The People's Health Movement
(PHM)
Analysis of the activities of MSP in Ecuador
Movimiento para la
Salud de los Pueblos
- Latinoamerica ■
The Peoples Health Movement (PHM)
Analysis of the activities of MSP in Ecuador
Author: Juergen Kraus
Review and edition:
Equipo ComunicandoNOS (Jorge Quizhpe)
Jorge Parra - Erika Arteaga
Arturo Quizhpe
Photos: File MSP Ecuador - Equipo ComunicandoNOS
Design and layout: Equipo ComunicandoNOS (Silvina Alessio)
Copyleft: The images, text and design of this book are the property dela humanity,
such as ancient wisdom, love, food, water and air, and can be
used freely, in its context and citing the source.
English translation
Enma Mora
Erika Arteaga
French translation:
Dominique Gomis
Remy Bourdillom
Cuenca - Ecuador May 201 1
medico international
($frlu({yfrrfr tofyl M tvfyiS, Piker a,!
M.S.P - Latinoamerica
Contact:
Telefono: + 593 7 2841865
www.phmovement.org
msplatinoamerica@gmail.com
Cuenca - Ecuador
Frente Nacional
por la Salud
de I05 Pueblos
del Ecuador
The author Juergen Kraus -a German political specialist- was in Ecuador for two months in 201 0. He visited members
of social organizations, activists and MSP-E structures in Cuenca, Guayaquil, Riobamba and Quito. He also attended
various activities of the anti-mining movement. With the aid of interviews conducted with activists and represen-
tatives of MSP-E and other social organizations, and by analyzing several previous publications of the MSP- E, the
author tries to portray a synopsis of the current situation and ongoing work of MSP Ecuador.
The author hopes the following summary will bring attention from the People's Health Movement global network
and will promote the exchange of information between different countries where the Right to Health and Health
Care Campaign is currently ongoing. Juergen Krauss wants to contribute to strengthen MSP structures and hopes
the information presented herein will prove useful to people from different sectors working in health in order for
them to learn more about MSP-E and to support its work. This material can also prove useful as an example on how
to collect similar information in other countries where struggles towards Health for All are taking place.
la
I INTRODUCTION
c
Savar - Bangladesh and Cuenca - Ecuador were two very important places in the genesis and deve-
^^^m lopmentof the People's Health Movement. The People's Charter for Health adopted and ratified at
these events, is a major strategic, programmatic and political tool that calls different social actors to
struggle for health as afundamental human right.
Cuenca 's Declaration establishes "The right to health will be achieved through large
scale popular mobilization. PHM will initiate or support struggles related to
the right to water, food security and food sovereignty, a healthy environment, dignified
work, safe housing, universal education and gender equity, since people's health depends onthe fulfillment of these
basic rights."
In this context and considering this momentum, in 2004, the National Front for the People's Health - Ecuador (FNS-
PE) was started. FNSPE was constituted by "community and neighborhood leaders, housewives,health workers,
teachers, students, and health professionals". Its purpose was the development of proposalsto restore and reaffirm
the universal right to health in the Ecuadorian context. FNSPE also sought to share experiences and engage with va-
rious social movements with a common vision of change and with themission to contribute to social transformation.
In this social transformation "the community is no longer the object and becomes the subject and social actor, ca-
pable of deliberation in the formulation of policies andcapable to make decisions regarding their health problems"
In his work, Juergen Krauss, summarizes PHM Ecuador's work, starting from the Second People's HealthAssembly.
This is an Important and well-done accomplishement, in a country of great social and political conflicts that has
confronted both: the organised popular movement on one side and the capital forces of both domestic and exter-
nal origin, engaged in the implementation of neoliberal policies, on the other. This is astage in which the desire for
change is expressed in the struggle for change; it is a period of achievements in the development of the political
consciousness of Ecuador's peoples who seek for alternatives in progressive proposals and who seek to reaffirm
their struggle for deeper changes, even when such struggles have been betrayed by Rafael Correa's government.
People 's Health Movement - Ecuador I 5
In this context, the aforementioned research describes the events in the construction of the FNSPE, its strengths
and weaknesses, its limits and political and organizational potentials. It also details valuable initiatives and actions
developed by PHM Ecuador, such as having Health as a Human Right included in the New Constitution and the
conformation of ReAct Latin America (Action against Bacterial Resistance) by theFaculty of Medical Sciences of the
University of Cuenca.
The struggle for Health as a Human Right, even when included in the New Constitution, is a continuous struggle for
PHM Ecuador.
The following pages also collect the experiences of the Peasants Social Insurance, the FEUNASSC as an organization
that defends the right to health of the Peasants Social Insurance members; the work of thelntercultural Coordina-
ting Committee towards people's health and social participation and initiatives such asthe Health Action Network
initiated in the Universidad Andina Simon Bolivar. A recent action with great social and political relevance is the anti
mining struggle that takes place in the South of the country. PHM and FNSPE have provided important support in
the resistance against mining.
Among the challenges identified by the current work, the need for a new agenda for PHM Ecuador given the new
context characterized by the government's lack of political will and the need to develop new strategiesfor streng-
thening the organizational structure of FNSPE, are the most important.
Undoubtedly, this analysis will
Undoubtedly, this analysis will be very useful for all the social sectors involved in the health field and willcontribute
to the overall strengthening of the People's Health Movement.
RamiroVinueza Puente
Director of the newspaper "Opinion".
I People '.
FOCUS OF THE ANALYSIS
f
he People's Health Movement (PHM) -or Movimiento por la Salud de los Pueblos (MSP)- is a global
network constituted by different social movements in the area of politics in health.
The common goal is the acknowledgement of health as a human right. To pursue this right, various regional and
global activities are organized to improve access to health care services and to reinforce the demands at the political
level for an integral health and for social determinants of health.
The following text is an analysis of the structures of MSP-E, and offers an example on how the network is functioning
at the national level. Ecuador hosted the Second People's Health Assembly in 2005. It was an important meeting for
the process of the global network and for MSP in Ecuador.
With the Assembly as the initial point, the analysis looks at the activities of MSP-Ecuador, the different campaigns
of its social organizations and the relationship between the network and its collaborating movements. Logically,
MSP work depends on national politics' scenario and the structure of health services countrywide. This justifies the
analysis of MSP within a framework of central political processes. Moreover, the analysis illustrates the problems that
MSP faces in order to establish permanent structures and continuous activities.
People 's Health Movement - Ecuador | 7
s Health Movement - Ecuador
The Peoples of the World ended the neoliberal tale
Cuenca's Assembly became a universal meeting of all the ways of solidarity, com-
passion and struggle. Added to the richness that allowed us to share many and
varied ways of organization; the possibility of closely experiencing the beauty of
different cultures expressed in this event; to attend the meeting meant for us, a re-
loading of batteries, a global demonstration that the rebel spirit and the collective
conscience have not died; that we are leaving behind us the silence of our peoples
that in the nineties seemed to have settled with the injustices done to their health
and their rights.
(Jaime Breith. Center for Studies and Advisory in Healht. CEAS. Pg 8-9. Voices of the
Earth . Cuenca-Ecuador. January 2007.
THE SECOND
PEOPLES HEALTH
ASSEMBLY:
AN OPPORTUNITY TO GROW
AND TO LEAR N FROM OUR
OWN EXPERIENCE.
^T
rom July 1 7th to 22nd, 2005, more than a thousand delegates of the global network Movimien-
to por la Salud de los Pueblos (MSP) met in the Faculty of Medical Sciences at the University
of Cuenca, during the Second People's Health Assembly. Five years after the First Assembly
in Bangladesh, scientist and health workers, social movements' representatives and aboriginal
Deoples, met in Ecuador, to develop strategies that promote "Health for all". In this Assembly, the importance
of the Declaration for the Peoples Health - a call for action for the worldwide population that includes the
struggles for freedom, dignity and health*- was reaffirmed and continues to be the network main document.
(Find the declaration annexed. Also in www.phmovement.org/files/phm-pch-spanish.pdf, www.phmove-
ment.org/files/phm-phc-english.pdf)
People 's Health Movement - Ecuador
Debates in workshops and plenary were con-
ducted, within diverse themes as: poverty and
health, militarization, environmental degra-
dation, traditional medicine, health and int<
culturally.
Also, special events such as the first session
the International Peoples 'Health University
(IPHU) and the launch of the Alternative Re-
4
port: Latin-American Health Watch took place.
In the program, we tried to promote that the
main voices heard were the most sensitive and »
vulnerable human groups voices, includii
the "voices of all the men and all the womer
(Quizhpe Peralto/Hamlin Zumiga 2006)
i
"Through the activities during the assembly, such
as the IPHU, fellow peers from different move-
ments participated. During the following years,
each international event was central to achieve
■■tual motivation and exchange learning expe-
lces. There are many possibilities for action
for the Movement, because no one is alone, only
fighting in different countries towards the same
objectives, and knowing what is happening in
other countries".
(Edgar Isch, FNSPEyMPD, Quito)
With focus on Ecuador, the Assembly expressed International solidarity with the national struggles: witl
communities, which had defended their land; with the indigenous movement that was figh
political decisions, participation in the social security system and to maintain their culture and idem
World Assembly in Cuenca not only was a big event that required a lot of prepar^
also was an occasion to strengthen the structures of MSP Ecuador.
"5"
People 's Health Movement - Ecuador
People s Health Movement- Ecuador
Own the defense of individual and collective life.
