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Date: 2016-02-01
Title: Division and Collaborators Strategize to Address Mental Health Needs in Rural Ecuador

In January 2016, the Massachusetts General Hospital Chester M. Pierce, MD Division of Global Psychiatry staff (Drs. Gregory Fricchione and Carlos Fernandez-Robles and Jon Fricchione) and Boston Medical Center/Boston University School of Medicine partners (Drs. David Henderson and Nadia Quijije) visited Santo Domingo, Ecuador to discuss collaborating to identify and address the mental health knowledge gap among primary care physicians in Ecuador. While epidemiological data on mental health needs are limited, mental health service availability has been evaluated. Indigenous people in rural areas are disproportionately affected by the limited population of psychiatrists centered mostly in large cities like Quito. In the smaller city of Santo Domingo, at the western gateway of winding mountain roads to the capital city, trained primary care physicians may help improve rural access to mental health care.

Drs. Diego Herrera and David Gaus welcomed Drs. Henderson, Fricchione, Quijije and Fernandez-Robles to Hesburgh Hospital, a high school transformed into a medical facility in Santo Domingo. A relatively new, rural teaching hospital, Hesburgh has a robust infrastructure for diagnostics and training as well as established residency training programs. It provides services to the population that are otherwise nearly unavailable, like palliative care.

During the discussions which took place over two days, the Ecuadorean doctors discussed their observations treating mental illness in Santo Domingo and engaged their guests in discussions about means of illuminating their population’s needs beyond the sheer need for rural psychiatric services. Most excitingly, the sides agreed on the necessity of quantitative and qualitative studies to better understand the mental health needs of their population. Plans were made to implement mixed method research collaborations with Ecuadorean physicians using qualitative interviews to develop culturally appropriate survey instruments. Eventually, quantitative studies on mental illnesses within the population will hopefully provide physicians with the information and context they need to provide more equitable mental health care to the rural population.

In addition to agreeing on a research plan, the group also planned to implement a training partnership through which Drs. Quijije and Fernandez-Robles–under the guidance of Dr. Fricchione–would devise a neurological and psychiatric training curriculum for Ecuadorean physicians. Under consideration for this training plan are regular, case-based teleconference seminars and supervision for physicians, podcasts, team visits, as well as Massachusetts General Hospital and BMC grand rounds. In the long run, the collaboration hopes to develop a psychiatry residency program in Santo Domingo.

The visit left both groups feeling very optimistic about the prospects of this collaboration. While challenges inevitably arise when building partnerships such as this, the team believes this to be an exceptional opportunity to identify and serve the mental health needs of a rural population with limited access.