Stories of Value
Class of 1984
Executive Director and Chief Medical Officer of Andean Health & Development
Ecuador, South America
Delivering health care in rural Latin America
When David Gaus was finishing up his accountancy degree at the University of Notre Dame in 1984, he realized he didn’t want to be an accountant. He wanted to do something else. That “something else” led him to create a hospital system in rural Ecuador, thought to be the first financially self-sustainable hospital in a non-urban area in Latin America that delivers high-quality care to an entire population. Gaus is executive director and chief medical officer at Andean Health & Development. During his senior year at Notre Dame, Gaus and his classmates “spent many evenings into the wee hours of the morning talking about doing service work, and I got the bug,” he said. With the encouragement of then-University President Theodore M. Hesburgh, David traveled to Quito, Ecuador, where he spent two years at The Working Boys’ Center, a Catholic mission that provides education and job training. “It was a life-changing experience for me,” Gaus recalled.
Another life change was just around the corner: Playing basketball at a missionary hospital’s gym, he met a man researching tropical diseases. That meeting sparked an interest in medicine that led Gaus to return to Notre Dame to begin the pre-med program. He finished his medical and public health degrees at Tulane Medical School, trained in Milwaukee, and returned to Ecuador, determined to make a difference in health care. Gaus started off setting up a small rural hospital to address urgent care. “Then the issue became, how do we make it work? How do we finance it? So that’s where those accounting skills and the business skills from the old days returned,” he said. “I started peeling off the cobwebs and using terms that I hadn’t spoken since undergrad days. The synapses started firing again.” The challenge was how to provide health care to a very poor population, where people live on less than $2 a day. About 30 percent of the population can actually pay out of pocket. For the rest, Gaus has tried a number of financing mechanisms over the years and found several that work. One is to pitch inexpensive health insurance to local business owners, pointing out that it is in their best interest to keep employees healthy and productive. Another is to sell a small prepaid health plan, which costs about $30 a year and covers most health services. Other options involve obtaining financial assistance from employers or from local officials. Between those mechanisms, the venture became completely self-sustainable as of 2007.
Today, Andean Health & Development operates a hospital in the rural town of Pedro Vicente Maldonado, and two more locations are planned. Since its founding in 2000, the hospital has treated more than 75,000 patients, including 2,500 childbirths, 1,200 surgeries and 7,500 emergencies.
One thing Gaus has learned is that patients generally are willing to pay something for health care. “The people have a tremendous amount of pride and they’re interested in paying,” he said. “There is a dignity and a pride there that is humbling.”
Another lesson gained was the value of listening. He has seen well-meaning people go to foreign country with a know-it-all attitude, but that just doesn’t work, he said. “Not only do I listen to patients, but I’ve surrounded myself with a great team of Ecuadorians who have taught me what no one can learn in any classroom.”
With an eye to the future, he’s applying his business and medical skills in a new venture: Andean Health & Development opened a medical residency training program jointly with the Pontifical Catholic University of Ecuador in 2008 to train family physicians in rural hospital care, combining medical and administrative skills. “Creating the leadership with business skills is critical in moving forward with our health agenda in Ecuador,” Gaus said.
By Nancy Johnson