Men and women, who have not lost yet their true human essence, can only respond
positively to the call of those who struggle for life. This is why we make our own, Celia
Iriarte's words: we must own the commitment to build a new mindset that opposes to
the "naturalization" of our current situation as the only way possible. It is necessary to
own the defense of individual and collective life, LIFE with capital letters, which goes
beyond the biologist vision to expand the horizon in search of human construction in
its broader conceptualization. The idea is calling ourselves out of this "sweet certainty"
of the worst which enslaves us, to take the risk to think about freedom. (Quizhpe/Calle
200: Health, the transforming power of life).
*5^M
(Quizhpe/Calle 200: Health, the transforming power of life).
THE COLLECTIVE CONSTRUCTION OF
A NETWORK AS A BASIC STEP TO SUS-
TAIN THE MOVEMENT
m
SP Ecuador belongs to the global network People's Health Movement (PHM) and to the re-
gional network MSP Latin-America (msplatinoamerica@gmail.com).
Latin American network has its coordination office in Nicaragua; along with several communication centers.
From Ecuador, ComunicandoNOS office, located in the city of Cuenca, is responsible to establish communica-
tion with MSP MSP Latin-American network.
1ST
People 's Health Movement- Ecuador
ComunicandoNOS team is a group with expertise in the construction of edu-communicational and au-
diovisual material. It has two partially paid workers and various activists who support the realization and
construction of products and campaigns (contact: comunicamspsud@yahoo.com).
T^
People 's Health Movement - Ecuador
ComunicandoNOS office is the headquarters of the national
network. According to Jorge Quizhpe, communication coordi-
nator of MSP Ecuador, ComunicandoNOS has five goals:
Selecting and disseminating information to Latin America
MSP network, member organizations, allies and friends of
MSP.
Produce materials regarding health, people's mobilization
and changes in health policies in Ecuador.
Produce promotional and educational material, such as:
videos, books and radio serials, and distribute them bet-
ween Latin-America and Ecuador networks.
Develop participatory communication strategies
Support training processes for popular and community
communicators.
The office is managing two web pages: the web page of the
global network in Spanish www.phmovement.org/es and the
web page of the magazine PIJUANO www.pijuano.blogspot.
com . The office tries to establish and maintain collaborations
with social movements, peasants and indigenous peoples in
struggle, both in Ecuador and other Latin American countries.
TiT
People 's Health Movement - Ecuador
"We are in the communication network of Latin America MSP. We work together with equipment and offices
in different countries, as Argentina, Brazil, Bolivia, Colombia and Nicaragua. From this relationship and com-
mon articulation, we strive to strengthen networks and social fabric, as well as progress in the collective cons-
truction of educational communication products. Also sometimes we became reporters, when something
happens in other countries; we contact a person from MSP network who can send all the information about
what is happening there. That is the way in which we support each other.
(Jorge Quizhpe, ComunicandoNOS, Cuenca).
I J9
People 's Health Movement- Ecuador
Medical Sciences Department and the MSP
The Medical Sciences Department in Cuenca (FCCMM) plays an important role in MSP Cuenca. Dr. Arturo Quizhpe
Peralta, a physician, professor and MSP activist who was the General Coordinator of the People's Health Assembly
(PHA) in 2005; is also the Department's Dean. Many researchers and practitioners who are committed to social
medicine and MSP objectives work at FCCMM. Due to the existence of this democratic space which is committed to
collective health, conferences and seminars take place, facilitating academic debates on topics such as the right to
health, social determinants and critical epidemiology. Another objective of FCCMM is to include the aforementio-
ned topics in the training of future health workforce.
20|
People 's Health Movement- Ecuador
The Nursing School is part of FCCMM and was one of the organizational pillars in the pre-
paration of PHA 2005. According to the Director Maria Merchan, the school is offering an
alternative training in nursing. The instruction includes aspects of social medicine in the cu-
rricula and internships in rural communities and urban neighborhoods. With this program
the Nursing School contributes to the training of health workers based on comprehensive
health.
People's Health Movement -Ecuador | 21
Central Office of ReAct Latin
America is located in the FCCMM
in Cuenca, ReAct is a network of
researchers in the field of bac-
terial resistance, who work in
scientific projects regarding the
effects of antibiotics abuse in me-
dicine and in stockbreeding. The
research is also focused on new
therapeutic options from a public
health perspective, on Indige-
nous Peoples' knowledge and on
concepts of the re-construction
of ecosystemic health.
Adding to the teams working in Cuenca, React has more groups in other parts of the Azuay province and in
neighboring provinces. Community workers work in local committees supporting them in the articulation of
the needs and demands of communities, as well as in the strengthening of people's participation on health pro-
grams. MSP has started Inter parish Coordinators that conduct research in communities and support the training
of community health workers.
MSP Militancy is represented by the National Front for the Health of the Peoples Ecuador (FNSPE).
Starting on 2004 as a platform for all the "fronts" (laborers organizations from different sectors) uni-
ted under the theme of health. The Presidency is located in Guayaquil. FNSPE has teams in fourteen
provinces that carry out demonstrations, actions for popular demands, activities in neighborhoods
with inadequate healthcare services and campaigns with other organizations to claim the right to
health in the labour context.
22 1
One of the weaknesses of MSP Ecuador is its
invisibility in Quito. Although there are people
from left parties in various organizations and uni-
versities that have collaborated with the network
on specific projects; there are no solid structures
to coordinate activities of the MSP in the capital.
The same problem occurs in other provinces of
the country. After its inception, FNSPE has expan-
ded its organizing efforts to fourteen provinces
but have failed to maintain its activities on them
all. However, some associations such as the Pea-
sants' Social Security affiliates (SSC), who have
their own platform called FEUNASSC, are consi-
dered part of the MSP.
People 's Health Movement - Ecuador
People 's Health Movement - Ecuador
a
Our proposal to health and decent living for the peoples is based on the
principles of integrity, solidarity, universality, equity, justice, dignity and social
participation, which should permeate the distribution of wealth and social,
economic, cultural policies: it is also based on the full enjoyment of human
rights and the preservation and respect for nature. This will lead to a healthy
society where people enjoy life and have a full development.
(National Front for the health of the peoples Ecuador. 2005)
THE CONCEPT OF HEALTH AND THE DEMANDS
OF MSP ECUADOR.
emands of the MSP Ecuador
To achieve health, the specific demands of MSP Ecuador are:
Universal access to comprehensive health care.
Coverage of basic health infrastructure by the Ecuadorian State
Eliminate the privatization of public health services
Changes in the state budget and increase in health and education budget
Prevention programs, especially in cancer and sexually transmitted diseases
Food sovereignty and social security for everyone
Programs and mechanisms for social participation to make autonomous decisions
Development of a national pharmaceutical industry for generic drugs.
Link the health system with traditional medicine and the knowledge of indigenous peoples
implement programs for occupational health protection, taking into account occupational
risks, as well as specific programs for people with disabilities
Establish public geriatric care centers where specialized care is provided to older adults in va
rious aspects of their life and health. (Solis/Quizhpe/Calle 2007: Health, the transforming for
ceofthe life).
(Soliz/Quizhpe/Calle 2007: Salud - La fuerza transformadora de la vida)
26 1
People 's Health Movement - Ecuador
Health must be guaranteed by the state
Health as a right must be guaranteed by the state through public policies that guarantee the
full exercise of this right and the access to health services for all people, regardless of their
economic status. Health goes beyond the offer of health services by the State. Health needs
a life of dignity, without violations of other rights such as housing and nutrition, with healthy
ecosystems and a preserved nature. Therefore, fight for health for all means to fight for healthy
circumstances in daily life:
People's Health Movement- Ecuador I 27
An integral vision of healthy ecosystems includes healthy
and fair economic relationships:
28 1
People 's Health Movement - Ecuador
This view of health is the basis of the political work of MSP Ecuador. The network is actively denouncing the des-
truction of nature and the pollution resulting from the exploitation of natural assets. Those actions are especially
important in Ecuador, a country that generates its income by exporting raw materials. Fumigations in banana, cacao
and other agricultural products; the spills produced during oil extraction; the pollution of rivers with heavy minerals
in mining areas, threatens the health of the Ecuadorian population and particularly the poor and vulnerable.
MSP rejects the industrial development model, free trade and the power of multinational corporations. On the other
hand, MSP is supporting social movements, peasants and indigenous people who are struggling against the exploi-
tation of natural assets that leaves behind displacement, violence and dependency.
| 29
People 's Health Movement - Ecuador
The National Front for the health of Peoples Ecuador- consisting of community and
neighborhood leaders, homemakers, health workers, teachers, students and professio-
nals- seeks to reaffirm the universal right to health and share experiences among social
movements with a vision of change. Its mission is to contribute to social transforma-
tion, that is, we pretend to transform community from a passive object to start being
an active subject and social agent capable of deliberation in the formulation of policies
and the decision making process regarding their health problems.
(Declaration of principles of the National Front for the health
of the peoples of Ecuador, 2004).
VjS.
THE NATIONAL FRONT FOR THE HEALTH
OF THE PEOPLES ECUADOR (FNSPE):
BUILDING A HEALTHY WORLD
The National Front for the Health of the Peoples of Ecuador as an articulation strategy
In 2004 the National Front for the health of the peoples Ecuador, FNSPE, was established,
as an organizational part of MSP Ecuador. It is playing an important role in social organi-
zation. FNSPE can be portrayed as one of the pillars of social movements in Ecuador along
with the indigenous movements and the peasant movements,
lost, but not all fronts, have historical roots in the Marxist-Leninist ideologies and the workers' struggle
against neo-colonial capitalist system. The best known are the Popular Front of the workers (FP), the FEUE
and FESE organizations of university and secondary students, respectively. There is alsoa front of health
workers (FTS), the National Teachers Union (UNE), the Confederation of Women for Change, the revolutio-
nary youth (JRE) and the front of popular artists. The strategic idea of FNSPE has been to bring together
the various fronts around the health issue, explains Edgar Isch, a leader in both the FNSPE and MPD, a
leftist party (Democratic Popular Movement):
liT
People 's Health Movement - Ecuador
"We had a conception in which the first criterion was the human right to health, involving health professionals,
but also environmentalists and educators. When FNSPE was born with these ideas, we break the hegemony of
official science in order to understand the concept of health in a much more comprehensive and inclusive way.
On the organizational side, we had two phases: a phase in which the network was convened to discuss with
various organizations regarding specific campaigns on certain issues, but without constant presence of the
FNSPE. In the second phase, in Guayas, Los Rios and other provinces, social activism nuclei were constituted,
having a much more direct access to popular sectors, achieving a permanent presence in social actions in de-
fense of the conditions of life. In the perception of people, FNSPE was a platform for actions and demands to
the State in the health area".
(Edgar Isch, FNSPE and MPD, Quito)
I 33
People 's Health Movement - Ecuador
FNSPE has its maximum visibility in the province of Guayas and in its capital, Guayaquil. Guayaquil's team organizes
forums with other fronts that have campaigns around the health issue and local meetings to strengthen auto orga-
nization of communities to demand their rights:
"We did a project in collaboration with the Anglican Church: in fourteen different workshops with farmers,
we talked about different issues, such as pandemics, AIDS, cervical cancer and the importance of clean water;
above all we discussed with them about the right to health for all. We organized groups and people continue
to debate about health in their area, free medicine, diseases that affect them most and their demands to the
municipality and to the government".
(Jose Matias, JNSPE secretary, Guayaquil)
FNSPE team in Guayaquil conducts campaigns to advocate for free health care and for a local generic drug industry.
They have organized Medical Brigades to work in poor neighborhoods of the city where there are no health centers.
Last year brigades distributed basic medicines in neighborhoods affected by floods and storms; nets and medicines
to combat dengue and malaria pandemics. Some people from FNSPE are working in universities of Guayaquil, Cuen-
ca and Quito, having access to academic infrastructure to disseminate information and organize seminars. FNSPE
president, Ricardo Ramirez, describes the structure of the organization at the provincial level:
&
"The FNSPE in Guayas ho
meetings monthly. We hav
rather broad team, includ
both doctors and nurses,
students and workers. On <
network we organize all i
people who need a bet
health system, and who ;
willing to fight to improve
where they live and where
they work. In our structure
have a directive from varic
organizations. We have rep
sentatives in the directive,
take collective decisions
campaigns and actions.
Before making decisions, delegates will discuss with their communities
(Ricardo Ramirez, FNSPE president, Guayaquil).
UT
People 's Health Movement - Ecuador
People's Health Movement- Ecuador \ 35
A recent initiative where FSNPE plays an active role is the establishment of a Front in Defense of IESS. IESS (Ecuado-
rian Social Security Institute) is the general system of social insurance in the country and has five levels: individual
and family health insurance, pensions (disability, retirement, death), occupational risks insurance, the Peasants So-
cial Security and insurance of the national administration. More than three million of people -near a quarter of the
population- are covered by IESS.
Currently, the government has a fiscal deficit of four billion USD, which meant cutting funding for the IESS and pri-
vatizing part of the Social Security. The Front in Defense of the IESS demands the government the increase of state
spending on social security and on health services, the improvement in those services, especially for patients facing
catastrophic diseases, epidemics and diseases due to occupational hazards, and finally, the guarantee of pensions
for retirees. According to Ricardo Ramirez the way the government is handling the IESS reflects the unjust economic
and political system in the country:
"We are in the midst of the debate; analyzing the causes and
roots of these problems. In essence, it is a problem of exploi-
ters and exploited, but it is not simply an economics discus-
sion. This struggle can also allow us to see the limits of this
government, which is proclaiming the new socialism of the
XXI century, but according to the facts, there are commona-
lities with the right wing and imperialism. With basic wages,
workers contribute to social insurance via taxes, that is why
we all have the same right to social security, the access to
health services, and to receive medication and all that".
(Ricardo Ramirez, FNSPE, Guayaquil).
Y 4 4;
•.<*»
36 I People 's Health Movement - Ecuador
FNSPE does not have funds from any political party or government or any NGO, all of the activities are carried out
with small self-financed funding.
Health is a process that includes both, the biological and psychological dimensions of the
individual, as well as the economic, political, cultural and environmental aspects, which are
produced by the social determinants and expressed in the quality of life of a community
and its members, and hence, in their health status.
Considering all the previous description of health, legislation regarding health problems
and the right to health can not be reduced to the field of attention of illness and curative
health care services, but must also cover the economic, political, cultural and environmen-
tal rights that make possible a healthy and fair society.
(The right to health Constitutional proposal from MSP Ecuador, 2007)
vH
THE RIGHT TO HEALTH IN THE
NEW CONSTITUTION OF ECUA-
DOR
Network for the right to health in the Constituent Assembly
hen the New Government took power in 2006, a process for drafting a New Constitu-
tion began. In the city of Montecristi, a series of assemblies where the New Constitu-
tion was being proposed, discussed, and finally formulated were organized.
Labor, peasant, indigenous, academic and women organizations formed a Network for the Right to Health
in order to influence actively the debate around this process and eventually include in the New Constitution
the right to health as a responsibility of State. Dr Jaime Breilh of the Universidad Andina Simon Bolivar
(UASB) describes the process of network:
"One year prior to the Constitutional Assembly, we coordinated a core of analysis to convene a meeting of
several organizations interested in participating in a debate regarding the New Constitution. We invited
the MSP to be part of the network and the network supported the work of MSP. We were divided into six
working groups on six major themes. We had several meetings with Alberto Acosta, president of the Cons-
titutional Assembly, and other Assembly members. We worked a full year in these six themes, studying all
the chapters of the New Constitution. There were several agreements in the network: to break with the
notion that health was integrated into a single isolated chapter in the new constitution, and to understand
the right to health as an entry point to talk about social and structural determinants of health. It meant to
discuss a new social, legal and cultural order, to transcend the biomedical vision, from hospitals, pharma-
ceutical industries, etc. It was a very rich and intense process".
(Jaime Breilh, director of the health area, UASB, Quito)
40|
The Network for the right to Health, as well as the MSP, participated actively in the meetings of the Constitutional
Assembly in Montecristi:
'The Montecristi Assembly also formed working groups. We went to Montecristi and participated in these groups
with all the preparation we had done with our six-axis. We had a basic document for discussion with the Assembly
previously prepared. In a meeting with Alberto Acosta and other Assembly members, we made a presentation for
the Constituent working groups. 70 percent of our proposals were incorporated in the New Constitution. Before
concluding this process, we organized an international forum on Constitutional Processes on health in Latin Ameri-
ca with the participation of people from Brazil, Venezuela, Bolivia, Colombia, to discuss our achievements, with the
experience of other struggles. These discussions enriched the document delivered to Alberto Acosta".
(Jaime Breilh, UASB, Quito)
TiT
People 's Health Movement - Ecuador
People 's Health Movement - Ecuador
We are in a time when humanity faces the noise of consumerism that invades our
privacy, that overtakes all spheres of life, creating magical solutions for everything and
for all, for diseases, for solitude, for anxiety and for sadness; that makes up needs, bu-
ying consciences, destroying societies and imposing values.
Global warming history is the history of human intervention on the macro ecosystems.
The history of bacterial resistance is the history of damage on the ecological micro-
systems -the oldest life form on the planet. There is however a difference between the-
se phenomena. The first is a visible problem, the second a threat with an invisible face.
(Magazine ReActiva Number 5/ June 2008, pg. 2)
ACTION TOWARDS BACTERIAL
RESISTANCE
n 2007 the ReAct Latin America (action against bacterial resistance) network was formed as a
regional organizational part of global ReAct. Global React was born three years earlier at the
University of Uppsala in Sweden, to investigate the determinants and causes of growing bacterial
resistance.
This issue is especially important in Ecuador because bacterial infections (pneumonia, diarrhea, sepsis, etc) are the
leading causes of death in children under one year. In addition, the problem of bacterial resistance mainly affects
the most vulnerable populations, such as indigenous, peasant and rural communities. A central objective of the
work of ReAct is expanding the spaces for debate about bacterial resistance to aspects of the use and abuse of
antibiotics, which normally is only topic of discussion among experts in microbiology, pharmaceutics and medical
sciences.
The severity of infectious diseases depends not only on medical but also on social aspects, such as malnutrition,
poor sanitation and lack of economic resources. Inappropriate use of antibiotics occurs both in large scale cattle
ranching and in treatment of bacterial Illnesses in humans. Using large amounts of antibiotics results in bacterial
resistance in the human body and in adapted microorganisms that later spread on land and water. This means the
imbalance of ecosystems.
Logically, ReAct Latin America reinforces the role of healthy ecosystems to refrain bacterial resistance, as well as, to
improve living conditions for poor population. In addition, ReAct is focusing on cultural diversity to achieve new
solutions in the area of prevention and treatment of bacterial infections. This means the integration of community
wisdom and the worldview of indigenous peoples:
People 's Health Movement - Ecuador
w
"For ReAct foundation, the vision of the indigenous peoples of South America was important, given that the con-
cept of health is fully integrated, ecological and social. This vision is also important for the ecosystems in balance.
The ecological , social, economical and political crisis seems like a civilization crisis. From this link, we are fighting for
the defense of ecosystems and an ecological vision in health and in medical services".
