Since 1990, an interdisciplinary and interinstitutional team of scientists has led a research-intervention initiative examining pesticide impacts on agricultural production, human health, and the environment in the highly commercial potato growing province of Carchi, Ecuador. This article synthesizes the key results of that initiative, analyzes the lessons concerning the process of transdisciplinary ecosystems health research from a methodological perspective, and identifies priority future research opportunities. Research on this initiative has covered a broad range of activities with a full spectrum of rural stakeholders. These have included: health studies of the incidence of pesticide poisonings and the neurological impacts of pesticide exposure on farmers and their families; environmental and personal exposure studies; economic studies on the role of pesticides in agricultural production; sociological studies of farmers attitudes, knowledge, and practices related to pesticide use; and participatory interventions to reduce pesticide-related impacts. Research results have shown that pesticide poisoning incidence in the potato growing zones of Carchi, Ecuador match the highest reported rates in the world. A majority of farm household members suffer significant neurological impairment. Economic and participatory research has shown that there are viable alternatives to the use of Class 1 highly toxic pesticides in the zone. Nevertheless, cultural and political factors are impeding substantial changes in current practices.Future research-intervention activities include longitudinal analyses of the health, environmental, and production impacts of participatory interventions, and a scaling up of analyses to encompass other regions in the Andean mountain ecosystem with more limited indicators of key constructs.