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Ecuador

Cultural Understanding For Optimal Nursing Care

Approximately 18,000 Ecuadorians have immigrated and live within Canadian borders. A majority of these people are settled within the province of Ontario. Provision of nursing care of the Canadian Ecuadorian can be improved with a basic understanding of the people, their history, their cultural and spiritual beliefs, their economy, and so forth. As well, this understanding would be prove valuable for the nurse wishing to work abroad and considering the South American nation of Ecuador.

Ecuador: Caring For It’s People

Ecuador: Official National Symbols

God, Homeland and Liberty

Ecuador: The Geography

• In 1830, Ecuador derived it’s name from the Spanish word for the equator, which crosses it’s entire northern sector.• Ecuador has three mainland regions: the

Coast, the Sierra, and the Amazonia, or the Oriente. It measures approximately 109,493 square miles, or 283,600 square kilometers. • Ecuador is located in western South America

and is the second smallest South American nation. It shares borders wit Colombia to the north, Peru to the east and south, and it’s western region along the South Pacific Ocean.• Ecuador also includes the Galapagos Islands in

the Pacific Ocean, approximately 1000 kilometers west of the mainland.• The landscape of Ecuador is variant and

includes tropical rainforests, wet-dry monsoon regions, snow-capped volcanic mountains, and rich, fertile valleys.

• Ecuador’s economy is the eighth largest in Latin America, with an average growth of 4.6% between 2000-2006, yet it remains one of the poorest nations.

• Oil accounts for 40% of exports and is a major contributor to a positive trade balance.

• Ecuador exports bananas, flowers, and cocoa. Productions of shrimp, sugar cane, rice, cotton, corn, palm, and coffee are also significant.

• Ecuador has potential for economic growth in raw materials, manufactured textiles, mining, oil, petrochemical, chemical, glass, pharmaceutical, and timber industries.

• The official currency of Ecuador is the U.S. dollar.• Despite current economic opportunities, many

indigenous people continue to follow traditional lifestyles.

• It is estimated that 55% of Ecuador’s indigenous population lives in poverty, with 28.6% living below the poverty line.

• The extreme poverty rate was estimated o be 17.4% of the total population in 2011.

• It is believed that over 300,000 children are working as child laborers in Ecuador.

• Ecuador has a per capita income of $5, 820.

Ecuador: The Economy

• Ecuador has an approximate population of 15, 223, 680 people.

• The major coastal city of Guayaquil accounts for nearly 4,000,000 people, while the capital city of Quito contains approximately 2,000,000 of the nations residents.

• All other residents reside within other smaller city centers, coastal villages, and indigenous communities.

• The people of Ecuador are divided into ethnic groupings, represented by the following terms: Mestizos, Montubios, Afroecuatorianos (Blacks), Indigenas (Amerindian), Blancos (White), and Other.

Ecuador: The People

Whites and Mestizos:• Most privileged ethnic groups representing the top of

Ecuador’s social pyramid.• Descendants from Spain, Italy, France, Germany, and

Lebanon.• Generally successful and employed as high-status

professionals, merchants, government officials, and financiers.

• While both Whites and Mestizos share many commonalities, Mestizos are generally viewed as being slightly inferior to Whites within a social hierarchy.

Blacks:• Descendants of African slaves who worked on coastal sugar

plantations in the 16th century.• Earn their livelihood in agriculture, general labor, fishing, and

working on cargo boats.• Hold a slightly higher position in the ethnic hierarchy than

other indigenous peoples.• Light-skinned blacks receive more opportunity than dark-

skinned blacks, simply because of a more similar resemblance to Whites and Mestizos.

Ecuador: Ethnicity And Social Class Defined

Sierra Indians:• Live in the intermountain valleys of the Andes and are

separated from whites and mestizos by a caste like gulf.

• Sierra Indians are usually poor and often illiterate. Most often, Whites and Mestizos view Sierra Indians as inferior.

• Visible markers of ethnicity (for example, hairstyle) separate Sierra Indians from the general population.

• Speak with indigenous language (Quichua), but may also be fluent in Spanish.

Oriente Indians:• Early indigenous people of the Amazonic region.• Speak with two main indigenous languages, Quichua

and Jivaroan. May also be fluent in Spanish.• Maintain similar social status as the Sierra Indians

within Ecuadorian culture.• Oriente Indians view themselves as separate than

other Indian groups, but quickly join ranks when common causes arise.

The people ofEcuador takegreat pride inbeing called‘Ecuadorian’.They insist, andmake it clear thatidentification as‘Ecuadorian’ is for all it’s people.It is not only for the elite and upper-middleclasses.

• Within Ecuador, there is a great importance placed on the family, both extended and nuclear.