(Klever Calle, communication coordinator ReAct Latin America, Cuenca)
Latin America ReAct office is located in the medical faculty of the University of Cuenca in Ecuador. Javier Peralta
works as Science coordinator and Klever Calle as coordinator of communication. Additionally, a post graduate stu-
dent, who does research aimed at the containment of antimicrobial resistance and appropriate use of antibiotics is
part of the team. It is the first doctorate with this emphasis on Latin America.
Office coordinators are also very active in the MSP Ecuador. For them, goals ReAct work is directly linked with MSP
objectives: universal access to treatment of bacterial infections and the struggle for healthy ecosystems are central
aspects of the right to health for all.
48|
"The basis of our work is theoretical, but the activities and objectives are very practical. We have three kinds of work:
education, research and production of materials. We advance participatory research with communities, in another
type of learning, focused on social determinants of health. We need to promote the training of health professionals
in the Indigenous vision, a change in worldview as well as in the training curriculum, which is too biomedical in the
moment".
(Klever Calle, ReAct, Cuenca)
Universal access to prevention and treatment
of bacterial infections should be an integral
part of Primary Health Care (APS in Spanish):
comprehensive APS strategy would be the
best contribution to the prevention of infec-
tious diseases. In 2010 an international gra-
duate program in comprehensive APS, with
emphasis on infectious diseases, has been es-
tablished. This is the first time a training, which
has integrated these two aspects, is part of a
medical school in Latin America:
HI imt* * t
WM
■
mmk — ihl f
y
'40
"Once we finish the program in our faculty, the process, the materials and the results will be evaluated to turn it
into a virtual program accessible to all professionals, organizations and institutions related with health care in Latin
America".
(Arturo Quizhpe, general coordinator ReAct, MSPyFCCMM, Cuenca)
| 49
People 's Health Movement - Ecuador
People 's Health Movement - Ecuador
In 2008, after an international conference on Bacterial Resistance, Infectious Diseases, Community Solidarity and
Ecosystems, a network of different organizations, scholars and activists in Latin America was formed. The network's
objectives are to increase social participation and to portray the social determinants in this issue. The memories
of this conference include ideas and strategies for social participation, the ecological view and cultural diversity in
those areas. (http://reactgroup.org/dyn/.62„.html)
As in other local health programs, fighting bacterial resistance requires the participation of communities, both in
the processes of formulation of problems, and in the solution proposals.That is even more valid from the ecosystem
perspective because you cannot restore and maintain healthy ecosystems without input from the local population
living in these ecosystems:
"We need the participation of local people in defining, planning, executing and evaluating all health issues. It is a
debate about the perspectives for the containment of bacterial resistance, which occurs as a universal threat to life,
and a discussion regarding comprehensive health strategies and the support of social, indigenous and peasants
movements. The success of a program depends on the participation of communities".
(Klever Calle, ReAct, Cuenca)
In June 2009, a national seminar on Infectious Diseases: Diagnosis, Treatment and Appropriate use of Antibio-
tics was organized to inform professionals and health sciences' students. The meeting portrayed experts from
the PAN AMERICAN Health organization (PAHO) and the IESS who gave conferences regarding antibiotics use,
the increasing bacterial resistance and their connection to unbalanced ecosystems. It was a successful confe-
rence with more than 400 scholars and academics and included a critical analysis of the biomedical model. This
event was organized with no funding from the pharmaceutical industry, which usually finances this type of
scientific conferences:
"For both seminars, it was very important that we were not funded by
pharmaceutical companies and that we stayed free from this influence.
It is very important that we are independent because we're developing
a different discourse. Besides the great contribution of the Pan Ameri-
can Health Organization (PAHO), the Faculty of Medical Sciences and
the Central Bank of Ecuador, there were also many people who partici-
pated with their own resources. All of these are aspects of our financial
architecture".
1ST
(Klever Calle, ReAct, Cuenca)
With healthy ecosystems as an integral part of the right to health,
ReAct has common ground with the indigenous communities and
peasant movements. It has established partnerships, especially with
movements of the south east and south west of Ecuador, who defend
their lands and their sovereignty against the threat of destruction pro-
duced by mining activities. With this collaboration, ReAct shows that
an academic issue such as the containment of antimicrobial resistance
has not only ecosystemic aspects, which should be integrated into re-
search, but also involves concrete solidarity with the political struggles.
People 's Health Movement - Ecuador
People 's Health Movement - Ecuador
^
I
%
*
The Peasants Social Security (SSC), based on the principle of
solidarity, subsidiarity and which is mandatory, is an insurance
system for peasants and the members of their families, regard-
less of contracts of employment or wages. With this special fea-
ture, Ecuador is the only country that operates a social insurance
system for the rural population without a dependency relation.
Its establishment in the Pilot Plan took place in 1968 and in the
four following decades, both the number of clinics and the num-
ber of members multiplied. In addition, the SSC incorporate the
rural population to the pension system for retired peasants in
1981.
THE PEASANTS SOCIAL SECURITY (SSC):
A TOOL FOR THE HEALTH OF ALL
We fight for a health system for all and for Social Security for all
urrently, the administration of the SSC is in hands of the Ecuadorian Institute of Social Securi-
ty (IESS) ), with approximately 2 million beneficiaries and 600 medical clinics.
Through the SSC, 18% of rural population has a health insurance (national average: 23%, figures for 2004).
For vulnerable groups in Ecuador, the SSC is the central aspect regarding access to health care services and to
social security for retirees.
"We are fighting for a health system for all and social se-
curity for all. A social insurance not dependent on payed
labor is the best and our system is unique in this regard.
Although primary health care (PHC) is very important, this
concept works only as an element in sudden health needs
and is implemented as a basic clinic for the poor, a low-
quality medical care. But a social insurance is a strategy
for all, the same type of coverage and the same quality of
medical services for all, without regards of their economic
status and guaranteed by the State. Health for all is the
right to social security for all".
(Jaime Breilh, area heath director, UASB, Quito)
m
People 's Health Movement - Ecuador
However, the Social Security is a system with permanent problems and the State does not fulfill its obligation to
maintain it or to increase it. The most serious limitations are:
a) The debt held by the State, which totaled up to four billion dollars in 201 0, causing cuts in payments to IESS, as
well as to the beneficiaries of SSC.
b) Shortages of health professionals: physicians, dentists and nursing assistants and the lack of economic resources
reflected in the low quality of health care services.
c) Although clinics offer free medicines, regularly those most needed are lacking and patients have to buy them in
private pharmacies.
mss*. &$!^
"We have medicine, but the same medicine for all
pains. It has no quality to cure the patients. They
[SSC] have not respected the law, which establis-
hes that more than a 1 00 types of medicine should
be available in clinics; only 16 drugs are available.
Diclofenac for headaches, for all pains. A few days
ago, in a press conference, a top leader of the IESS
said: we don't need to give the peasantry medica-
tions, because people in the field are surrounded
by many herbs to heal"
(Vicente Ortiz, president of the SSC affiliates ' asso-
ciation - Riobamba - Chimborazo)
People's Health Movement - Ecuador I 55
Those are the reasons why, the beneficiaries of the SSC who have organized themselves in the United Federation of
Peasant Social Security Affiliates (FEUNASSC), demand the implementation of the services needed and the impro-
vement of the SSC system. The FEUNASSC demands: timely and complete delivery of medications in clinics, the es-
tablishment of new clinics with expanded schedules (more attention hours) and bigger medical teams, construction
of new second and third level hospitals, and the improvement of the retirement pension.
MSP Ecuador also has played an active role in the defense of SSC given that a universal social insurance is a precon-
dition of the right to health for all and that the access to health services is an integral part to the social production
of health with democracy and participation. In some provinces as Riobamba and Pichincha, members of SSC asso-
ciations are part of the MSP:
"We have been part of the People's Health
Movement, we have formed committees for
the defense of health and we are spreading
all materials that exist on the MSP. We are
also part of the directives of the Health Front
lere in Ecuador; we met several times in a
month to analyze what is currently happe-
ning, the information of the PHA and how
!re workshops being organized in other
ountries. We have always downloaded the
^formation; we have also transmitted the
information to each of the provinces in the
committee of FNSPE. We are trying to inform
>le about the concept of health as a hu-
right and train them in this aspect. In
same spirit, we are fighting for a future
in which social security is an obligation of
the State for the entire rural population. At
^he time, it is just a demand but we will fight
o establish health as a universal right".
(Vicente Ortiz, SSC affiliate, Riobamba -
Chimborazo)
People's Health Movement - Ecuador I 57
The activities of the Association of SSC Affiliates in Imbabura are very similar to those of MSP: training of community
health workers in the field, workshops on disease prevention, education of the rural population on pollution, waste
disposal and malnutrition. Currently, the Association organizes events and demonstrations to denounce the neglect
of the State's obligations to the IESS:
"We have participated in strikes and marches, organizing struggles for our demands. We have had good medicine
/hich has been decreasing in recent years. Last week we had a demonstration against the National Government's
appropriation of SSC money to cover the State's deficit. We demand to be consulted as owners of the money. There
is one authority, the IESS directive board, which takes the money without asking anything. Then, in the future we
will have problems. Leaders inform people through the radio or through notifications and we did a significant de-
monstration".
(Vicente Ortiz, SSC affiliate, Riobamba - Chimborazo)
58 I People 's Health Movement - Ecuador
There is still 75% of the Ecuadorian population who has no health insurance. MSP claims for the integration of the
various insurance organisms (IESS, SSC and others) to a Unified Health System (SUS- Sistema Unico de Salud) that
guarantees the right to health for all the population.
