of San Salvador By Denise Zwahlen |
| “It was inspiring to witness this impressive social movement in action after having heard about the struggle of the Salvadorian population against the privatization of healthcare.” |
A group of us slowly gather to board the two buses that will take us to San Salvador, the capital, to join in a mass demonstration to protest the government's plan to privatize the health care system. I know most of the people who arrive one by one to make the trip to the capital. They are a pretty good representation of the community: farmers, housewives, students, young mothers, teachers, community-council members, health promoters. A week ago I saw many of them in Sensuntepeque, the Departmental capital, joining in a local protest on the side of physicians and nurses from the area hospital and others from neighboring communities.
As the sun rises, the old school buses, colorfully painted, make their way up the steep road picking up more passengers along the way. I love that ride out, with a great view over the mountains of Honduras some 15 kilometers away.
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| Health workers marching against the privatization of El Salvador's healthcare system. |
It is hard for me to remain a by-stander and just take pictures. I chant along, raise my fist, run up and down the street to catch a good view of the huge march. By the time we arrive at our destination at the National Cathedral, the crowd has swelled to thousands (estimated at 150,000). This third Marcha Blanca (white march) will play a key role in putting the pressure on the legislative assembly to approve a decree that outlawed the privatization of health care.
It was inspiring to witness this impressive social movement in action after having heard about the struggle of the Salvadorian population against the privatization of healthcare. When I returned from a six-month stay as a DGH volunteer in El Salvador last year, I was anxious to continue my involvement in support of the people I had come to know and love. But it is not difficult to stay connected in the US, since over a quarter of the Salvadorian population now is living here, forced to emigrate for economic or political reasons.
This on-going strike began in the Fall of 2002, when workers from STISSS (the health care workers union) held a one-day strike to protest privatization and the firing of union leaders. Since then, the movement has gained tremendous momentum under the leadership of both health care workers' and physicians' unions. It has the wide support of the general population. I had learned more about the struggle from Ricardo Monje, Secretary General of STISSS, at a conference convened by 1199/SEIU (Service Employees International Union) in the Dominican Republic. Delegates from many countries met to discuss the impact of Globalization and Privatization on the healthcare systems in the Americas and to elaborate an action plan. Monje took time away from his important organizing work to make us aware of their fight, to garner support and to encourage participants in their own struggles against privatization in all sectors of society.
Wherever the participants came from, whether from the first or the third world, all had observed the negative impact of privatization: access to quality health care had never been there for the majority or had been severely curtailed in recent years. Privatization means that governments with their current limited resources allocated to health are further abdicating their responsibility to serve the most vulnerable and disenfranchised in their population. In many cases, it is the majority. When large corporations take over the delivery of health care services, more then ever it reinforces a two-tier system: those who can pay versus the poor. Health as a human right is replaced by health as source of profit for stock holders.
The discussion of this phenomenon seemed particularly vital at a time when the United States is trying to force seniors with Medicare into managed care plans, despite rampant proof that they are less cost effective than the government-run system, and exporting this private "model" to the rest of the world. Furthermore, CAFTA (Central America Free Trade Agreement) implementation requires from participant countries that they privatize the different sectors of their economy and open their doors to transnational corporations.
I came back from my trip last fall inspired by what I witnessed and participated in, and with a renewed commitment to international solidarity and local activism. What can you do?
- Support striking workers in El Salvador by sending letters to the President of El Salvador and the Salvadorian Desk Officer at the US State Department, and donating money to the Emergency Fund in support of union workers (www.cispes.org/english/Newsletter/).
- Put pressure on our own US representatives to oppose the implementation of CAFTA.
- Participate in the movement to provide health care for all and to save Medicare in the US.
- Bear witness to the effects of globalization and advocate for the voiceless.
By Virginia Rodrigues, MD
When the ARENA party came to power in El Salvador in the late 1980's, it began the structural adjustments to pay the external debt recommended by the World Bank and the International Monetary Fund. They called for reduction and privatization of many state services, including the healthcare system.