• The basic domestic unit focuses on the mother as being both the nurturer and household manager, while the father provides both financial and legal responsibility. This system exists in all of Ecuador’s cultures and class levels.

• Men attempt to keep their nuclear and extended families near them. Elderly Ecuadorians will often live with their children until death.

• Godparents are quite important in Ecuador and often are expected to provide financial support to their godchild.

• Families are formalized in one of two ways: Civil Marriage or Free Union. Civil Marriage is a legal process which all married couples are required to undergo. Free Union is simply when a man and woman decide to form a family without a legal process. Regardless of their differences, Ecuadorian Constitution provides both family structures with equal rights.

• Children are cherished immensely in Ecuadorian culture. They are raised to appreciate respect to all people, their community, their country, and to God.

• Homosexual activity is legal in Ecuador, but same-sex couples are not granted all of the same legal protections as heterosexual couples. Child adoption is not granted to homosexual couples, but there are no laws denying a single person the opportunity to adopt.

Ecuador: The Family

• Woman make up a considerable segment of the workforce, especially in the areas of finance, university teaching/research, and NGOs. They are involved in political and government roles, including indigenous and Afroecuadorian rights and movements.

• Gender roles vary immensely across ethnicities and classes, ranging from equal status to male-dominated ideals.

• Through time, woman have gained significant legal rights over their property and children within the court setting.

• Woman in rural areas are traditionally held responsible for the care of their husband and children, however, with more woman joining the workforce, these roles are slowly changing. Men are increasingly choosing to take on domestic roles.

• Girls tend to be more protected than boys within traditional family settings.

• Within indigenous communities, tradition prevails as identifying the woman as the domestic caregiver within the family unit and the man as the provider of the physical necessities of life.

Ecuador: Gender Roles And Statuses

• Ecuadorian Constitution requires that children attend an educational institution until they attain a “basic level of education”, which is estimated at nine school years.

• In 1996, the primary school enrollment rate was estimated to be 96.9%, with 71.8% of those children staying in school until the fifth grade.

• The financial cost of primary and secondary education is the responsibility of the government. However, families are often burdened with significant additional expenses (for example, transportation cost).

• The number of quality public schools needed in relation to the population falls below minimal requirements. Class sizes are very large and families often find it necessary to pay for a more adequate education, despite their financial means.

• Only 10% of children in rural areas proceed to high school.

• The mean number of educational years actually completed by Ecuadorians is 6.7.

• Ecuador has sixty-one universities and three hundred institutes of higher education.

Ecuador: Education

• Catholicism is the primary religious following in Ecuador, although other religions exist.

• According to the Ecuadorian National Institute of Statistics and Census, the breakdown in spiritual belief is as follows:

80.44% Catholics 11.30% Protestants 1.29% Jehovah’s Witnesses 6.97% Other• 7.9% of the Ecuadorian population is believed to

be Atheist, while 0.11% are presumed Agnostic.

Ecuador: Spirituality

• Food preparation in Ecuador is diverse, varying with associated agricultural availability, and altitude.

• There are several Ecuadorian meals that are typical to the various regions of the country. For example, a popular dish on the coast is ceviche. This is a meal prepared with seafood marinated in lime juice, served with cassava bread. Conversely, people of the mountainous regions prefer meat (particularly guinea pig), potatoes, rice, and white hominy.

• Most regions in Ecuador follow a traditional three course meal of sopa (soup), segundo (second dish; usually includes rice and protein source), and dessert with coffee.

• Drinkable yogurt is very popular in Ecuador, often consumed with pan de yuca (warm bread filled with cheese).

• A wide variety of fresh fruits are often available, especially at lower altitudes.

• Religious influence will sometimes determine food preparation and consumption in Ecuador. For example, Fanesca ( a fish and bean soup) is often eaten by Catholics during Lent and Easter.

• Despite the availability of food across the nation, 25.8% of Ecuadorians suffer from malnutrition due to a variety of political, geographical, and economic factors.

Ecuador: The Food

• The Ecuadorian Ministry of Public health strives to provide social support and healthcare services to all populations within it’s national boarders.

• Patients may be seen daily in public general hospitals by general practitioners without a scheduled appointment.

• There is also ‘external consultation’ available for the following disciplines: pediatrics, gynecology, clinical medicine, and surgery.

• Specialty hospitals are available and part of the public health care system. There are ontological hospitals for cancer patients, psychiatric hospitals, gynecological/maternity hospitals, children’s hospitals, geriatric hospitals, and so on.

• Major cities have modern, fully equipped general hospitals, while smaller villages and canton cities generally are limited to basic care in gynecology, pediatrics, clinical medicine, and surgery.

• Community healthcare centers are available within the cities and rural areas for patients requiring a short stay less than 24 hours.

