We are currently focusing on supporting our community partners and local health care workers in responding to the COVID-19 pandemic in both Mali and Ecuador.
Though our ongoing health care program in Ecuador, The Tandana Foundation aims to improve rural community members’ access to health care and support local rural health professionals in caring for the residents of their areas. Tandana’s health care work has two stages: community visits by groups that include volunteers and extensive follow up after these visits. We also support the local health centers with particular needs, such as a nutritional garden, supplies, and activities for their health clubs.
Our community visits are made possible through our Health Care Volunteer Venture program twice a year and by custom programs we coordinate for hospitals or medical schools when possible. Volunteers including doctors, P.A.s, dentists, nurses, physical therapists, and willing assistants sign up for these programs and spend one or two weeks in Ecuador. Together with Tandana staff and local professionals including interpreters, these groups visit various communities in the canton of Otavalo. We coordinate with the Ecuadorian Consulates in the United States, the Ministry of Public Health, the Quinchinche and Gualsaqui Subcentros, and the Union of Kichwa Otavalo and Rural Communities of Quichinche. We have provided over 12,000 patient visits since we began the program in 2007.
Our Health Care Volunteer Venture groups work mostly in communities pertaining to the Quichinche and Gualsaqui Subcentros (rural health centers). We collaborate with Subcentro staff to visit the more distant communities that are served by their center. The Subcentro staff are mandated to visit these communities regularly, but are given no funding to do so and have very limited supplies of medications. With Tandana’s help, they are able to fulfill their mission of providing care in these distant communities, from which access to the Subcentro is difficult.
When patients arrive at the school, community center, or health center where we are working, Tandana staff and volunteers take their names, ask basic questions, and take vitals, preparing them to see the health care providers. The providers examine the patients, make diagnoses, and prescribe medications from our portable pharmacy. We ask a contribution of $1 per family for the medications in order to promote valuation of the medicines and avoid creating dependency. Following the providers' recommendations, a nurse or other volunteer performs basic laboratory tests, such as those for h. Pylori, urinalysis, pregnancy, and streptococcus, and does ear cleanings as necessary. We are also able to do ultrasounds during our visits. Our providers fill out referral forms for any patients they feel need additional care, tests, or specialists.
During our community visits, we can also address dental, vision, pediatric, and preventative care needs. Local and visiting dentists use our portable dental equipment to fill cavities, extract teeth, and do preventative treatments such as sealants and fluoride. For vision complaints, we conduct vision screening, provide reading glasses to those who need them, and refer those who require more specialized diagnosis and treatment to Fundacion Vista Para Todos. At schools, we weigh and measure the children, a nurse or doctor listens to their hearts and lungs, and we provide parasite medication if the children have not received it within 6 months of our visit.
For all of these services, we keep records in our Electronic Medical Records system so that as patients return for subsequent community visits, we have their history accessible.
The Tandana Foundation is committed to providing culturally- and individually- respectful care. Volunteers receive an orientation including an introduction to the local culture and a discussion of the cross-cultural aspects of our work. Our team always includes at least one fluent Kichwa speaker, and we take the time to listen to patients fully even while trying to be efficient so that we can see as many patients as possible. We promote a spirit of collaboration with local health care options, including both professionals in Western medicine and traditional healers such as shamans and yachaks. We see our work as complementary rather than contradictory to that of traditional healers, and we make efforts to meet with, discuss with, and learn from local individuals with these specialties.
The second phase of our health care work begins after the visits to the communities have taken place. Tandana's Patient Follow Up Coordinator and interns review the referral forms and make a plan for where each of the patients needs to go. Staff communicate with the patients and advocate for them in the public health system. It is our goal that, through this process, patients learn how to use the system on their own.
Through many appointments, first at the rural health center, then at the hospital, and sometimes at specialized hospitals in the capital city of Quito or with other organizations such as Vista Para Todos or the Lions Club, patients access the care they need. Whether they need lab tests, specialists, surgeries, or eyeglasses, our Patient Follow Up Coordinator works tirelessly to help them access the resources that are available. We work primarily with the Ministry of Health, and also with other foundations and private options when the public system does not offer what a patient needs.
Unfortunately, access to health services is very difficult for people living in rural communities for the following reasons:
Communication gaps among the different levels of care
Difficulty scheduling appointments and long wait times
Cultural differences, language barriers, and racism
Our staff work with patients to navigate and overcome these challenges so that they can benefit from the services to which they are entitled as citizens of Ecuador and improve their health. Our goal is to ensure that once patients are on track and learn how to navigate the health system, from that point forward they are able to take advantage of its resources on their own.
Work is starting on the construction of the new health center in Sal, Mali, thanks to a generous gift from Kitty and Dick Rosenthal. Here is a photo of the site for the new health center, which will serve about 9,000 people, who currently have to travel long distances over rough tracks to access health care. The residents of Sal have completed breaking the stones for the foundations of the five buildings, and the contractor is transporting the sand and gravel needed for the construction.
In a project combining health care and gardening, The Tandana Foundation collaborated with the rural health center in Quichinche, Ecuador to plant a vegetable and medicinal plant garden. In 2017 a visiting group of gardeners worked alongside the nurses to clear the garden, weed the beds, and plant 150 new seeds. Later in the same year another group of gardeners worked alongside staff from the health center to weed the garden and plant 60 more medicinal plants. The vegetables are used to teach the pregnant mothers' club new ideas for nutritional diets. The medicinal plants, such as oregano and lemongrass, are used to make soothing teas as well as to support a nutritious diet.
Each rural health center has an elders club to promote health through keeping people active. The one in Gualsaqui, Ecuador is called Segunda Juventud (Second Youth). They love to go on outings but can't raise enough money for the trips. They asked Tandana for support and we helped pay for their trip to go visit the Zoo in Guayllabamba.
The health center in Quichinche has a room where club meetings are held for pregnant mothers and elders as well as where staff teach students about nutrition and other subjects. The staff asked Tandana to help fix up this space with tile, a sink, and glass for the windows. Now, they have a much cleaner and more comfortable environment for dance therapy classes, nutritional cooking demonstrations, and all kinds of meetings.
In Mali, we are helping our partner communities, who have no access to running water and limited access to public health information, limit the spread of COVID-19. Our team has done hundreds of education sessions on preventing the spread of coronavirus and distributed dozens of hand wash stations to make it more practical to follow health guidelines. We are also supporting a hospital and local health centers with supplies they need to care for their patients.
So far, we have:
● Provided supplies and PPE for 5 health centers and the local hospital
● Hosted 530 education sessions in 112 villages on preventing the spread of the virus
● Provided 5 small hand wash setups for women's associations, families, and other groups
● Distributed 700 masks
● Produced and broadcast a radio program about preventing the spread of COVID-19
In Ecuador, strict distancing measures have strained the ability of some community members to access food and medicine and exacerbated educational inequalities as school has gone online. We are supporting health center staff with supplies and transportation so that they can visit patients in the communities and deliver needed medications. We are supporting our scholarship students with additional expenses as they resourcefully access the internet from their mountain communities to keep up with assignments.
So far, we have:
