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., Introduction: Against the increasing recognition of the critical importance of a direct participation of community members to assure effective health care in peripheral areas of Middle and Low Income Countries (MLIC), representative field experiences of their essential role are only occasionally available., Aims and Methods: We report a narrative, factual documentation of a spectrum of projects covering the basic and specific health needs of the disperse communities in Ecuador, a model MLIC, and discuss the broader implications of the role and performance of HPs over a long period, 1980-2018, in the project activation, implementation and monitoring., Results: The role of 60 HPs, with the coordination of a small core group of professionals of the Centro de Epidemiologia Comunitaria y Medicina Tropical (CECOMET) is documented through their main achievements which include: infectious diseases and in particular Neglected Tropical Diseases (eradication of onchocerciasis and yaws; virtual elimination of malaria and of strongyloidiasis; identification and control of a new focus of Chagas Disease; control of tuberculosis), mother and child health, reproductive health, hypertension (as model of the emergence of non-transmissible, chronic diseases). The most effective and sustainable strategies and methods are discussed also in terms of their more general transferability, already partially tested in programs in Bolivia, Burkina Faso, undeserved areas of Argentina., Conclusions: The systematic availability of non-professional, trained HPs should be recommended as a sustainable and reliable component of health care strategies and interventions targeted to marginalized settings, to assure a concrete accessibility to the fundamental human right to life.

Chikungunya is an arboviral disease transmitted by Aedes mosquitoes. The disease typically consists of an acute illness characterised by fever, rash, and incapacitating arthralgia, that can persist for months. Chikungunya virus, a member of the genus Alphavirus, has recently caused a large outbreak on islands in the Indian Ocean and on the Indian subcontinent. The ongoing outbreak has involved more than 1.5 million patients, including travellers who have visited these areas. We describe our casistic of six travellers with Chikungunya arthropathy. All patients experienced fever and rash of short term during a travel in areas of epidemicity. All patients had peripheral poliarthralgias, which duration was >2 months in 4 cases (66%) and >6 months in 1 case (16%).