The impact of community-based ecotourism is contingent upon the community’s involvement in the development and management of activities, as well as their access to and the comprehensiveness of benefits. The ecotourism business owned by the Tacana Indigenous community of San Miguel in the Bolivian Amazon provides a model as to how Indigenous communities can harness social entrepreneurship to address economic, social, and environmental challenges. This article reviews the origins and development of this business, and draws on participant observation research, interviews, surveys, and economic analysis to illustrate the lessons learned and challenges faced. The findings are presented to inform existing and new Indigenous tourism ventures, policy considerations, and future research.

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Background and Objective Children of Spanish-speaking caregivers face multiple barriers to care in academic medical centers. This study identified barriers and facilitators of health care, and described use of health information technology in order to guide interventions and optimize services. Methods In-depth, audiotaped interviews were conducted with monolingual Spanish-speaking caregivers (N=28) of children receiving care in academic medical center clinics using a structured interview guide. Interviews were transcribed in Spanish, and key themes were identified using thematic analysis. Illustrative quotes for each theme were translated into English. Results Language-specific barriers included: arrival/registration occurring in English, lack of bilingual personnel, heavy reliance on interpreters, long wait times, and challenging phone communication. Non-language-specific barriers included: medical center size and complexity, distance to services, lack of convenient and coordinated appointments, missing work/school, and financial barriers including insurance coverage or lack of citizenship. Caregivers identified interpreters, bilingual physicians and staff, and written materials in Spanish as facilitators of care. Most caregivers had internet access and expressed interest in health information technology, including patient portals, to communicate about their children's health. Conclusions Caregivers of Spanish-speaking children encounter many language-specific barriers, which are compounded by non-language-specific barriers arising from complex health systems and social needs. Caregivers with limited resources described working hard to meet children's complex health care needs despite these barriers. Most caregivers had internet access and interest in patient portals. Academic medical centers may need multifaceted interventions that improve the availability of bilingual staff and interpreters and also address caregivers' social and informational needs.

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