People's Health Movement -Ecuador I 59
Is not about to erase the political boundaries of existing
States, but to build a policy where indigenous people can
walk again in the living spaces they have built for millen-
nia, without having a passport; walking together with the
mestizo and Afro-descendants peoples.
(Jaime Idrovo/Dominique Gomis. Intercultural Health: pers-
pectives from indigenous peoples and Afro descendent from
Abya Yala. August 2010. ComunicdndoNOS team.
I NTERCULTURAL COORDI NATI NG
COMMITTEE FOR THE HEALTH
OF THE PEOPLE AND THE SOCIAL
PARTICIPATION ISSUE
cuadorian people have a constitutional framework conducive to social participation in health sin-
ce 2008. Examples of participatory actions are the Committees of Users (CUS, in the context of
the Free Maternity Law), over 100 provincial and cantonal health councils, the existence of Basic
Health Teams and the Conferences for Health and Life (COSAVI). A Sub-Secretariat of Health Promotion and In-
terculturality was established in the Public Health Ministry to support participatory processes in health. Cantonal
programs with strategic plans and baselines have been launched and those should take into account the views of
local people. Cantonal councils also have encouraged a more local-level organization: i.e.: parish councils and health
community committees.
However, there are many factors that undermine autonomous participatory and solid processes. Although commit-
tees and councils are exchange spaces for the population and the government, they have no power or influence in
the decisions made by politicians. Law-making processes lack the tools needed to include the rich discussions of the
committees and the actions of the Ministry of Public Health continue to have a vertical nature. Community health
programs are organized in a centralized fashion and thus, the councils simply do not know the activities of the Mi-
nistry of Public Health. Furthermore, health centers and health sub-centers carry are boud to carry out government
programs with no input or participation of health promoters or from the committees.
"In what State processes in the health field is the population participating? There is a participation law, there is a
peasants' social insurance, there are clinics; but we are not participating in anything! They take their own decisions,
but we as citizens are not participating. We are simply used in the organizational objectives of the institutions, but
not in tune with the objectives of social movements".
(Ulises Freire, leader ofintercultural coordination for the health of people, CSIP, Sigsig)
People 's Health Movement - Ecuador I 63
'The Ministry policy is vertical in nature. We have to generate, from social participation, the application of the
right; the Constitution has to respond to our interests, the interest of the people. It is called Intercultural coor-
dinating committee because we have to work on forms and formats of the professional world and of our own
practices. We say "for health" instead of "of health" because we are fighting for health, we are not talking about
recovery health services but about all dimensions of health, production, consumption, of health care. Lets not
talk about the health coordinating committee for the institutions, but lets talk about the health of the people; we
are the ones who have to put pressure for our rights to be implemented. We have the obligation to exercise this
right. We have a CISP strategic plan, prepared in accordance with the constitution and the good living strategy,
and the fight against poverty and for a development in harmony with the ecosystem".
(Ulises Freire, CISP, Sigsig)
64 I People 's Health Movement - Ecuador
The CISP is organizing training programs for community workers at the parrish level. Seminars take place regularly
to provide a space for exchange regarding the local health situation, the development of health policy and the
relationship with representatives of the municipality or the ministry. CISP promoters have conducted diagnostic
programs in different communities to help at the local level and to coordinate with the government around the
health needs in communities (i.e., they use the results of the diagnoses of cervical cancer to demand a program of
sexual and reproductive health). In rural areas where there are no hospitals, health sub-centers are responsible for
providing basic health care services. However, due to material, financial and personnel constraints, the sub-centers
do not meet the needs of the population. Through collaboration among community promoters, participatory coun-
cils and local municipalities, the documentation of diseases and the treatment at the community-level take place.
People's Health Movement -Ecuador I 65
For CISP promoters, only a genuine people's participation through participatory councils, User Committees and Affi-
liates 'Associations, could guarantee that state programs reflect the interconnected needs from the communities.
It should also be valid for the new government initiative called Citizens' Committees, through which the Govern-
ment would try to improve collaboration and coordination at the cantonal level. The CISP is not opposed; instead
it supports the idea of the Citizens' Committees, in a very critical sense, demanding the transformation of vertical
programs into horizontal processes.
*9pft
Wtr
*%
m
hensive care model. PHC is implement
we have to support it".
"The strategic goal of the coordinating
committee is to develop local commu-
nities policies based on the input from
participatory health councils, in each
parish, with inter-sectoral participation
that allows the exercise of the right to
health. Participation in decision-ma-
king at the local level, support for the
administration and the effective use of
financial resources for the protec-
i of health and life are also goals.
•port health activities in a coordina-
ted way while developing the Primary
ilth Care strategy and a compre-
e Ministry of Public Health or by the IESS, it is not in our hands, but
(Ulises Freire, CISP, Sigsig)
66 1
People 's Health Movement - Ecuador
The Health Action Network
Despite the organizational weakness of MSP Ecuador in the capital, there are some initiatives in Quito with the same
objectives and similar strategies of MSP.
Those actions were initiated around the Universidad Andina Simon Bolivar (UASB). Dr. Jaime Breilh, Director of the
Health Area at UASB, is the general coordinator of this network. The network has organized discussions about the
situation of public health in Ecuador and about the right to health for the population; it has collected proposals and
conducted public policy analysis, especially of the Ecuadorian government's health policy in the last decade.
The Health Action Network presented a proposal in six themes for the New Constitution. As a part of the Network for
the right to health, they have achieved the integration of the social determinants perspective and the right to health
perspective, in the New Constitution. Activities in 2006, 2007 and 2008 have resulted in national collaborations with
organizations in other areas, social movements, politicians and other health networks, such as MSP.
Nowadays, various academicians, public sector ser-
vants and NGOs technicians participate in the acti-
vities of the network. In recent years it has worked
with the Committees of Users of Free Maternity care
Law, with Associations of Peasantsl Social Security
Affiliates of Quito and the Northern provinces of the
country, and with the National Movement Women
for Life: a movement that is organizing women in
marginal urban neighborhoods of the country. Cu-
rrently, the Women for Life Movement has conduc-
ted a survey of quality (sensed quality) in 8 public
health care services in Quito and Cuenca. Additio-
nally, the Health Action Network launched with fos
(Belgian Socialist Solidarity) an event at the end of
201 0, that tried to integrate the Women for Life Mo-
vement and ALAMES (Latin American Association in
Social Medicine) in the debate regarding the right to
health and social security in Ecuador.
People's Health Movement -Ecuador I 69
v/i
vffi
Our planet is undergoing a major environmental crisis as result of
a predator production system, with macroeconomic growth, de-
velopment, progress and other fallacies as a pretext, it has led to
massive impoverishment and exclusion of the population and to
social injustice, to the destruction of ecosystems, to the commodi-
tization of life while appropriating of biodiversity and of ancestral
knowledge, disregarding our cultures, and imposing their model
of consumerism and unsustainable lifestyles.
Declaration of People for the Life, Cuenca January 2007
MSP AND FNSPE SUPPORT
TO THE ANTI- MINING
STRUGGLE
elow, the development of the mining sector and the situation of the anti-mining movement in
Ecuador are described. In recent years, MSP Ecuador has worked intensively on this issue, inclu-
ding ways of collaboration with movements fighting against mining.
Popular resistance in Jimbitono and El Pangui were the first major success against mining activities in 2006. MSP
Ecuador contributed as a platform for convening a National Assembly of communities' victims of the negative
effects of mining, from which the national network of anti-mining struggles emerged, The National Coordinating
Committee for the Defense of Life and Sovereignty, CNDVS.
"In 2007 the MSP along with other popular organizations convened communities who were facing mining to deve-
lop a meeting, a large meeting to discuss the problems that mining companies can cause; the meeting was atten-
ded by thousands, including people from other countries who contributed with evidence of the fatal consequences
of this activity. In this meeting the CNDVS was born, a coordinating committee for the anti-mining struggle. This
coordinating committee makes visible the problems of mining in the country, generating multiple actions: two
national uprisings which resulted in 70 fellow partners'imprisoned and accused of terrorism. Communities' struggle
was intense and massive. At this time, the New Constitution was being discussed in Montecristi. Thanks to these po-
pular uprisings, the National Assembly decreed a mining mandate that stopped mining concessions; unfortunately
this mandate was not fulfilled ever".
(Jorge Quizhpe, ComunicdndoNOS, Cuenca)
MSP ComunicandoNOS office in Ecuador took an active role in the coordinating committee: they provided the in-
frastructure for communication among organizations, producing and distributing informational materials about the
CNDVS. Unfortunately CNDVS strength has weakened, due to the difficulty in maintaining the collaboration among
organizations.
^T
People 's Health Movement - Ecuador
People's Health Movement - Ecuador I 73
Currently, there is still some regional coordinating committees and hopefully CNDVS would recover. Also, since
2009, the Confederation of Indigenous Nationalities of Ecuador, CONAIE, has been involved in the fight against
mining. Historically, indigenous peoples had done small scale mining. Later, in the centuries of colonialism, large
scale mining takes place primarily in indigenous areas. Today, the most interesting areas for mining companies are
those where indigenous populations are concentrated. Logically, indigenous communities are the ones that have
being displaced and have suffered from land and water pollution and the destruction of their forests and mountains.
