War Torn El Salvador On the Mend

Although I had never been to El Salvador before, there was a familiarity to being in this Central American country. Some of that came from having been to other parts of Latin America: Colombia, Bolivia, Costa Rica, Peru, Mexico. But the stronger sense of deja-vu came from having been in other war-torn countries like Vietnam and Cambodia, where Clear Path has its programs and where I visit regularly.

Just when I arrived in El Salvador last week, the newspapers were full of commemorative articles marking 15 years since the end of the civil war that deeply scarred this small nation from 1980 to 1992. The area around San Miguel, the country�s third-largest city where I attended a project conference for Rotary, was a leftist rebel stronghold. It hasn�t been a generation yet since both sides laid down their weapons.

There are reminders of El Salvador�s recent instability. Every office, store, hotel, restaurant and bank in San Miguel has armed guards with pump-action shotguns, revolvers or Uzis. But this country of 6 million people between Guatemala, Honduras and Nicaragua is further along in its recovery then, say, Cambodia.

The infrastructure looks fairly �together� with a lot of decent roads, plenty of newer vehicles and buses. Chain restaurants are beginning to pop up. There is even an American-style shopping mall in San Miguel. A lot of money comes into the economy from Salvadoran family members who work in the United States, from drug trafficking, coffee trade, sugar cane processing, cattle and dairy farms and a modestly growing tourism industry.

A big new seaport on the Pacific coast will form part of a new land bridge moving cargo containers to Honduras on the Atlantic because the Panama Canal has become too small for the newest generation of containerships that can carry as many as 64,000 containers.

Despite a brightening future, however, many segments of the population haven�t shared in much of the newfound prosperity.



In many ways, it�s hard to tell there was a war here now. I saw no bullet-pocked walls, no wrecked military vehicles or bomb craters like you still do in Vietnam. Neither did I see many landmine accident survivors so visible in Southeast Asia. According to the Landmine Monitor, El Salvador has been 97 percent mine-free since the mid 1990s despite a legacy of 20,000 in 425 minefields at the end of he war.
In 2005, the Landmine Monitor recorded four mine/bomb casualties, including two killed and two injured in one landmine and two incidents involving explosive remnants of war (ERW). All of the casualties were children. In 2006, no new accidents were reported. El Salvador has an existing population of nearly 3,000 landmine accident survivors. They are treated within the regular health care system, which is one of the reasons Clear Path decided to tap into its medical donations program to help some of the local hospitals.
But there are other health problems that require attention. The country has high rates of dysentery, typhoid, malaria, dengue and malnutrition. Three to four people are newly infected with the AIDS virus every day. Teenage pregnancy is endemic, despite a growing acceptance of birth control in this overwhelmingly and traditionally Catholic nation.
Our mission during the Rotary project fair I attended was to check in on San Miguel�s health care facilities. We found they need a lot of help, lacking a lot of the equipment and basic supplies to meet a growing patient demand. We visited two hospitals. In an earlier blog, I described the hospital in Ciudad Pacifica, a low-income barrio of more than 60,000 residents with little access to decent and affordable medical care.
On Saturday, we visited the �federal� Hospital Nacional San Juan de Dios. The place was crowded. As many as 700 people a day come into the emergency room, though the official bed count for the facility is only 180. The hospital handles about 6,000 deliveries per year. Often, young mothers have to double up on a bed in the maternity ward.
Here and at Ciudad Pacifica, I was lucky to be accompanied by Mike Keckler, a Rotarian who runs a medical equipment business in Modesto and makes large used medical donations on the side. The two of us and his wife Suzy identified a long list of items they need: wheelchairs, IV poles, respirators, patient monitors, delivery tables, ultrasound, gurneys and all sorts of surgical supplies. We noticed the hospital staff simply autoclaves surgical items over and over again, even disposables such as plastic drainage trays that were beginning to look warped and rubber gloves that should be tossed after a single use.
Between the Centro de Salud Josefina Vilaseca and the Hospital Nacional San Juan de Dios, Mike and I will try to put together several additional container shipments to provide the poorly paid doctors here (they make only $400 - $450 per month) with better tools and supplies. We�re lucky to have a local partner in the San Miguel Rotary club which helped us navigate last year�s container to the Centro de Salud through Customs.
By the time we�re done with the series of shipments this year and next, there should be about four or five containers� worth of new equipment and supplies at the two hospitals. I am planning to come back next year to check on the use of what we send and reassess the facilities needs.