I hold a special place in my heart for Ecuador. Cheesy but true. Whenever I find an organization doing health or development work there I try to highlight them here. I first learned about Andean Health and Development after my return to the States and was a bit bummed that I didn’t get to see this organization in action. What makes Andean Health unique is that they are a social enterprise making great strides. I had the great pleasure of learning more from Laura Dries, the Director of U.S. Operations, which I share below.
1- Please introduce Andean Health and Development. What is the mission of the organization and how did it get started?
Andean Health & Development, or AHD, started when Dr. David Gaus volunteered in Ecuador and wanted to make a difference for the disenfranchised people he saw in the countryside. He saw families sleeping on cardboard boxes outside of the public hospital hoping to be first in line the next day. He met women who had nearly died on the long trek to the city when they had complications during child-birth. And he heard about children in the countryside dying from relatively easy to treat issues, like snake bites or pneumonia.
His dream started as a makeshift one-room clinic in a small town and over the past 15 years it unfolded into a model for health care that can systemically change the way medical services are delivered in Latin America.
In 2000, David, with the help from friends and his mentor, then president of Notre Dame, Fr. Theodore Hesburgh, built an all-out hospital in the community of Pedro Vicente Maldonado. In 2007, the hospital became financially self-sustaining thanks to public-private partnerships with Ecuador’s Social Security Administration and the local municipality. The hospital is locally staffed and even has a physician residency and nurse training program for Ecuador’s docs and nurses. Residents and nursing students enroll in the program through a partnership AHD has with two local universities.
The hospital has been so successful in providing comprehensive secondary care — hospital care — to a population otherwise isolated from health services, while maintaining financial break-even, that AHD is expanding into another community: Santo Domingo, Ecuador.
The new facility will be a 40-bed hospital, a larger physician residency and nurse training center, and a global health research center. Its construction in Santo Domingo is planned for 2012.
2- Please introduce yourself and your role at the organization.
I am the Director of U.S. Operations, which means that I help transfer the efforts of those in the US — donors, volunteers, universities, researchers, Board members — into the field in Ecuador. My main concern right now is raising 3 and a half million dollars to get this Santo Domingo project off the ground. The easy part about the fund-raising is knowing that the hospital will cover its own expenses within its first year thanks to this innovative hospital model that AHD developed.
3- What makes Andean Health different from other organizations?
Andean Health is very different because we not only recognize the grave need for health care for those on the ground now, but we’ve also established a model for long-term sustainability.
First, sustainability is possible because our hospital is locally staffed. We work in the community with the community to help its residents for the long-term.
Second, we concentrate on health care’s greatest asset — human resources. We train Ecuador’s docs and nurses to be tomorrow’s leaders in rural health. We have partnerships with local universities in Ecuador and train health professionals in modern medicine in the rural and cultural context.
Finally, our model emphasizes financial self-sustainability. This means that, monthly revenues cover the monthly hospital costs. The hospital accepts payments from the Social Security Administration on a service-rendered basis or small patient fees-for-service. Those who do not have SS insurance, which by the way is different from SS in the US, or cannot afford services, still receive the hospital care they need. This financial set-up means that the hospital will be around for the long haul. Its survival is not forever dependent on donations from the US or elsewhere.
I should also mention that the quality of the care is outstanding thanks to the training program, electronic medical records and many generous equipment donations from the US! AHD has served over 400,000 children and adults.
4- What do you think has been the reason behind the organization’s success?
David Gaus, a social entrepreneur through and through, witnessed an important void in health care in Ecuador in the late ’90s. He just had received a fresh dose of public health training at Tulane and he went back down to Ecuador thinking that primary care — vaccinations, health education, outpatients — was the country’s principal need. He learned from the community, however, that what they really needed was somewhere to go, say, if they got into an accident or got pneumonia.
Ecuador’s Ministry of Health already had done a fairly good job of addressing primary health care needs since the Alma Ata Proclamation. At that point, the community needed a more sophisticated infrastructure for health care. When young Dr. Gaus was giving public health education classes about disease prevention, people would raise their hands and ask “well that sounds good but where should I go when I go into labor?”
5- What has your most rewarding experience been so far with Andean Health?
My most rewarding experience was in Hospital Pedro Vicente Maldonado when I spoke with a family in the waiting room. Their two year old was suffering from serious asthma and seemed to be breathing a mile a minute. While we waited for the doctor to give us word on the baby’s condition, we spoke about the hospital. The father told me that they felt amazed that a modern hospital like this showed up in their community. They feel safe everyday knowing that it’s here. I asked a little bit about their lives… they work on a farm nearby and received “seguro campesino” which is insurance from Social Security. Thankfully, they were able to use that insurance for their son’s care at this hospital and didn’t have to travel three hours to Quito, the capital. They told me that even if they went all the way to Quito, they might be turned away because they didn’t have an appointment. The ERs were constantly packed and understaffed.
Finally, the doctor — one of the many wonderful residents in training – told us the good news that the baby was doing fine and would be able to go home the next day. We all felt relieved and they went in to visit their son. The next day I ran into them again when they were bringing bread and candy to their doctor!
6- One of your founders, Dr. David Gaus won Social Entrepreneurship Award from the Schwab Foundation earlier this year. What do you think are some advantages and challenges of being a self-sustaining social venture?
Yes, that was such great news that Dr. Gaus won that award. What an honor!
I already told you a bit about the advantages of self-sustainability. AHD created this model to transform health care in Ecuador’s countryside, and someday we’d like to export it to other countries in Latin America. This will require a lot of careful effort: continuing to establish and foster relationships with local governments, universities, and institutions and listening to those living in each community.
It is a challenge, of course! We constantly need to see the big picture with every decision we make in the short-term. We constantly ask ourselves: What is the best use of our limited resources? How can we make the largest impact for the greatest number of people and their families for the long-term? Sometimes that means doing research in the field and partnering with universities or consulting experts in medicine and public health. These big-picture-projects take time and patience even though we just want to save the world RIGHT NOW!
7- Are there any new projects we should be on look out for?
There is never a dull moment with Andean Health. The biggest project is planning the new facility in Santo Domingo which I mentioned before. It will be very exciting to replicate this innovative model in a new location.
There are other projects in the works also. Our founder, Dr. Gaus, is writing a book along with his friend from Notre Dame…think Mountains Beyond Mountains meets Three Cups of Tea. It should be really interesting for everyone to read about this once-accountant from Wisconsin who moved to Ecuador to change the world as a doctor and hospitalist!
8- Where can people learn more and/or support Andean Health?
Our website is www.andeanhealth.org, where there is an email newsletter opt-in. We have a Facebook Cause and Twitter feed as well:
http://www.causes.com/causes/346545?recruiter_id=47597046
and http://twitter.com/AndeanHealth
Anyone is always welcome to contact me about questions or updates: laura.dries@andeanhealth.org.