To face the Ecuadorean government plans that envision the launching of large-scale mining activities; there is the
need, more than ever, to establish partnerships between movements and the national anti-mining struggles:
Icoordinadora
national TDlkl^l
yyFUERA
*MIHERAS
5I0NALES-'
t task is to provide arguments to the struggle: how you can deal with it without knowing mining
u ... . ,.-er countries, because we have not had large scale mining. That is a very relevant task which can
give strength to the struggle. The second task is to contribute with a human rights-based logic: rights here have
been seen as gifts or favors from the State: "thanks to the government, because it gave me a health center". But you
have to change the point of view and enforce the struggle for the right to defend your life. In that sense, the issue of
health is central not only in relation to the question of the health of human beings, but also the health of ecosystems
as an enforcement of the rights of nature The third task is the direct support to the struggles, not only to the big
ones, but also to the small ones: i.e. in Guayas the struggle against the pollution of their rivers is very significant".
(Edgar Isch, FNSPEyMSP, Quito)
m
The Mining Mandate, or the agreement on the mining policy discussed in the Assembly included:
Cessation of the mining concessions that do not comply with obligations established under other laws;
Restriction of mining activities in protected areas and in water sources;
Overturning of concessions given to former officials of the Ministry Of Energy And Mines;
Creation of a state mining company to maintain mining operations with better social and environmental con-
ditions, to organize the sector without dependence on transnational corporations and to help with technology
and funding to small scale miners.
People's Health Movement - Ecuador I 7$
People 's Health Movement - Ecuador
However, neither the New Mining Law of 2009, nor the practices of the Government of President Correa meet those
standards. They continue to give concessions that contradict the Mandate, allowing the extraction of mineral in
highland areas with fragile ecosystems and providing no protection for threatened communities or fair compen-
sation to the already affected ones. There are no visible activities of state enterprises than can establish alternative
forms of extraction and cause less damage. All of this is done, while transnational corporations continue exploration
activities and prepare to exploit.
The largest mining projects in exploration phase in Ecuador are:
Rio Blanco (IMC), 6000 concession hectares, estimated reserves (RES): 4 million ounces of silver.
Quimsacocha (IAMGOLD), 1 2000 hectares, RES: 3 million ounces of gold, 1 8 million ounces of silver.
Condor (Aurelian), 95000 ha, RES: 1 3 million ounces of gold and 22 million ounces of silver.
Mirador (Ecuacorriente/Corrient Resources), 64000 ha, RES: 1 80 million tons of copper.
S»
Reserves figures are based on estima-
tes of the companies involved. Until
there are no independent and reliable
studies, these figures must be assumed
to be oversized because the companies
want to attract investment and credit.
The investment in the mining sector fo-
cuses on Canadian companies: Corrient
Resources, IMC, lamgold and Aurelian
come from Canada. If these figures
had been correct, the mining potential
would equate 70% of the current value
of oil reserves of the country (1 .4 billion
dollars).
People 's Health Movement - Ecuador
In the recent book by Alberto Acosta (2009: The Curse of Abundance) some figures on the production of waste and
water consumption are presented: in the case of copper, over 95% of the original rock removed becomes waste; in
the case of gold, an ounce (extraction done with the best technology) will produce 28,000 kilograms of waste (13
million ounces of gold waiting in the Condor project would produce more than 350 billion kilograms of waste). One
ounce of gold requires 8,000 liters of water, one ton of copper contaminates between 10,000 and 70,000 liters of
water (depending on the source of information).
"Regarding the impact of extractivism there are three myths: first that there is clean technology; second that extrac-
tivism creates jobs, while destroying agriculture and livestock, in fact it destroys more than creates; and third, the
idea of development, growth and progress through the exploitation of natural resources. That is in the mindset of
the people and it is difficult to stop this conviction.. First, you have to justify why you are against the new extractive
model since the government tries to show that the income is spent in education and social insurance; there is no
alternative but to break illusions about the extractivism".
(Edgar Isch, FNSPEy MPD, Quito)
For MSP the connection between mining and health is of great significance: open pit mining causes serious envi-
ronmental impacts such as pollution of land, air and water; both at the time of exploitation and many years after
the mining operations ended. Facilities destined to try to minimize environmental pollution can be built, but in
rainy weather or during El Nino, these facilities can burst or break. The devastation of surfaces, the modification of
the morphology and course of rivers, the formation of large debris accumulates pollutes water and rivers near the
mines. Tenguel case is an example of the destruction resulting from mining activities.
People 's Health Movement - Ecuador I 77
A) Popular resistance in Jimbitono and El Pangui
Hydroabanico Company Inc.built a hydroelectric dam, on the river near Jimbitono town in Morona Santiago pro-
vince. The hydroelectric dam generated electricity for the needs of industrial production in Guayaquil, especially for
Coca Cola and KFC companies. Technically, to generate 1 5 megawatts of electricity, Hydroabanico decanted 5 cubic
meters of river to another river range. This resulted in the absence of water along the first river with negative effects
on irrigated land and the increase of water along the second river, with severe impacts destroying land, livestock
and fisheries. In August 2006, all local communities became aware of environmental problems caused by Hydroa-
banico. Jimbitono's population organized against the second phase of the dam construction, which will result in
much more water deviation, due to the double amount of electricity required to supply the mining transnational
corporations (Ecuacorriente/Corrient Resources, Lowell, BHP Billiton). These companies are carrying out the exploi-
tation of minerals in the neighboring province, Zamora Chinchipe. At the same time, there were plans to develop
the construction of a 250 km power lines by the company Sipetrol (linked to Hydroabanico) to bring electricity to
mining sites.
(MSP Ecuador 2007: Jimbitono, A Free-
doms Yell)
Hydroabanico project also has an important international aspect: part of the funding for this project comes from
the World Bank, who runs a so-called "clean development mechanisms (CDM)"from the Netherlands (Holland). Hy-
droabanico, according to the criteria of the Kyoto Protocol, is a clean energy project in a developing country, inves-
tment in this project discounted C02 emissions of industrialized countries. That is the idea of the services of Clean
Development Mechanism (CDM), a program of the Kyoto Protocol. Holland is making investments in Hydroabanico
to offset any emissions in their industry. The truth is not only the electricity generated by Hydroabanico is a dirty
energy because of its environmental impacts, but also Hydroabanico provides electricity to mining companies (not
for the public network) to facilitate a dirty industry, exploiting copper and gold in an opencast way.
People's Health Movement -Ecuador I 79
Through a 75 days strike, Jimbitono communities closed the main road to Riobamba, demanding the suspension of
the second phase of Hydroabanico and payment of compensations to communities affected by the destruction of
the first phase. After five weeks of strike, community activists faced a series of violent attacks by the army, police and
Sipetrol and Hydroabanico workers. The attacks prompted an increase in Jimbitono popular uprising.
Meanwhile, an International Forum for anti-mining struggles was organized in El Pangui. At the end of the forum, the
participants were called for a march of solidarity with Jimbitono. Hundreds of people came to Jimbitono and formed
a committee to defend the life of Morona Santiago and to articulate the fight against Hydroabanico hydroelectric
project with the fight against Current Resources mining company.
In November 2006, the protests peaked when the President sent his Work Minister to the popular assembly in Macas:
a meeting with officials of the government of the two provinces and some community leaders.The whole Assembly
approved the Act of Commitment to the most important agreements: the immediate and permanent suspension
of the second phase of the project Hydroabanico and the discontinuation of mining activities of Current Resources
in Morona Santiago and Zamora Chinchipe. However, companies, especially Current Resources, did not stop mining
activities. The Popular Assembly decided to stop these activities with direct actions on the company facilities and
faced afterwards Human Rights abuses and violent attacks, resulting in injuries and arrests.
B) Tenguel the disastrous results of mining
In Tenguel, a parish of the province of Guayas, everyone can see the consequences of mining activities as serious
contamination of rivers in the area. Water is loaded with heavy metals such as arsenic, chromium, vanadium and
mercury. These heavy metals provoke reactions and damage to internal organs of humans; it also produces the loss
of all fish in the rivers. Esther Landeta, an activist who has organized community resistance in Tenguel for years,
describes the impacts:
80 |
People 's Health Movement - Ecuador
Mining activities take place mostly at high altitudes in the mountains of the neighboring province, Azuay.The fields
of small scale miners and mining companies as ORENAS- the largest in the region- are located in the mountains
where large amounts of water are used in the gold extraction process. There are pools of contaminated water al-
ready used in the process. Pools have been built with minimum security: a plastic layer serves as protection. There
are often spills of polluted waters flowing to the land and the rivers located within a few meters distance. There are
four rivers that are born in these mountains and flow through parish of Tenguel.
'Here is the Chico River, above, it is almost dead, all poisoned, is useless. Mining impacts on health and nature, Ian
Decomes infertile. Look the color of the river. Sometimes the water of the rivers is red or blue due to all the poison.
Despite the fact that the rivers carried the red water, the tests came back negative and they pretend that there is
no pollution in the rivers. Tests are never going to come out positive because the miners pay the exams, we should
pay for the exams to get a positive result".
(Esther Landeta, activist of communitarian resistance ofTengue,
.
In 2007 the municipality of Guayaquil published an independent study. According to this study, the concentration of
heavy metals in the four rivers exceeds the permitted limits: from 7 times more for arsenic up to 265 times more for
mercury, a highly toxic metal. The rivers carry waste from the mines to the most productive agricultural area of the
country: the coast of the Gulf of Guayaquil, where shrimp, bananas and cocoa (organic and conventional products)
are grown; a great quantity of those is exported to other continents. Cultivation of these crops consumes large quan-
tities of water; therefore, these products for consumption and export contain heavy metals.
Eln the same year, the National Assembly for the Defense of Our Rivers was born, demanding the urgent cancellation
of mining concessions in the area of Ponce Enriquez. Repeatedly inspections of the mining area have been carried
out by the direction of mining of Azuay. However, the pollution of the rivers continues.
