Maria del Carmen in the hospital

On Tuesday I took Maria del Carmen to the National Hospital in Cojutepeque, where she had an appointment with the orthopedic surgeon.  I know the Cojutepeque hospital from our eye surgery week there in 2011 - it's a beautiful hospital, recently built after the 2001 earthquake damaged the earlier site and well run.

We got there at 9 am and were met by Maria del Carmen's sister, Ana Maria Melendez, who has worked at the hospital for 32 years.  She brought a wheelchair and an orderly who huffed and puffed and barely managed to lift Maria del Carmen from the car to the wheelchair - my respect increased for Alcides and Darren, who have both carried her greater distances without breaking a sweat.

The orthopedic surgeon was supposed to be seeing patients at 10.  He arrived at 1 PM, after getting out of surgery.  In those three hours, we got to know some of the other patients and practiced our patience, an essential act in El Salvador.  He looked at Maria del Carmen's X-rays and agreed that her leg needed surgery and pinning, but said that he did not have the equipment for that in the Cojutepeque hospital.

I said that I would be glad to purchase the pin or other equipment needed, and was surprised to hear his answer: the Ministry of Health no longer allowed families or friends to purchase materials needed for surgery, and this rule was being strictly enforced.  I didn't know whether to cheer or weep - it's truly an act of justice that all patients in the national health system are being treated equally, that those who can find some money don't get to jump the line.  But I had so hoped to help Maria del Carmen get her surgery early!

That was not to be.  The surgeon said he would admit her to the Cojutepeque hospital where all the preliminary tests would be made.  Then she'd be transferred by ambulance to the hospital in San Vicente or Usulutan, where she'd have the surgery, and be transferred back to Cojutepeque for rehab.  It did occur to me that it might be more efficient and more effective to move the pins to Cojutepeque!  There was no clear date when the surgery would be done, though I'm hoping that having a sister in the system will help insure that Maria del Carmen doesn't have to spend any more time than necessary in Cojutepeque.

We then took her through a couple of stations for tests - chest X-Ray, blood tests - and up to the surgery ward, to a room with eight beds, where I left her.  We've talked the last two days - all her tests came out well, but she hasn't yet heard anything about when or where she'll go for surgery.  May it come soon.

Bureaucratic tangles

Last week I had two brushes with Salvadoran bureaucracy that left me both crazed and awestruck.

Darren and I came out of a meeting at the Ministry of Health - I'd been pleased to find a place to park my car right in front of the building - to find a ticket on the windshield.  I saw that I'd parked by a yellow-painted curb, and down at the other end of the block was a small sign saying that parking was only available for official cars.  Ooops.  It had been raining and the ticket was soaked, so we put it to dry on the back seat.  A couple of stops later we noticed that the car no longer had license plates.  Our first and natural assumption was that they'd been stolen - a good possibility, as the Ministry of Health is in the historic center of town where thieves are said to abound.  Darren called a lawyer friend to ask how we should report this crime, and the lawyer asked if by chance we'd gotten a ticket.  Well.....yes.  And when we looked more closely, we discovered that the ticket - which was listing this parking mishap as the heaviest possible level of transportation crime and assessing a fine of $54, astronomical in Salvadoran terms - had a little checkmark noting that the plates had been removed.

So we called Darren's lawyer friend again and he sent us to an office of the transportation police.  When we got there, the guard at the gate refused to even let us enter; instead, he gave me a one-page paper telling me that I couldn't pay the fine and get my plates back for 24 hours.  I drove back to Suchitoto hoping I wouldn't have to explain myself, and then back into the capital the next day, 24 hours later, to pay the fine.  In Sertracen (where one pays fines and renews licenses) they happily took my $54 and told me to go around the building to the Vice-Ministry of Transportation Office to collect my license plates.  When I got there, the officials on hand looked at my paperwork and looked at their files and informed me that my plates were....somewhere else.  I would have to come back the next day.

And so I drove back to Suchitoto (this time at least I had paperwork to show I'd paid the fine, and a good thing too, as finally the police did stop me to ask why I was driving with no license plates) and back to Sertracen the next morning where I finally got the plates, but not the nuts and bolts that had held them on the car - those had apparently been discarded on site, or in someone's pocket.  I'm still trying to figure out why parking in a forbidden parking space is a crime more heinous than speeding (ticket of about $15 if I remember correctly, and no tinkering with the license plates) or any of the other really dangerous tricks that Salvadoran motorists get up to daily. 

That same day, after retrieving my plates, I went to the Migration office where I'd paid for my year's Residence Visa in January, but had yet to receive it.  I've had to purchase two 3-month temporary visas so I could leave and re-enter the country.  But the best moment in this particular bureaucratic hell was in August when the office called me to come in, and told me that I had to get a letter from the embassy to say that I am really who I say I am because the version of my name was slightly (very, very, very slightly) different in my birth certificate, my police check, and my passport.  Never mind that all three showed the exact same place and date of birth and that the difference was between Susan Vera Dewitt, Susan Vera De Witt, and Susan V. Dewitt.  Not only did I have to go to the embassy for a letter ("we see this all the time," they said, tiredly), I had to pay to have Salvadoran staff in a special little office not far from the embassy to put an apostille on my letter from the embassy to certify that it was genuine.  I had, of course, to pay for that, which may well have been the point. 

This time, in October, I didn't get past the front desk of the Migration office.  The receptionist kindly informed me that my card wasn't ready, and probably wouldn't be, and they were changing the whole process somehow, and things would be different next year, but meantime...meantime....

And then I went home, asked Alcides to attach my license plates, and tried very hard to stay peaceful.

Elections

I learned that the blissful silence in our next-door disco last Saturday was owing to Sunday's elections for legislative deputies and mayors in El Salvador - no liquor sales are allowed for three days before an election and I gather there's no fun to a disco that can't sell booze. 

It was a beautiful thing to see my friends and neighbors dressed up in their Sunday best - it was Sunday after all - to vote.  Martha said that, after all, it is a fiesta day - and that's what voting should be everywhere where we are privileged to vote in free and open elections - which these mostly were, from all accounts.

The results were cheerful for ARENA, the largest party on the right, and dismal for the FMLN, the main party of the left.  Arena gained some seats in the legislature, the FMLN lost a couple, and lost several important mayoralities as well.  The vote was much lower - at about 50% of eligible voters - than it had been three years ago.   And Suchitoto will continue to have an FMLN Mayor - Pedrina Rivera will be the new Alcaldessa. 

For a fuller analysis, see Tim's El Salvador Blog.

La vida política

I drove back to Suchitoto in the late afternoon yesterday to find a couple of policemen directing me away from my usual route to the Centro Arte para la Paz where I park the car. I turned the corner and found a few more policemen at the next corner. Several corners and several policemen later I was finally able to get to the Centro Arte by making a wide swing around the center of town, noticing on the way several FMLN buses parked. Of course I had to find out what was going on, so I walked back via the Parque Central and noticed that the street that goes past the Alcaldia (City Hall) was set up with a stage, lots and lots of FMLN flags, and a covered area for dancing. A normal enough sight in this city that for the past 24 years has been voting FMLN (this is the party of the left, formed by an alliance of five smaller political parties in 1981, in the early years of the civil war). But the event wasn't normal, and that's why the police were out in force. The FMLN 's central committee has named Pedrina Rivera as the candidate for Mayor in the elections coming in March, 2012, and many in Suchitoto were upset that they had not been consulted and that the current and very popular FMLN Mayor, Javier Martinez, would not be up for re-election. The flags and banners and stage were set up for Pedrina Rivera's opening speech in the campaign, and supporters had been bused in to make the event look festive and popular.

