Women's health is a critical issue that has been overlooked in many parts of the world, particularly in low- and middle-income countries. Most of these countries have socialized medicine and access to primary care, but access to specialty services is more limited. Ecuador is no exception, where women face numerous challenges in accessing gynecological services, especially when procedure and surgical interventions are needed. However, there are individuals who are dedicated to empowering women and improving their health outcomes.

From improving women’s health to providing support in gynecological procedures, UAB physicians have been at the forefront of a movement to empower women and transform global healthcare for years. Equally important, they bring the lessons learned from these experiences back to Alabama.

Meet the OB/GYN

Almost every year since 2002, Brian P. Gleason, M.D., has flown to Quito, Ecuador, and traveled three hours to Ambato, Ecuador with a team of UAB Obstetrics and Gynecology nurses, anesthesiologists, and residents for two weeks of clinical visits and surgeries.

“I was fortunate to travel to Colombia during my fourth year of medical school for my rural health rotation,” said Gleason. “That was a great experience, and I saw how their health system worked. After that, I was approached by a UAB anesthesiologist, Dr. Gwen Boyd, about going on a trip to Ecuador, and I agreed to go in 2002.”

This year marked Gleason's 19th trip to Ecuador. He said it has been a great opportunity to learn how to connect with people from different backgrounds, who need the care that he can offer.

“People are people,” said Gleason, “and we share a common humanity at a very profound and fundamental level. I have also learned to emulate their practice of doing more with less, and optimizing resource utilization.”

He emphasizes that this is not a one-way street or just a mission to help others, it is about a bidirectional global perspective where lessons learned in Ecuador can be applied here in Alabama and the human connection of making this world a better place no matter where you are located.

The Challenges in Meeting the Population Health Care Needs in Ecuador

Despite its status as a middle-income country, Ecuador faces numerous challenges in providing healthcare services to its citizens. In addition, many of the existing healthcare facilities lack the resources, supplies, and equipment necessary to provide comprehensive care. From the patient's perspective, women in Ecuador face numerous barriers to accessing healthcare services, including limited financial resources, distance from healthcare facilities, cultural norms, and a lack of education about women’s health.

“Ecuadorians are better prepared for doing more with less than us in the U.S.,” said Gleason.

Gleason said that for many surgeries available locally, the patients have to buy their own medical supplies that the hospital doesn’t have on hand. Some patients have had to be turned away if their procedures require complex surgical supplies.

“It has humbled me and made me grateful for the things we can provide here that too often, we take for granted,” said Gleason. “It has also reinforced my efforts to be less wasteful and to conserve healthcare resources when appropriate.”

While in Ecuador, Gleason typically performs gynecological surgeries that local physicians don’t generally offer like surgeries for heavy bleeding, prolapse, and urinary incontinence. In the past, Gleason and his time have also done obstetric work including emergency Cesarean sections, hysterectomies, and cervical laceration repairs.

Collaborative Efforts to Improve Women's Health in Ecuador

Gleason and other healthcare providers in Ecuador recognize that improving women's health outcomes requires a collaborative effort. That's why they work closely together to develop and implement healthcare programs that meet the needs of women.

The local Rotary Club (Rotary Club of Ambato), which is a group of dedicated volunteers who raise funds all year long and coordinate an army of volunteers on the ground, has also played a major role in the efforts. They are able to mobilize the entire community for this effort, including preparing the healthcare facilities to receive U.S. healthcare providers, translators, transportation, etc. Gleason said that collaborating to plan local patient screening and follow-up appointments is also crucial to the care of the patients he sees while in Ecuador. 

“I have been extremely fortunate to have an association with Dr. Octavio Miranda Ruiz, who works there and sees all the patients before and after the trip,” said Gleason. “He was also Dean of the Uniandes School of Medicine for several years.”

Gleason said he feels very fortunate to have had the variety of training and experience during his trips. He also appreciates the tremendous efforts of the doctors and nurses he has collaborated with during his time in Ecuador.

“They have to provide the best care they can under very challenging conditions,” said Gleason. “We have a lot more in common at the end of the day than things appear at first glance.”

Gleason also mentioned that the language barrier while communicating with the patients has been a challenge that has been overcome by collaboration.

“I have studied Spanish and have had students serve as interpreters in the past,” said Gleason. “I have also had a former medical student who is now a Pediatrician, Dr. Gabriel Naranjo, and a Pharmacist, Dr. Maria Fernanda Zuniga, work with me for many years during these trips. Their English is excellent, and the trip would not be possible without their help.”

Looking Forward: The Future of Women's Health in Ecuador and Beyond

Despite the challenges that remain, Dr. Gleason is optimistic about the future of women's health in Ecuador and beyond.

Gleason is committed to continuing his work in Ecuador and hopes to inspire other healthcare professionals to join in transforming global healthcare.

“It’s very important for healthcare providers to assess what the limitations are within different healthcare systems around the world,” said Gleason “It is also important to have the full support of the local community and healthcare personnel.”

Gleason also suggested that healthcare professionals hoping to do their part in global health should think of creative ways to use their professional training and experiences to help improve patient care in low- and middle-income countries, which, in turn, will also benefit our state, particularly in rural areas that face similar challenges, including lack of gynecologists in many rural counties in Alabama.

The Vital Role of Empowering Women's Health in Building a More Equitable World

Dr. Brian Gleason’s work in Ecuador highlights the vital role that empowering women's health plays in building a more equitable world. By providing women with the resources, they need to take control of their health, we can improve health outcomes for women and their families.

However, achieving these goals requires a collaborative effort from healthcare providers and community organizations. By working together, we can create a world where every woman has access to the care she needs to live a healthy and fulfilling life.