People 's Health Movement - Ecuador
However, more and more critical voices say it is essential to review the mining practices in the country, particularly
before carrying out the government's plans under President Correa. Currently the government tries to establish
large-scale mining. The mining law of 2009 facilitates the delivery of concessions to mining companies and shows
no reconsideration of the practice.
Tenguel popular resistance has faced intimidation by mining companies and by the regional government. Esther
Landeta confronts constant threats from the mining companies, she can only move with police escort. Intimidation
is a major problem to organize communities and to maintain an effective resistance.
"I do not speak out, people say, because it is a bit risky. If they speak they fear for threats, so they prefer to keep quiet.
The Environmental Prosecutor came to us and asked which symptoms they had, "nothing happens, we're well", peo-
ple remain silent. There is threat everywhere; often people do not talk, for fear".
(Esther Landeta, activist, Tenguel)
84 |
c) UNAGUA, anti-mining resistance in Quimsacocha
Since the eighties, Ecuador started a process of private and foreign investment to develop large-scale mining. For 1
years the Ecuadorian governments have given a huge amount of concessions; nearly 20% of Ecuadorian territory is
destined for mining exploitation. IAMGOLD, a Canadian company, has acquired concessions to exploit gold deposits
in thousands of hectares in Quimsacocha, an area at 3000 m. of altitude.
People 's Health Movement - Ecuador
People's Health Movement- Ecuador I 85
Quimsacocha is the most valuable reserve of gold in terms of quantity and quality in Ecuador. With a projection of
three million ounces of gold, the State will receive nealry 800 million dollars in taxes. Currently, IAMGOLD is explo-
ring the field with machines and measuring the amount of subterranean gold in 200 meters. In addition, the com-
pany carries out preparations to build the employees house. The operations have not begun yet.
In the area there are no affected populated zones, but the open-pit mining is a highly polluting practice and it means
a serious threat to the fragile ecosystem of this region. In other countries, such as in Colombia, no mining activities
are permitted at an altitude of over 2000 meters. Quimsacocha contains a large quantity of water sources and the
two largest rivers in the province of Azuay, passing through Cuenca, the capital of the province, are born there. With
the aim of protecting the ecosystem and communal property, communities in Victoria del Portete,Tarqui, San Ge-
rardo and Giron have organized a prolonged and persistent popular campaign to halt the plans of IAMGOLD mining
activities:
86 |
"The source of theTarqui River, one of the four rivers that flow through Cuenca, is located in Quimsacocha. This body
of water, before joining theTarqui, forms the river llquis, from which we have water for irrigation, animals, and to
1 200 families in Tarqui and Victoria Del Portete. Right here, we are denouncing that water for industrial use will be
destined for our consumption. We are concerned that when mining comes, all these sources of water, sources of
life, will be ended. This is why we are fighting for water, for life. It is the fight of our partners and all people. We will
achieve victory with the determination of people that stick together. We have completed six years of struggle and
we will follow six more years".
(Carlos Perez, UNAGUA, Quimsacocha)
Ecuador's government- as well as other"XXI century socialism"govemments in Venezuela and Bolivia- has increased
social programs budgets. These budgets are funded by taxes on exports of natural resources such as oil, minerals
and metals. In recent debates, that is called "new extractivism" (Eduardo Gudynas 2009: Ten Urgent Theses on the
New Extractivism). Facing the fact that the oil in Ecuador gradually wears off, President Correa tries to facilitate large
scale mining of metals and minerals. His argument to win Ecuadorian population's approval is that extractive acti-
vities allow national economic development and cover the costs of education, health and housing programs that
benefit the entire population.
People 's Health Movement - Ecuador
People's Health Movement- Ecuador I 87
Opposition groups have been insulted
by the President as "infantile environ-
mentalists". In an authoritarian manner,
the government has criminalized the
leaders of the anti-mining struggle and
is trying to divide the indigenous move-
ment and affected communities. A re-
cent example: the state repression to the
protests against the approval of the new
water law in May 201 0:
^
m*k
'Many people are being persecuted for this struggle; they are crimina-
lized, accused of terrorism. Extractivism requires conditions that only
authoritarian governments can provide. You do not find either in La-
tin America or in Africa a democratic country with extractive practices.
This relationship is valid also in Ecuador. If you say Venezuela, Bolivia
and Ecuador have progressive governments, you are right; but when it
comes to extractive activities, they portray themselves as authoritarian
governments. And there are no new forms of extractivism because for
the population, for the peasants and in a health context, the extracti-
vism today means the same disaster as in the previous decades".
(Edgar Isch, MPD y FNSPE, Quito)
88 | People
s Health Movement - Ecuador
The proposal of a new Water Resources' law has caused serious conflicts and has been portrayed as a contradiction
to the New Constitution. The Constitution points out that water management will be exclusively public or commu-
nitarian; the new law will allow the privatization of water. The Constitution states that energy sovereignty will not
be reached at the expense of food sovereignty; the new law would favor the productive use of water by mining
and industrial production at the expense of rural and communal agriculture. Social movements that protested in
the streets have demanded to prohibit all forms of water privatization, the guarantee of the human right to water
and the rights of nature -which has been one of the paradigmatic achievements in the New Constitution-
"We want the water law, but a water law for life; a law that guarantees its use for humans, and also for industry.
Our struggle in southern Ecuador is that these 2 million of high land grasses remain free from mining activities.
For example, in Colombia, you cannot do mining activities in an altitude of more than 2000 meters, on high land
grasses. We just ask that. And why are we asking that? We ask to have water for ourselves and for our children.
We are convinced that big
changes are done by the
people, the collectives,
not by presidents; we are
hundreds and thousands
of water struggle owners,
we are doing this so that
our children can enjoy the
benevolence of nature".
(Carlos Perez, UNAGUA,
Quimsacocha)
People's Health Movement -Ecuador I 89
D
MSP- LA CALL
We call to the people and urge the governments of the region, to fight and work towards:
Reinforcement of health as a fundamental human right, as result of the interaction of
the social, economic and environmental determinants.
Revitalization of the national and international community commitment to achieve
Health for All, according to Alma Ata, signed in 1 978.
To establish effective channels of communication in order for the organized people,
the professional unions, the talent training institutions involved in health can partici
pate in the planning, implementation, monitoring and evaluation of health services.
To guarantee that the health sector transformation meets the needs of the population
and responds to the Constitutional text and to principles of good living Those princi
pies as they were originally conceived and not only in discourse.
To secure resources for universal, equitable, decent and quality access to health servi
ces for all, in prevention, treatment, rehabilitation and health promotion.
Allocate adequate resources for health research and production of generic drugs un
der state control. ^*J
Adopt public policies to ensure adequate, well educated, protected staff, which is trai
ned under the principles of right to health.
i
%
w
■kl :m
4 \\\
MSP CHALLENGES
FOR THE FUTURE
Collaboration between the MSP Latin-American Net-
t
he last internal meeting of MSP Latin American took place around the UISP (International Universi-
ty for the Health of the People) in Guatemala, April 201 0.
5 participants, students and professionals in the area of health and representatives of indigenous communities,
earn, "unlearn" and exchanged ideas on issues related to intercultural health. The MSP Latin America communica-
tion team was involved in UISP to interview and record testimony of participants. They were also involved in the
production of three videos and a book
(Idrovo/Gomis 2010: Health Intercultural Perspectives from Indigenous Peoples and Afro descendents from Abya Yala,
published in August 2010, download www.phmovement.org.es).
92 1
"We want our own media for the MSP Latin America network.. During the last meeting of the communication team
we decided to launch a radio and popular television project in the health area, broadcasting on the Internet. In Ecua-
dor, Argentina, Colombia, Nicaragua, Bolivia, Mexico and Guatemala there are teams that want to start a project of
popular radio and television. We will do it, I don't know how, but there is the decision and that is important".
(Jorge Quizhpe, ComunicandoHOS, Cuenca)
The concept of the UISP was also discussed. It was the fifth UISP in Latin America since 2005. The annual realization
of a UISP seems to be very positive. It has succeeded in spreading the prospect of a struggle for the right to health
between advocates and activists who work in medical services or influencing health policies. However, the organi-
zational work for continental UISP was intense and consumed much of the human and financial resources of the
Latin-American MSP network. The central issue of debate was to establish to what extent the collaborative process
undertaken by the UlSPs strengthens the structures of MSP.
People 's Health Movement - Ecuador
People's Health Movement -Ecuador | 93
"We need to monitor, evaluate and make a compilation
of the materials. We need teams in each region, suppor-
ting the struggle for the right to health, which is linked
to the movement, and participating in national and re-
gional projects".
(Arturo Quizhpe, dean ofFCCMM, Cuenca)
"UISP courses could be virtual in nature; participants
receive technical tools to participate in video conferen-
ces. This ensures wider participation, dissemination of
materials and at the same time saving money. A virtual
university as a space between multiple organizations
and nobody has to travel with a lot of time and money".
(Nidia Solis, FSNPE and secretary of Nursing School,
Cuenca)
94 |
People 's Health Movement - Ecuador
A new agenda for the MSP Ecuador
As mentioned earlier, one of the MSP Ecuador network problems is its invisibility in some of the provinces and in
the capital of the country. In the same way, the national MSP program would need a campaign to make visible the
government's unwillingness to fulfill its constitutional obligations to improve the health situation of the population:
"Following the seminar in September 2009, there was no continuation of cooperation. We do not have a common
struggle agenda, we stand, we are involved in many specific struggles, as against the laws of water and mining, but
there is a continuing agenda. We need a national congress of Ecuador MSP to decide on a new agenda. We need
to build an agenda that also reflects the changes of recent years, the policy of the new government neoliberalism
and the new post extractivism".