I didn't stay around to witness the event - it seemed like one of those fights in the family where you'd just as soon the guest didn't witness it - but I learned from the paper today that there had been protests and a scuffle, plastic bottles and pop cans had been thrown, and there was enough shouting to drown out the official words. And then, perhaps to everyone's relief, the sky broke open with thunder and lightning and torrential rains and the rally was at an end.

This morning when I walked over to church, the banners and flags were torn and tattered. It had been a hard night in Suchitoto.

Noise and silence

Apologies for the blog silence...it's only because I've been in the United States - in Bellevue, Washington - since early June, so I haven't had much fresh info about El Salvador to post. Strange things have been happening there: a big constitutional crisis has heated up with the legislature passing a law to require the judges of the country's Constitutional Court to be unanimous in any decision about the constitutionality of a law (many recent votes of this five person court have been 4-1 decisions), and there's been a strong popular protest. The court, perhaps predictably, declared the law unconstitutional. You can read about it in Tim's El Salvador blog, but it's pretty hard to understand the dynamics at a distance (like someone in El Salvador trying to understand the current dynamics around the debt ceiling crisis in the United States).

Meanwhile, blessedly, my own health crisis has been resolved with great medical skill and lots of prayer. I am able to enjoy long walks for the first time in six months - what a joy! - and I will be heading back to El Salvador on July 25th, most thankfully. Perhaps I will find someone there who can help me understand the constitutional crisis.

And also, meanwhile: I've been assembling photos from the last year for our PazSalud calendar selection, and here's a favorite from the May eye surgery mission - left to right, Dr. George Sesson, our optometrist; a happy patient; Dr. Tony Pisacano, our ophthalmologist, and Dra. Silvia Pleitez, our circulator.

Terror on the roads

In the last three days, a rash of bus accidents have left more than 20 people dead, more than 100 injured in El Salvador. This is a story at least as familiar and as terrifying as the stories of extortion and intimidation by gang members.

In each case some of the bus drivers were going far faster than the speed limit, and in some cases the buses were jockeying with each other for the lead. The result - not surprising given the age and mechanical condition of many buses here - was a disaster for the people on the buses and for the overworked hospital system, but not for the owners of the bus lines. (photo from La Prensa Grafica)

I'm told that the owners of bus lines have no requirement to buy insurance or to indemnify people when they are injured by wild drivers or bad equipment. In other words, they have no serious financial interest in making sure that their buses are well maintained and driven by competent motorists.

Since most Salvadorans have no choice but to take a bus or one of the many pickups that provide para-transit around the country, it's a matter of justice to give the bus route owners some self-interest in safety. There's been a call to require owners to have insurance, which seems like an obvious next step, but that seems to be mired in a tug-of-war between those who favor a public insurance provider and the private insurance market. Meanwhile, the crashes continue.

First day of school

Tomorrow is the first day of school for kids in El Salvador. They're at the end of the their summer vacations, which stretch from mid-November to mid-January; school packets are being handed out to parents for the second year, with uniforms, shoes and notebooks. Today after church we ran into a single mother who Margaret Jane has been helping. Her 12 and 15 year old daughters are entering 2nd grade - because, I imagine, last year was the first time she was able to send them to school properly clothed and with notebooks. This is one government program that's worth more than every penny.

Here's one more student on his way - Moises, a young man who our doctors helped to get successful surgery about 8 years ago is now ready to start university. He's going to be studying computer technology for a couple of years, on his way, we hope, to a good career and a happy life, with the aid of a scholarship from some of his friends in PeaceHealth.

Things to take back

I'm beginning to assemble a mighty pile of things to take back. There are the vitamins, and my refilled prescriptions, and yesterday I added the lightest and most important item: three apostilles. These beautiful documents, produced by the Secretary of State's office in Olympia, certify that the license and curriculum vitae of the three doctors who will be part of our May eye surgery mission have been notarized by an authentic notary in the state of Washington. I drove down to Olympia yesterday with my sister Kathy, and the whole process was cheerfully completed within 20 minutes. Our lack of apostilles for the February mission gave me serious anxiety and a bit of heartburn, but now that I know how this process works, I can see that it will be an easy requirement to fulfill in the future.

