DGH in El Salvador: Earthquake Relief By Marcelo Venegas-Pizarro, MD

The warm humid air of San Salvador struck me as soon as I got off the plane. Like other Latin countries, the airport was filled with family members awaiting their loved ones. Surveying the crowd I saw my name on a sheet of paper with Franchesca and Maximo holding it. They both belong to the church Maria de los Pobres in La Chacra, an area known for its crime and poverty.

“Entering San Agustin was like entering a war zone, not only because of the strong presence of the military and police armed with rifles, but because of the overall devastation. It seemed that there was not one house left standing.”

As we sped down to the town of San Agustin in the province of Usulatan, Franchesca, the gringa, introduced herself as a volunteer at the Church for over two years, having left behind Lansing, Michigan and bringing her pharmacy skills to use in San Salvador. Maximo, the driver and church handyman, would later tell me his harrowing story more in depth.

As a child I had participated in activities concerning El Salvador that my parents assisted, denouncing the atrocities by paramilitary death squads and the US support of them. In my memory stood out the assassination of the Archbishop of San Salvador, Oscar Romero, an outspoken critic of the government and a “priest of the poor.” The rapes and slayings of three American nuns and a female religious worker in 1980 also stood out in my mind. The more than ten-year civil war had come to a halt in 1992 through a peace agreement between the guerrilla, Farabundo Marti National Liberation Front (FMLN) and the Salvadoran government. The war had claimed the lives of over 75,000 people, mostly civilians, with over $6 billion given by the US in support of the Salvadoran government.

Marcelo (far left) with Honduran volunteers, two weeks after the quake.

I had come to El Salvador as a DGH volunteer to aid in the earthquake relief. The earthquake had struck El Salvador on January 13th, leaving massive destruction in the poorer regions. On the highway we passed relief trucks heading in the same direction. Fields of cotton, wheat and corn surrounded the highway along with chains of volcanoes on the horizon, including San Vicente and San Miguel. Soon we hit dirt roads and dense vegetation, as we entered the road to San Agustin. On the road we met Father Cesar, with his sombrero and constant smile. Young men with their machetes climbed onto the back as they hitched a ride to go and work the fields.

Entering San Agustin was like entering a war zone, not only because of the strong presence of the military and police armed with rifles, but because of the overall devastation. It seemed that there was not one house left standing. The women in makeshift ovens made tortillas and the children played in the dusty street running behind cars. Pigs and dogs ran in the streets and an occasional ox-driven cart stumbled by. We arrived to what was once the church of San Agustin greeted by Father Amilcar, Jaime and Olman. Jaime was a volunteer from the Maria de los Pobres Church, where he was in charge of the clinical lab. Olman is from San Agustin and had also been volunteering in the church reconstruction. Over 30 Honduran volunteers had come from a sister church to help in the earthquake relief. The overall scene was very busy, with tents sprawled over the grounds and people at work building latrines, bathhouses, cooking, or removing the concrete and adobe debris.

We walked all over the town surveying the wreckage. Jaime told us about how much aid had arrived, but explained that the ARENA party government of President Flores had allocated it mostly to its controlled zones. We also went into the San Agustin Clinic ran by two recent Salvadoran medical school graduates, Drs. Maureen and Jose, who were doing their year of social service. They had received several donations of medication from abroad and were busy seeing many patients, but the majority of the emergencies had been already controlled. They explained how lucky it was that the earthquake had occurred at midday, when most people were at work. Otherwise, they said, many more would have died.

That afternoon, I worked at the clinic seeing patients, but after a visit by one of the Salvadoran ministers of health (who showed up in a Range Rover and had the audacity to ask me for tents for their clinic), Father Amilcar, Father Cesar and I decided that my work would be more useful visiting the surrounding communities or cantones. That night, after getting used to the dust, latrines and outside bathhouses, we congregated to sing songs with a guitar in hand–mostly religious songs, but intermixed with songs of protest, many of which I knew from Chile, my birthplace, and the resistance movements in exile. We all ate together with the Honduran volunteers and shared our day’s events in the evenings as well as handed out medications as needed.

We visited a total of six cantones, all surrounding San Agustin: Buenos Aires, Galingawa, El Coroso, Los Patios, El Jicaro and El Rodeo. Many were far and hard to reach, some accessible only by walking. Many cantones had smaller populations, decimated by the war. In fact, some had been wiped out completely. We would set out with our medications in boxes, mostly acetaminophen, ibuprofen, parasite medication, common antibiotics, anti-fungal cream, vitamins, first aid supplies and oral rehydration salts. The people in the communities greeted us with great warmth and friendship, bringing cool water or atole to drink.