The doctors' movement to improve the healthcare system and fight privatization began in 1998 with the appointment of Dr. Jose Marinero Caceres as president of the Colegio Medico (the Salvadoran Medical Association). Inside the Salvadorian Institute of Social Security (ISSS), doctors who had already organized a union began to demand their rights. As a surgeon in Hospital Rosales, the largest public hospital in El Salvador, and an active member of the Colegio Medico, I have an insider's perspective on the struggle.
When initial negotiations with administrators failed, we began small demonstrations and one-day strikes. The government agreed to negotiations, which resulted in a signed agreement stating that the government, the Colegio Medico and civil society together would plan a stronger healthcare system.
Soon after current President Flores Perez took office, the ISSS saw that privatization was going forward when two hospitals were given in concession. As a result, lobbying began again inside the ISSS, spreading through the Colegio Medico and the public hospitals. This time hospital doctors dared to strike and participate in marchas (protest marches) in November and December 2001. The government responded with the use of tear gas, powerful water hoses and firing at people inside the hospitals. The leader of the protest movement received threatening phone calls.
The administration ignored the previously drafted agreement, but when doctors threatened to leave the hospitals, Flores Perez temporarily stopped his policies. After several months of work, another document was signed that proposed improving the healthcare system and not privatizing both ISSS hospitals (although details about exactly how to carry it out and pay for it were still pending).
The government, however, continued to undermine its own agreement. The director of the ISSS was replaced by Ramos Falla, who had been the key advisor in the privatization of Salvadoran telecommunications. Meanwhile healthcare-system reform was put on hold due to the first dengue outbreak, the conversion from Salvadoran colones to US dollars as the official currency, two big earthquakes, and a second outbreak of dengue.
Astonishingly, the government did nothing to repair the damage the hospitals sustained after the earthquakes and they would have remained in their battered state had it not been for direct international aid.
It was not until after the meeting of the National Association of Private Enterprises (ANEP) in 2002 that the privatization of the ISSS emerged as one of the President's principal goals. Health care worker representatives tried to speak with Salvadoran business leaders from ANEP, as well as people in the executive branch and the ministries of labor and health. Nobody listened, prompting a one-day strike at the main hospitals, which was not taken seriously. Then, on September 27, 2002, doctors at the Oncology hospital of the ISSS walked out. When they continued to be ignored, doctors staged walkouts at the Medical, Surgical and Specialty Hospitals as well.
When President Flores Perez sent his privatization proposal bill to the Salvadoran Legislative Assembly, the Colegio Medico sent a counter bill with a "state guarantee of health and social security," which was surprisingly approved by the Assembly and passed to the executive branch for final approval. To force the passing of the bill, the first Marcha Blanca (named for the health workers' white coats) was carried out with 50,000 doctors, nurses and other concerned citizens on October 16, 2002. Seven days later, the second Marcha Blanca brought out 200,000 people. A week after that, President Flores Perez withdrew his privatization bill from the Assembly. On November 9, the third Marcha Blanca brought hundreds of thousands of people to the streets. The Colegio Medico's bill became law 1024 on November 20.
Immediately after it was passed, however, the President, his administration and the deputies of ARENA began to show their disapproval. They suggested the bill was unconstitutional and began to create chaos inside health institutions in order to blame it on the new law. They did this through strategies, such as not renewing the contract for the treatment of hazardous waste and firing all doctors with annual contracts. The Colegio Medico continued the strike, though repression and threats against the marchas began to escalate.
To the people's surprise, law 1024 was revoked on December 19 and replaced by law 1025, which permits any type of privatization. The government opened negotiations with the doctors mediated by the Catholic church, but were not serious about negotiating, proven by the fact that one of the ISSS hospitals was taken over by the police. When the Colegio Medico asked for an international mediator, the government halted all negotiations. Now that the elections have passed, the government seems more interested in negotiation because the ARENA party lost a lot votes due to their authoritarian attitude.
So the struggle continues!
