2 systems of health care coexist in Ecuador. The traditional system combines elements of the indigenous system, the modifications brought by the Incas, and elements of medieval European medical theory and practice. The official medical system comprising both public and private institutions is inaccessible for large sectors of the population due to shortages of manpower and materials and high costs of services. The official system tends to address itself primarily to the relatively high income urban population. Ecuador's high infant mortality rate of 64/1000 attests to the limitations of its health care system. The traditional system provides care for much of the rural population and areas where western medical care is not available, but it is also represented in the city. According to traditional beliefs, illness is a social phenomenon indicating a problem in relations with one's peers, nature, or supernatural beings. Traditional disease classifications are different from those of western medicine and show strong regional variation. Improvements in health conditions in Ecuador should take into account the coexistence of multiple medical practices serving large numbers of people.