mindo. Or explore the beautiful nature around you, at Bellavista Cloud Forest Lodge. The lodge is an amazing destination and a great place to visit on the way to the Galápagos. Sights of hummingbirds, beautiful plants and fog-covered valleys are guaranteed, and it’s been known to be able to get glimpse of even a toucan or monkey.
Participants stay with homestay families, chosen and screened by the CFHI Local Coordinator and language school. Homestays are located in a middle class residential neighborhood in the northern part of Quito. They are located in close proximity to one another and the language school, allowing participants to walk to language classes and meetings with ease. In Nanegalito CFHI uses one main homestay, a quick taxi or bike ride from the main hospital rotation. 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 who have a foundation in Spanish and have an interest in health and medicine in small town and rural settings. Non-students are also eligible. The program offers an overview of primary and secondary level care through visits within a hospital and primary care clinics, as well as Spanish language classes with an emphasis on medical Spanish. To confirm whether you're eligible to apply, please read CFHI's general eligibility requirements.
Minimum Language Required: Beginner 1 Spanish or Above
Beginner 1 Spanish: “I can speak a little and understand at times if people speak slowly and clearly.”
- I can understand and use familiar everyday expressions and simple phrases to get across basic needs.
- I can introduce others and myself. I can ask and answer questions for example where I live, people I know and things I have.
Leading this program on-site are our on-site partners (see Local Team tab), all of whom share Spanish as their native language, but may speak 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. This information will then be shared with the on-site partners. Most important is your general ability to communicate verbally with those around you and to be proactive in speaking Spanish, 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 Quito, 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 Quito with local CFHI representative
- Welcome orientation with other participants covering safety, transportation, and other logistics
- Spanish Classes: 35 hours/month of Spanish classes, including medical Spanish instruction and cultural activities
- Welcome dinner, city tour and cultural activities through language school
- CFHI Local Team: providing instruction, logistical support, and 24/7 emergency response
- Assistance with purchasing bus ticket to/from Quito to Nanegalito
- Weekly meetings and lectures on local healthcare system and socio-economic determinants of health
- Placement and coordination of clinical rotations/public health activities
- Accommodation, two meals a day, and laundry services once a week
- 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. Susana Alvear - CFHI Quito 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. Alvear is the expert on socioeconomic determinants of health in the region and healthcare delivery strategies in low-resource settings.
Dr. Alvear has served CFHI since 1996. She is an accomplished family physician who obtained her MD and specialty certificates in Ecuador. She then completed clinical education courses at the University of New Mexico and workshops at McGill University in Montreal, Canada. Dr. Alvear teaches at Pontificia Universidad Catolica del Peru, where she manages their residency program. Dr. Alvear has participated in several international trips providing healthcare services to countries after natural disasters stricken areas such as Pakistan and Ghana.
Rosita Tamayo - CFHI Quito Local Coordinator: The role of the local coordinator is to organize housing, transportation, orientation and weekly meetings. Rosita is a great resource for any questions related to navigating the program locale, cultural norms and tips on planning weekend travel.
Rosita has served CFHI since 1998. Rosita is co-founder and owner of the language school that CFHI participants attend and also regularly hosts CFHI students from in her home. She participated in an intercultural exchange as a young student, and lived the United States for a year. Rosita graduated from the Universidad Central del Ecuador with a degree in International Relations. Rosita has a passion for volunteerism and supporting underserved communities.
Dr. Matilde Diaz - CFHI Chone Main Preceptor: Dr. Diaz is the main supervising physician for the Chone portion of the program and the primary contact for CFHI students. She has worked with CFHI since 2004 and is originally from Cuba, though she has lived in Ecuador since 1977. She is a Pediatrician and received her degree from The University of Havana. She likes interacting with CFHI students and their enthusiasm for learning about the healthcare system and local culture. Her hobbies are reading, writing stories and going to the beach with her family including three kids.
What Alumni Say
"I worked with Dr. Sancho, who is a family care physician. It was really great to see a mix of pediatric and adult patients, as well as the variety of issues that come with primary care. I had a few new experiences this week, such as using a fetal stethoscope to listen to a fetal heartbeat, a skill that has been replaced by…” read more on Matt's blog.
-- Matt Riddle (Urban & Rural Comparative Health Program Participant, February-March 2013)