TEMUMHSTAS . otiSnM^ 6 *
Nl CANALLAS
, SOMQS MADRES . ABUELAS . HERMANN
ttEFEUS0in\S l)E LA PACHAMAMA
0E LlMON INDANZA
Others propose a development of network structures: the FNSPE could provide steps toward an organization that
manages different cantonal offices and regional coordinators:
People's Health Movement -Ecuador I 95
"The problem is we have not moved the FNSPE
-an organizational structure- to have a presen-
ce in the provinces. In the national level there
is fixed structures of FNSPE, but in the provin-
ces there is not. There is a lack of human re-
sources to work even more in communities by
promoting the right to health".
(Vicente Ortiz, president ofSCC, Riobamba -
Chimborazo)
$?****'
Moreover, we could compile the training of community promoters. A new approach to their training should
to be connection between environment and health. Also, learning the tools to carry out research with local
communities and strengthen the articulation of the voices of the bases should be considered:
"Training events could be national and regional: there
is the urge to train the promoters, collecting testimo-
nies of the community, search for scientific research on
the situation of the rights of nature and health in the
broadest sense. The promoters team needs academic
information to develop research and contacts with mo-
vements and networks to collect testimonies. All that
work, unified, could be the source of a "Health Obser-
vatory In Latin America", a collection of analytical evi-
dence".
(Arturo Quizhpe, general coordinator of MSP Ecuador
and dean ofFCCMM, Cuenca)
MSP is also considering a popular communication campaign: the distribution of information on social aspects of
health accessible to indigenous communities. These two projects would improve the presence of MSP in the pro-
vinces.
"To produce materials more suitable for the bases, materials in a vernacular language, culturally accepted. It must
also include the translation in kichwa. Especially when Global Health Watch 3 is released, we could produce popular
brochures in kichwa. It Is necessary to include other forms of communication, more dynamic, more interactive, in
fact we're doing this now, there is a rich production, in print, audio, video, multimedia, we've also made two short
films with cartoons. For example, in the case of MSP Argentina there are professionals who made documentaries;
they produce great video series. That is the reality of the MSP, play according to their abilities and each country has
to generate its own resources and funds".
I 97
People 's Health Movement - Ecuador
People s Health Movement - Ecuador
Observing human rights in anti-mining struggles
As mentioned earlier, the mining of metals will increase to a large-scale industry, which will become strategically
important for the government of Ecuador. Therefore, more mining projects are expected in the coming years, espe-
cially in the south of the country. State repression against indigenous resistance were observed, which is directed
against the mining law and water in the past two years. This repression includes the accusation of terrorism against
many movement leaders and activists involved in strikes. Taking into account the government's reaction to popular
resistance, the increased number in human rights violations by the state in the near future should worry us.
"We could establish a communi<Btions
network and popular human righ 1 ob-
servers. That we need urgently an I MSP
may be integrated into this proje | We
need rights observers here in the
water law showed us that we neeJ
support in legal issues. Movements lack to
logistical supply and MSP could be provi-
ded it through the equipment of popular
communications and with econonr» and
human resources".
(Klever Calle, communicator coordinator
ReAct Latin America, Cuenca)
98 I PeopU
e 's Health Movement- Ecuador
Similar to the idea of training community workers to document the issue of health and environment, a key initiative
for the future, will be the establishment of a popular communicators team, which would document social move-
ments and respond to the mining activities and other mega projects.
"Visualize the criminalization of the struggle in different parts of the region, through the record of: testimo-
nies, reports, documents, producing and disseminating materials, strengthening the communication itself.
As, for example, in the fight against mining, on one of the manifestations a student was arrested, she was
accused of terrorism, the police claimed that the student had been firebombed in his backpack, the version
of the student and his companions was that the police put them in there, in front of this fact the deans of
law and medicine went on hunger strike in solidarity with the student, this brave, convening and mobilizing
action, was an instrumental in getting the student freedom. Events such as, shows the need to build a group
of human rights observers with a broad vision, not sectarian, but of unity, we propose the formation of a core
of human rights and the rights of nature and in that scope the right to health. This is an action".
(Arturo Quizhpe, MSPyFCCMM, Cuenca).
People 's Health Movement - Ecuador I 99
LITERATURA
Acosta, Alberto 2009: La Maldicion de la Abundancia, Quito
Barrero, Pedro Isaac 1998: Seguro Social Campesino, Historia y Reforma, Quito, CEPAR
Frente Nacional por la Salud de los Pueblos del Ecuador 2004: Principios y Propuestas, Cuenca
Gudynas, Eduardo 2009: DiezTesis Urgentes sobre el Extractivismo Nuevo, Contextos y Demandas bajo el Progresismo Sud-
americano Actual, manuscrito de una exposicion en Quito
Idrovo, Jaime / Gomis, Dominique 2010: Salud Intercultural, perspectivas desde los pueblos origiarios y afro-descendientes
de AbyaYala, Cuenca
Movimiento para la Salud de los Pueblos (MSP) 2007: Jimbitono - Grito de Libertad, Cuenca
Organizacion Panamericana de Salud (OPS) 2008: Perfil de Sistema de Salud: Ecuador - monitoreo y analisis de los procesos
de cambio y reforma, Washington
People's Health Assembly 2, 2005: Declaracion de Cuenca, Cuenca
Quizhpe Peralta, Arturo / Hamlin Zumiga, Maria 2006: Las Voces de la Tierra - De Savar a Cuenca
ReAct Latinoamerica 2008: Declaracion de Cuenca - Llamado mundial a la accion frente a la resistencia bacteriana a los anti-
bioticos, Cuenca
ReAct Latinamerica 2009: Restablecer la Salud de los Ecosistemas para Contener la Resistencia Bacteriana, Cuenca
Soliz, Nidia/ Quizhpe P., Arturo/ Calle H., Klever 2007: Salud-la Tranformadora de la Vida, Cuenca
ENTTREVISTAS
Erika Arteaga (coordinadora de la Red de Accion en Salud, UASB) en Quito: 1 6 de Abril 201
Dr. Arturo Quizhpe P. (decano de la Facultad de Ciencias Medicas de la Universidad de Cuenca y coordinador general del MSP
Ecuador y de ReAct Latinoamerica) en Cuenca: 1 9 de Abril, 26 y 27 de Mayo 201
Jorge Quizhpe (coordinador del Equipo ComunicandoNOS, oficina del MSP Latinoamerica y del MSP Ecuador) en Cuenca: 1 9
y 29 de Abril, 25 de Mayo 201
Klever Calle H. y Javier Peralta (coordinadores cientificos y de comunicacion del ReAct Latinoamerica) en Cuenca: 20 de Abril,
26 de Mayo 2010
Maria Merchan y Nidia Soliz (directora y secretaria de la Escuela de Enfermeria Cuenca) en Cuenca: 26 de Abril y 6 de Mayo
2010
Ulises Freire (dirigente de la Coordinadora Interparroquial para la Salud de los Pueblos, Sigsig) en Cuenca: 28 de Abril 201 0.
Esther Landeta (activista de la resistencia comunitaria Tenguel) en Tenguel: 30 de Abril 201 0.
Dr. Jaime Breilh (director Area de Salud de la Universidad Andina Simon Bolivar, coordinador general de la Red de Accion en
Salud) en Quito: 1 7 de Mayo 201
Edgar Isch (dirigente del Frente Nacional por la Salud de los Pueblos Ecuador y miembro del MPD, Movimiento Popular Demo-
cratico) en Quito: 20 de Mayo 201
Carlos Perez (dirigente de la UNAGUA - Union de Sistemas Comunitarios de Agua) en Quimsacocha: 22 de Mayo 201
Vicente Ortiz (presidente de la Asociacion de Afiliados del Seguro Social Campesino Imbabura) en Riobamba: 23 de Mayo 201
Ricardo Ramirez y Jose Matias (presidente y secretario del Frente Nacional por la Salud de los Pueblos Ecuador) en Guayaquil:
29 y 30 de Mayo 2010
| 301
300 I People 's Health Movement - Ecuador
People 's Health Movement - Ecuador
7
3D
]6
26
32
40
INTRODUCTION
HACIA DONDE SE ENFOCA ESTE ANALISIS
THE SECOND PEOPLES HEALTH ASSEMBLY: AN OPPORTUNITY TO GROW AND TO
THE COLLECTIVE CONSTRUCTION OF A NETWORK ASA BASIC STEP T<
SUSTAIN THE MOVEMENT
THE CONCEPT OF HEALTH AND THE DEMANDS OF MSP ECUADOR.
FNSPE: BUILDING A HEALTHY WORLD
THE NATIONAL FRONT FOR THE HEALTH OF THE
PEOPLES OF ECUADOR AS AN ARTICULATION
STRATEGY
THE RIGHT TO HEALTH IN THE NEW CONSTITUTION OF ECUADOR
46
54
62
72
92
ACTION TOWARDS BACTERIAL RESISTANCE
THE PEASANTS SOCIAL SECURITY (SSC):
A TOOL FOR THE HEALTH OF ALL
I NTERCULTURAL COORDI NATI NG COMMITTEE FOR T H OF 1 HE PEOPLE AND T HE SO-
CIAL PARTICIPATION ISSUE
MSP AND FNSPE SUPPORT TO THE ANTI-MINING STRUGGLE
MSP CHALLENGES FOR THE FUTURE
i_l4j* H^H
••••••''■• ^B I ^1
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