Tramites

The rhythms of a delightful week of family and sightseeing and visiting were interrupted by word from the Junta Vigilancia de la Profesión Médica. I had given the Junta - the group charged with approving all doctors in the country, whether visitors or residents - notarized licenses and curriculum vitae for all our doctors in mid-December. Now in mid-January, they announced that all the documents lacked an apostille, and that without this they would not approve our medical mission.

For those of you who've never had to get one, an apostille is an official document of the state - in this case Washington or Oregon - which certifies that the notary who notarized the licences and CVs is indeed a legitimate notary. It can be obtained quickly, while you wait, but the offices are in the state capitals, Olympia and Salem, and the licences and CVs would have to be gathered again and notarized again. The requirement for an apostille has been on the Junta's list of requirements for some time, but it's never been enforced before. But here we were with new leadership of the Junta Vigilanicia, and they intend to enforce every requirement. And it wasn't at all clear that we would have time to get the apostilles before our group arrived.

In a fairly frantic day in San Salvador, Dina Duvon and I pled our case at length to the Doctora in charge of our application. We had brought mission groups down here for nine years without ever getting an apostille, we said, and there had been no problem. The people of San Juan Opico were waiting for their chance to get a free consulta, we said. The apostille wouldn't give them any additional guarantees, we said, since the licenses are already instruments of the state and the notary has affirmed that they were presented by the person named in the license. But it didn't do any good. We would have to get apostilles. In phone calls back and forth to Kathy Garcia and other PeaceHealth staff, we figured we might be able to get it done, barely, if everyone hustled their documents over to a notary again and hustled them to Kathy again, and she drove them to the state office and sent them to me by rapid express. Dina and I wrote a letter to the Junta, asking that they allow the mission to go forward even if the apostilled documents can't be presented to the Junta - which meets once a week - first. And we asked the Archbishop of San Salvador to write a letter of support, which he most kindly did.

And that's where it stands. Kathy is hustling and I'm continuing with the organizing here, and we're pretty sure we will have everything together before our mission group arrives, but we'd ask for the good wishes and prayers of anyone reading this. As I've thought this over, I understand that the Junta Vigilancia wants to make sure that any group of doctors that comes here is really legitimate, that they fear, and reasonably so, that the people of El Salvador will get a raw deal from unlicensed doctors or out-of-date medicines. I wish they had been more open to compromise, and perhaps after the new leaders have been in office a little longer they will not be so intransigent.

But most of all, I desire the outcome that will be good for everyone: our group approved and providing health care to people in San Juan Opico who have little access to care. If it takes an apostille, we'll provide an apostille.

We desire a life free from violence

Peggy and Pat answered my wish to have the Suchitoto bird-and-flower motto stenciled by my door, and here it is. The motto says: En esta casa queremos una vida libre de violencia hacia las mujeres - In this house we want a life free from violence against women. You see this stencil all over Suchitoto, a town where women's organizations and women's organizing thrive. But I'd like to amend it slightly as my wish for the new year: In this house we want a life free from violence. In that wish, I join all my Sisters of St. Joseph of Peace, working and praying to make non-violence the touchstone of our lives.

There has been news of terrible violence in this week's papers - two men ran into the waiting room of a pediatric clinic in Cojutepeque, the town that's the capital of our district, threw a grenade and ran out. Two children were killed, others badly hurt. There's been news of organized violence against the people who have been opposing mining interests in the neighboring district of Cabañas - two community activists have been killed, and the day after Christmas a woman environmentalist eight-months pregnant and carrying a two-year-old baby was shot and killed. Little seems to be done in any of these cases to bring the guilty to justice.

So, on behalf of the people of El Salvador who enter this new year full of hope and full of fear, in this country in 2010 we desire a life free from violence.

Suchitoto hosts El Presidente Mauricio Funes

Today was a very big day for Suchitoto, as President Mauricio Funes, his cabinet, and legislative and judicial leaders came to town to inaugurate the Civic Month - September, the month when the country's indepen- dence is celebrated. The event was supposed to start at 9 am, but because there was a demon- stration and tire-burning in San Martin (by a group of campesinos asking for packets of seeds and fertilizer) the cars were re-routed to Aguilares and didn't get here until about 10:30. Meanwhile, the band from Cojute- peque, complete with baton twirlers and dancers, entertained us and the honor guard, in their hot red and black uniforms, had the sense to stand in the shade until the honorables got closer. The women's collective of Suchitoto prepared a huge banner (it reads "Women voted for this government. President Funes, we salute you and hope that you will secure the exercise of our rights.") and many smaller signs; they presented the President and cabinet members with the results of a study of women and demands for greater representation and equality. And yes, that's Sister Peggy O'Neill and Sister Margaret Jane Kling on the right admiring the banner.

Finally the President came in - he's in the center of the bottom photo, the man wearing glasses. I went back home at that point to hear his speech on television, and I could tell that the women would be pleased. He pledged to rebuild the delapidated maternity hospital, to help women secure title to their homes and to find financing to build their businesses. He also said that the liberty of Salvadorans today is menanced not by foreign armies, but by murders, extortion and crime and by the fear and insecurity which these create. Together, he said, Salvadorans can change these conditions. A good challenge for the Civic Month and for the next few years.

On time

Jennifer Cowan from Bellingham is my first visitor in the Suchitoto house. Jennifer arrived yesterday right on time (the plane was a little early, but customs was slow). What wasn't right on time was the process of getting a 220 volt line into the house for the stove. Felix the electrician told me he could finish all his work yesterday. Ah, I said, then I can use the stove? Well no, he said, CAESS (a subsidiary of the multinational giant AES, and the privatized provider of electricity here) still has to approve the connection to the main line. Oh, I said, I thought that happened already. Well part of it did, he said, they gave approval for the line to be installed, but now they have to approve the work that's been done. By now I was becoming a bit hysterical, as I explained to Felix that I have four guests visiting in July and had planned on being able to boil an egg. Felix said he'd do his best to hurry the process along.

The argument for privatizing electricity, like so many other "public" services here, was that a private company would provide more efficient service at lower prices. The price of electricity is very high here, and there seems to still be plenty of bureaucracy to slow things down.

I've lived in Central America long enough to know it may be quite a while before the stove actually works, so Jennifer and I stopped in San Salvador for lunch and a quick trip to a hardware store where I bought a single burner that does not need 220 volts to operate. Boiled eggs assured, we drove back to Suchitoto where we found Felix and his son and daughter hard at work. Felix told me he'd hooked up a connection for the stove that I could use while I wait for CAESS. Great, I said, let's see how it works! Seems the hookup is to a 110 volt line, so when you turn on a burner the red "on" light glows - but the burner, alas, does not get warm.

Jennifer is the perfect guest for times like this, ready to adapt to any circumstances. We went out walking, ate pasteles (a deep-fat fried potato puff, totally yummy though perhaps not totally healthy) and pupusas, went to the first two thirds of an excellent concert by the El Salvador Youth Orchestra (Jennifer had been up for about 27 hours at that point, so we skipped the last number) and we did not miss the stove at all.

The orchestra's appearance was preceded by the singing of the Salvadoran national anthem which, speaking of time, goes on forever and seems to incorporate about three different songs, in an inverse relationship to the size of this country. We were all ready to sit down when the theatre's owner announced that now we would sing the Suchitoto anthem. Thankfully, it's shorter. Today I'll start cooking on the single burner, and I'll be glad for that boiled egg.

The really important thing

The really important thing that happened on June 1st in El Salvador - and that I didn't blog about because I ran out of time - was the inauguration of President Mauricio Funes, the first President from the left-wing FMLN. This is also, I believe, the first peaceful and democratic transition of government from one party to an opposing one in El Salvador's history. A wonderful and memorable day!

At the start of the day, Funes and his wife went to the crypt of the Cathedral to pray at Monseñor Romero's tomb, and to pledge themselves to carry on his preferential option for the poor - a moment of deep resonance throughout El Salvador.

Marta and I watched it all on television from Suchitoto - an event filled with pomp and ceremony, and with deep meaning. I rejoiced in Hillary Clinton's presence - wearing a red pantsuit, the FMLN color - as a sign of U.S. Government support for this democratic transition and for Funes. And we rejoiced in Funes' inaugural address, where he called for a focus on the needs of the poorest people in El Salvador, for new homes, a better healthcare system, better education. Funding all of this and carrying it out will not be easy, it never is, but Funes begins his term with a 72% approval rating, which will surely help. For more details on his speech and the first steps of the new government, go to Tim's El Salvador blog, always an excellent source of evenhanded information. By the way, Funes named Obama and Brazil's President Lula da Silva as his inspirations in choosing the path ahead.

Now I find myself in Guatemala, which is having its own political troubles. But in the beautiful city of Antigua, all seems very calm and peaceful (and full of U.S. tourists - you hear as much English as Spanish in the streets). I'm spending four hours a day with my splendid teacher, Rosa Maria, and let me tell you, it is exhausting to have one-to-one instruction for four hours. Home is about eight blocks from the school, with Thelma Molina, who has a great family and a pleasant house - and is a good cook as well. Between times, I'm reading novels in Spanish, going to Mass at the historic churches here, and wandering happily in Antigua. Oh, and going to sleep at 8:30 pm because I can't keep my eyes open any longer.

Views of Suchitoto

So much is going on right now - on the national level, tomorrow is the inauguration of Mauricio Funes, the first FMLN President of El Salvador, and it's going to be a very big day, and a very big celebration in the capital and in Suchitoto, which has long had FMLN Mayors. On the personal level, early Tuesday morning I'll be turning my back on the unpacking and arranging that still needs doing in this house and heading to Antigua, Guatemala for a month of Spanish studies.

There's so much I'd like to talk about, but I'm short on time, so I was delighted when my friend Patti said she'd like to see more photos of Suchitoto and I walked out with the camera. It's Sunday night, and people are relaxing, sitting in their doorways or getting ice cream down at the plaza or sitting around the fountain which wasn't playing tonight. My next door neighbors are in the bottom photo. This is a friendly place where everybody seems connected to everybody else. I've only been here a week, but I'll miss Suchitoto when I'm in Antigua. I'll be here blogging when I can, but probably not very often.

A new day for El Salvador

Yesterday the people of El Salvador went to their voting places and elected Mauricio Funes, of the FMLN, as the next President of the country. This is a historic shift, since the ARENA party has been in power for 17 years. Peaceful transfers of power through a fair and reasonably transparent election system (international observers were pleased with yesterday's process) is something new for El Salvador. The next challenge will be assuring that the transfer of power IS peaceful: it's encouraging that ARENA conceded defeat, and that the leaders of both parties pledged to work together in good faith.

It won't be an easy road for Funes: the economic downturn has hit El Salvador, of course, especially by lessening the remitances from the U.S. on which so many families depend. The legislature is divided. There's huge poverty and unemployment, especially for the young.

In his victory speech, Funes proclaimed a preferential option for the poor, echoing the call of Archbishop Romero. May his work for El Salvador be good news for the poor and for all Salvadorans!

Me caí

One of the areas where Spanish is a lot more subtle than English is the reflexive which - forgive me, I'm no linguist - takes the responsibility out of the hands of the speaker and puts it on those stubborn things that trip us up. Literally, in this case. