ECUADOR Information Sheet

Credentialing Verification Authorities: At present (June, 2019) there is no official credentialing exam for nutricionistas. ANNE, (Asociación Nacional de Nutricionistas del Ecuador) is the recently created (2017) National Nutrition Association. Headquartered in Ecuador’s capital Quito, ANNE consists of a national board, incorporating 9 zones and 24 subsidiaries representing Ecuador’s 24 provinces.

ANNE has established Ecuador’s first professional organization of nutritionists: their goal is (as required for physicians, dentists, nurses, and ophthalmologists), is for nutritionists to sit for a national credentialing examination after fulfilling their required education and practical experience. ANNE is working toward enhancing the professional profile of nutritionists, and importantly, increasing the required number of nutritionists on staff in hospital settings, which currently is not enforced. ANNE: http://www.annecuador.com/

Official Language: Spanish For many Ecuadorians, Spanish is their second language after Quichua, an Inca language spoken by the indigenous population.

Ongoing Nutrition Activities in Ecuador

1. National Dietetic Association ANNE, Asociación Nacional de Nutricionistas del Ecuador is the National Nutrition Association. Established in 2017 and headquartered in the capital of Ecuador, Quito, ANNE consists of a national board, incorporating 9 zones and 24 subsidiaries representing the 24 provinces.

Website: ANNE: http://www.annecuador.com/ Contact: http://www.annecuador.com/contacto Facebook: https://www.facebook.com/annecuador/

Related organizations ASENPE: Asociación Ecuatoriana de Nutrición Parenteral y Enteral Phone: +593 -098 910 2158 Website: asenpe.com Facebook: https://www.facebook.com/asenpe/

2. National Nutrition Programmes/Projects Encuesta Nacional de Salud, Salud Reproductiva y Nutrición (ENSANUT) http://www.ecuadorencifras.gob.ec/salud-salud-reproductiva-y-nutricion/

3. Organizations working on Health & Nutrition a. National Organizations (Government) Ministerio Salud Ecuador Av. Quitumbe Ñan y Av. Amaru Ñan Quito, Ecuador EC170146 Website: www.salud.gob.ec +593-(02) 381-4400

3b. International Organisations OrganIzacíon Panamericana de la Salud: Ecuador (OPS): https://www.paho.org/ecu/ Sociedad Latinoamericana de Nutrición (SLAN): https://www.slaninternacional.org/ Federacion Latinoamericana de Terapia Nutricional, Nutricion Clinica y Metabolismo (FELANPE): http://felanpeweb.org/

3c. Educational Institutes (Nutrition Education & Research) Escuela Superior Politécnica del Universidad Técnica del Norte (UTN) Chimborazo (ESPOCH) Universidad de Especialidades de Universidad Técnica de Manabí (UTM) Espiritu Santo (UEES) Universidad San Francisco de Quito Universidad Técnica de Babahoyo (UTB) (USFQ) Pontifica Universidad Católica de Quito Universidad Estatal de Milagro (UNEMI) (PUCE) Universidad Internacional del Ecuador Universidad de Cuenca (UC) (IUDE) Universidad Católica de Guayaquil Universidad Iberoamericana (UNIBER) (UGC) Escuela Superior Politécnica del Litoral Universidad Técnica de Ambato (ESPOL) Universidad Espíritu Santo (UESS)

3d. Non-Governmental Organizations (NGO's) Unicef Ecuador: World Health Organization: Ecuador https://www.unicef.org/ecuador/overview.html (WHO): https://www.who.int/diabetes/country- profiles/ecu_en.pdf

4. Assessment of Training Quality of National Dietitians, their Professional Role and Prestige:

Ecuador nutritionists have only recently formed a credentialing organization, however, the first School of Nutrition & Dietetics was established in Chimborazo on April 3, 1972. In 2018, it became mandatory for all Universities with a Nutrition degree to enroll their students in the dietetic internship during their fifth year of college. The rotations include: Clinical Nutrition, Food Service Management and Community Nutrition.

At present, there are 15 schools that graduate students with a Bachelor of Nutrition and Dietetics degree in Ecuador. Currently there are approximately 9000 professional nutritionistas and 5000 students training to be Nutricionistas Dietistas. A bachelor of nutrition course duration is approximately five years, and all programs require a one-year practical experience: for example, at the University of Cuenca the program is seven semesters, with the final year (two semesters) consisting of six months internship in a clinical (hospital) setting, and six months in a community setting. Programs include courses for main areas: clinical nutrition, food service management, community, and nutrition education. After graduation with a Bachelors Degree in Nutrition and Dietetics most will practice in hospital or clinical settings, in food service and management, in athletic centers, and in the public health sector. Students may earn a Master of Science degree in Infant Nutrition (Maestría en Nutrición Infantil) and an MSc in Clinical Nutrition at Escuela Superior Politécnica del Chimborazo (ESPOCH). The Universidad de Especialidades de Espiritu Santo (UEES) has a Maestría en Nutrición Infantil online. The Universidad San Francisco de Quito (USFQ) offers a MSc in Nutritional Sciences - Maestría en Ciencias de la Nutrición.

5. Brief Description of National Healthcare System and Private Practice

Ecuador has a comprehensive national health system. Since 2007, when Rafael Correa became president, health care in Ecuador has improved impressively. Various surveys have shown that the country has moved from the middle of the pack of Latin American countries in health care quality, to being one of the top five.

There are two ways that Ecuadorian can access health care: Social Security health care is administered by the Social Security, or IESS, system. It offers services through full-service hospitals in large towns and cities, and dozens of clinics in smaller communities. For residents who are members of the national Social Security Institute, a modern system of hospitals and clinics is provided through employee and employer payroll deductions or voluntary payments, as is the case with many expatriates residing in Ecuador. The monthly contribution for voluntary members (family of two) of this system is just over $80. Employees, on the other hand, contribute .0935 of their salaries for this coverage but this also includes membership in the national pension system.

Public healthcare. Although it shares some of the same resources and personnel with IESS, the public health care system is technically separate and receives less funding on a per patient basis. Its services are free to everyone, citizens, expats and visitors, fulfilling a constitutional mandate that no one in Ecuador can be refused medical care. As does the IESS system, it has hospitals in major cities as well as hundreds of walk-in clinics. Remote rural areas are also served by this system with physicians, dentists and nurses performing an obligatory one-year "rural" and serve isolated or underserved populations. In Ecuador, this one-year of service is mandatory for professional licensing. Although as of this report (June 2019) there is as yet no licensing for nutritionists, since 2016 the Education Sector has included Nutritionist as part of the healthcare team to provide medical support.

Private health care is available from mostly doctor-owned clinics. Private health insurance is available from Ecuadorian insurance companies.

6. Employment Opportunities Profile

Most nutritionists with bachelor’s degrees work in clinical settings, namely hospitals, public health clinics. There are also opportunities in foodservice management and public health, and in sports centers and education. All nutritionists must practice under the auspices of the physician on staff. They may have a private practice, however they must work with a physician to oversee their practice. The average salary for a nutritionist ranges from $600 to $1000 monthly.

Nutrition Related Volunteer Opportunities In Ecuador:

FUVIDA: Fundación Aprendiendo a Vivir con Diabetes: Foundation: Learning to Live with Diabetes. http://fuvida.org.ec/quienes-somos/

Banco de Alimentos Diakonia: Diakonia Food Bank: Fruits and Vegetables pickups (FRUVER Program), Healthy Breakfast Program, Community Garden Program. https://www.diakonia-ec.org/index.php#

Manna Project International: http://www.mannaproject.org/ecuador Specialized opportunities are available for working professionals with a desire to serve and equip communities with a specific skill or trade. UNICEF Ecuador: https://www.unicef.org/about/employ/index_volunteers.html: If you have an undergraduate degree, several years of work experience and are interested in long-term volunteer opportunities in developing countries, you may be eligible for entry into the United Nations Volunteer (UNV) program.

Peace Corps in Ecuador: Volunteers work with their communities on projects in education, health, and youth development. During their service in Ecuador, volunteers learn to speak Spanish. https://www.peacecorps.gov/ecuador/

NGOabroad: International Volunteering & Careers http://ngoabroad.com/

7. Obtaining Work Permits

Foreigners must first obtain a work visa. The 9-IV visa is intended for technicians or technical experts that work under contract for a company based in Ecuador and legal representatives that possess unlimited power of attorney to represent a company in the country.

The requirements are:  Indefinite Work Contract, legalized by the Labor Ministry  Indefinite Work Authorization granted by the Labor Ministry

The other work visa, the 9-V visa, is for professionals with a college degree who wish to practice his or her profession in Ecuador. With a professional visa, a foreigner can work legally in any legal type of work. Those who want to work in a field that is licensed by Ecuador, such as a doctor or lawyer, must have their medical or law license approved and registered before legally working. If the profession doesn’t exist in Ecuador, they must be locally certified.

Applicants must also complete the Ecuadorian requirements to practice the profession, such as the bar exam.

Here are the requirements required to work in Ecuador (all documents must be translated into Spanish):

 The original and a certified copy authenticated by the Ecuadorian Consul (in your home country), validated by an accredited Ecuadorian institution of higher learning for equivalency, and registered with CONESUP.  If the applicant is taking advantage of an International Agreement, a certified copy of the agreement is required.  Original and a certified copy of the degree, legalized by the granting authority, and endorsed by the Ministry of Education (if the degree was granted in Ecuador).  As of November 1, 2018, foreign tourists wishing to enter the province of Galapagos must have private health insurance.  All may enter Ecuador with a valid passport on a 90-day tourist visa, however, to maintain temporary or permanent residence in Ecuador, all foreigners must have public or private health insurance, valid for the length of time the foreigner is authorized to stay in Ecuador.  With residency status, you will get an Ecuadorian ID Card called a Cédula. You can use your Cédula to enroll in the national healthcare system (IESS - Instituto Ecuatoriano de Seguridad Social), and if you are over 65 years of age you can qualify for senior citizen discounts on a wide range of services from municipal taxes to airline tickets to household utilities.  More information about the types of visas here. https://www.visahunter.com/visa/ecuador/  Sectretaria de Educación Superior, Ciencia, Tecnologia, e Innovación: SENESCYT: To register a professional title in Ecuador: Information: http://servicios.senescyt.gob.ec/servicio/reconocimiento-de-titulos- profesionales-o-grados-academicos-en-el-campo-de-la-salud/

8. Local Food Customs and Culture

Ecuador, a small country about the size of Colorado, is bordered to the north by Colombia, Peru to the east and south, and the Pacific Ocean to the west — included are the Galapagos Islands in the Pacific, about 620 miles (998 kilometers) west of the mainland. As of May 5, 2019, Ecuador’s population is 17.63 million, up from less than 5 million in 1960.

The majority of people live in the central Andean Mountain region or along the Pacific coast. Only 3% live in the tropical forest east – Amazonia Ecuatoriana. The largest concentrations of Ecuadorians live in the two largest cities: Guayaquil, near the Pacific (population approximately 2.5 million) and the capital Quito in the North Andes region (population approximately 2.3 million). Cuenca, the third largest city (approximately 700,000) has the largest number of North American expatriates: there hasn’t been an Ecuadorian official census since 2010, but the estimate ranges from 5,000 to as high as 8,000. According to CuencaHighLife.com, the average age of all Cuenca expats is 66, and 65% of Cuenca’s population is under age 35. The average age in Ecuador is 26.9 years.

Ecuador is a multicultural and multi-ethnic nation, with one of the largest indigenous cultures in South America. The ‘Mestizos’ (decedents of Spanish Colonialists and indigenous people) make up about 75% of the population with smaller numbers of indigenous groups (10%) and Afro-Ecuadorians, who are descendants of slaves and make up seven percent of the population.

Ecuador is a country of contrasts — in the larger cities you’ll find quite modern infrastructure and shopping malls. Food courts in the larger cities will include the usual franchises including Burger King, Pizza Hut, McDonalds, KFC: you’ll often see sides with a local flavor — for example, a KFC chicken leg meal is available with a side of beans and rice. Ecuador has many of their own fast food chains similar to International ones.

Each of the three distinct regions — the Amazon, the Sierra, and the Pacific coast — has their traditional dishes. On the coast, beef, chicken, and fish and shellfish are typically eaten with rice, lentils, or plantains. Fish is plentiful: a favorite is ceviche —a cold-cured fish dish, made with fish, conch, and/or shrimp marinated in lime juice and seasonings. Bollos de pescado (fish and peanuts wrapped in banana leaves) is a coastal favorite. In the central Andes, pork, chicken, beef and cuy (guinea pig) are served with rice (arroz), corn (maiz) or potatoes (papas). Hornado is a popular dish of potatoes served with roasted pig. Patacones are green plantains fried in oil, mashed, then refried; llapingachos are pan-seared potato balls. Seco de chivo is goat stew. In the southern Sierra, typical foods include repe, a soup made with green bananas, and cerdo asado (roast pork).

Soups are popular throughout Ecuador. In the northern Sierra, locro de papas (potato and cheese soup) is a favorite as is arroz con menestra de lentejas, a thick lentil stew served with vegetables and either meat or fish.

The indigenous people of the Amazon consume freshwater fish, and yuca or a relative of yuca called manioc, eaten boiled and fried. Yuca is also made into flour and made into pan de yuca (yuca bread).

Ecuadorians eat three meals daily. Desayuno (breakfast) — typically early at 6:30 am, may include scrambled eggs and rice or simply bread and coffee (instant), hot chocolate or tea. Almuerzo (a set lunch) is at 1pm or 2pm, and is traditionally the main meal of the day. Soup is typically the first course, followed by a segundo (plate) of lentils or beans with chicken, meat or pork, and of course, rice, accompanied by jugo (juice). Cena (dinner) at about 8pm is traditionally a light meal — soup, bread, and juice. Expats typically comment that comida tipica (typical food) is bland, but usually some type of spicy sauce (salsa) or aji (hot sauce) is on the table. Upscale restaurants may offer canelazo, a served-hot spiced and spiked with aguardiente – Ecuador’s high-octane distilled fruit beverage.

The variety of fruits and vegetables in Ecuador is astounding, and of course, with a year-round growing season, fertile Ecuador is heaven for plant-based eating. Ecuador is the world’s largest exporter of bananas and grows 300 varieties. A favorite is the red banana with its creamy flesh: it’s much more flavorful than the thick-skinned yellow Cavendish that is Ecuador’s main export and familiar to people around the world.

Mercados offer a colorful and inexpensive array of familiar and possibly exotic fresh fruits, mostly grown in the lower altitudes. North Americans will be drawn to familiar favorites including piña (pineapple), papaya, and mango. But you must try new ones, such as pitahaya, guanábana, naranjilla (little orange), and tuna - not the fish, that’s atún in Spanish — tuna is the prickly pear, with sweet, red flesh inside). Read more: https://cuencahighlife.com/the-exotic-fruits-of-cuenca/

9. CE Opportunities

CPE opportunities are provided through IAAND professional development activities such as IAAND conferences and webinars, through the Academy distance learning programs, the Journal of the Academy of Nutrition and Dietetics and the Academy Foundation resources.

10. IAAND Volunteer Opportunities

Opportunities to assist IAAND with your time are probably endless. Learn as much as you can about IAAND and where your skills and interest would be of most benefit both to you and to IAAND. You could: . Assist IAAND in spreading awareness about nutrition and dietetics globally and advocating for nutrition issues in your local communities. . Support IAAND’s growth by recruiting new members and assisting fund- raising team. . Be a member on the IAAND leadership team . Assist in organizing conferences . Submit articles to the IAAND newsletter . Be a Kids Eat Right International volunteer.

For further information please contact the Country Rep for Ecuador: [email protected]

Written by: Susan Burke March (2019)