The majority of the cases we saw were not actual emergencies or earthquake-related medical needs. They were mostly chronic problems that already existed in the community. The mothers would diagnose parasites in their children–mostly enterobious and ascaris–when they saw the children not wanting to eat, fatigued and grinding their teeth at night. Cough and sore throat was very common due to the great amount of dust from the demolished buildings and clearing away of debris. Headaches, urinary tract infections, and fungal infections were all very common as well. Anxiety was also prevalent due to the aftershocks that continued to shake the earth well beyond two weeks after the earthquakes. I would awaken at night to temblores, the earth swaying back and forth, not knowing if another earthquake was soon to come.

In all, with the help of Jaime and Dr. Maureen, we must have seen some 800 patients in the cantones. There were also some memorable cases, such as a young man with an arterial laceration from a machete and a child who was brought to us in a state of lethargy from vomiting. We started an intravenous fluid line and sent the child to the closest hospital (one-hour away). We also encountered an elderly gentleman with a cerebral stroke and followed up on a mother and child in leg casts because a wall had fallen on them.

Marcelo at the health workshop held every Sunday at the San Augustin church.

Three days into my arrival there was talk of organizing a health promoter group with representation from each canton. On Friday night Jaime, Maureen and I headed to San Salvador to meet Father Daniel from the Maria de Los Pobres Parish to help organize a meeting with representatives from each canton. It was the following morning that Maximo, the driver, explained to me during breakfast how a military death squad had killed his father and brother. He showed me their pictures in a thick binder along with many more pictures of those killed. Jaime had talked to me about the hundreds of deaths of protesting youth at the university and at the hands of death squads in the middle of the night. With that in mind they gave me a poster of Monseñor Romero to take home with me, which read (in Spanish): “It is blood and pain which will water and nourish new and each time more numerous seeds of Salvadorans, who will take consciousness of the responsibility that they have in constructing a society that is more just and humane.” El Salvador had been one of the main centers for the Liberation Theology movement espoused by Monseñor Romero and many others, who believed in the church as an active entity in the struggle for justice and equality for the poor.

That Sunday after mass we met with representatives from nine cantones. The people discussed some of their main health issues–such as latrines, waste containment, first aid medical kits for each community, transportation and emergency care. The theme for that day was hygiene, with several points discussed, including the washing of hands, washing fruits and vegetables, the daily bathing of children and adults, dental care, water purification, latrines, and the containment of animals. An elderly man stood up and announced that more emphasis should be placed on medicinal plants, listing several of them and their uses. From there it was established that they would all meet the following week to discuss natural medicine. Back at La Chacra, Jaime had already ordered several hundred herbal pills of Passiflora and Valeriana, used for anxiety and nervousness. A student from San Salvador arrived with several posters on good health promotion that were handed out and the people seemed enthusiastic to meet again.

Dr. Maureen, Jaime and Olman will continue the health promoter project with support from both parishes, the San Agustin clinic and the clinic at Maria de los Pobres. They plan to meet every Sunday after mass with the canton representatives for a health workshop. In turn, each will take what they learn and teach within their respective community. I will coordinate DGH help to raise funds and send volunteer teachers for this project. One of my first goals is to raise enough money to buy first aid kits for each canton.

My last day in El Salvador was spent in celebration of all the work we had accomplished, bathing and playing futbol on a beach named Espinares. At night we said our farewells, with the Honduran volunteers speaking beautiful words about all the work that was done. I explained how I viewed health as something that should be available to all and something that encompasses, not just the use of medication, but also adequate housing, food, jobs, space for children, mental sanity and a healthy environment, and that means striving against poverty and for more equality. We all sang together and promised to meet again.

I got a ride to the airport from Father Amilcar. As he was leaving I gave him all the dollars I had left, not realizing I would end up stranded, trying to pay the $28 airport tax with an out-of-order cash machine. While talking in vain to a manager, a man approached me and said he recognized me as the doctor working in Usulatan and handed me forty dollars.

Upon leaving, I thought of the countless children I had seen, beautiful, barefoot children, innocent of all their parasites, innocent of all the poverty, innocent of all the war, innocent of all the greed, and a quote came to mind of a Guatemalan poet, Otto Renee Castillo: “Nothing can against this avalanche of love... nothing can against the faith of the people, in the sole potency of their hands... nothing can against life...”