• Most rural communities with a large indigenous population have a ‘rural doctor’ assigned to them. These physicians run small clinics to meet the health needs of the people in the same manner a day hospital would in a metropolitan area. Respect for the culture of the people is considered a critical component of care given.

• Public healthcare does differ from the Ecuadorian Social Security healthcare service. This health service is for individuals with formal employment obliged by their employer to contribute. People without formal employment can become part of this system, but it is often unaffordable. The Ecuadorian Institute of Social Security (IESS) has several major hospitals and institutions throughout the nation.

Ecuador: Healthcare Service Positives

• Despite attempts to have equal access to healthcare across the nation of Ecuador, the combination of 40+ indigenous groups, their languages, and their remote geographic locations have made this endeavor quite difficult.

• Ecuador’s poorest (those living in Amazonia, central provinces, and urban shantytowns) receive no medical treatment from the two main public sources: the Public Health Ministry and the Social Security Institute.

• It is estimated that as much as 30% of Ecuadorian people lack immediate access to healthcare services.

• It has also been suggested that as many as 70% of the population are without health insurance and cannot afford to pay for medical services.

• Many indigenous people have to rely on traditional medicine and aide from NGO’s and volunteers.

Ecuador: Healthcare Service Negatives

• Due to environmental conditions, unavailability of healthcare services, and environmental conditions, Ecuadorians are at risk for many diseases.

• Some of the more common health problems in Ecuador are malnutrition, health problems due to smoking, diabetes, heart disease, HIV/AIDS, tuberculosis, malaria, dengue fever, diarrhetic disease, acute respiratory infection, and infant mortality.

• There are an estimated 14, 000 new cases of tuberculosis each year.• Growth retardation from malnutrition affects 26% of children under the

age of 5. • There are approximately 686 malaria cases amongst every 100,000

people.• Infant mortality is estimated to be 24 per 1000 live births.• Life expectancy at birth is 78 years. • Rates of malnutrition are worse for indigenous people, with

Afroecuadorian being at highest risk.• Different geographical regions also present with unique health risks. For

example, lack of oxygen in the Andes because of high altitudes place people at high risk for altitude sickness.

• In the Amazon, diseases like malaria and yellow fever are prevalent due to transfer of disease through mosquitos. Deforestation in this area has increased breeding grounds for mosquitos and, in turn, has resulted in more cases of insect borne diseases.

• In Ecuador, only 21.9% of households have access to clean drinking water. Only 5% of wastewater is treated and less then half of households have sewer systems. Therefore, water borne diseases , like cholera, can be transferred easily.

• Air pollution is high in Ecuador and result in many respiratory and air-born illnesses. As well, there has been an increase in the number of illnesses caused by the uses of agricultural pesticides and chemicals.

Ecuador: Health Risks

• As with any persons of immigration, always consider the influence of their particular culture when providing care.

• Something as simple as a proper initial greeting can influence a relationship. For example, Ecuadorians prefer a smile, a handshake, and direct eye contact when communicating. They are comfortable with close body proximity during conversation. However, only close friends or family will commonly use their first name.

• Ecuadorians are known to be polite and highly tuned to body language and non-verbal communication.

• Ecuadorians view blunt communication as rude and generally speak with courtesy. They are non-confrontational and will generally say what they think will please a person.

• The family is a critical unit within Ecuadorian culture and often, health care decisions are decided by this entire unit.

• Spirituality is also highly regarded within Ecuadorian culture. Health, nutrition, and other personal practices can often be determined by religious beliefs, keeping in mind the majority of Ecuadorians are Roman Catholic.

• Indigenous background and an understanding of how different cultures live and view each other is also highly important when caring for the Ecuadorian person. Ecuador has a vast number of unique cultures and a cemented view on social ranking.

Canadian Ecuadorians: Nursing Considerations

• Serious consideration of the Ecuadorian’s health care history and a knowledge of culturally associated risks and exposures is critical when providing healthcare to the individual. Knowledge of immunization records, if they exist, is quite beneficial.

• Consider the many languages and dialects of the Ecuadorian culture and the potential for communication struggles and the need for an interpreter.

• With knowledge of the extreme levels of poverty within Ecuador, understanding the environment from which an individual has come from can produce many clues regarding current health status and risks.

• Knowledge of the Ecuadorian’s education level may prove useful, as well, in providing appropriate health teaching, particularly knowing that Ecuador has many struggles with it’s education provision.

• In essence, always remain culturally sensitive when providing care for the Ecuadorian, or any person in general. Maintaining respect and good communication with all individuals will help to ensure optimal health care is delivered.

“Knowledge is power? No. Knowledge on it’s own is nothing, but the application of useful knowledge, now that is powerful.” – Robert Liano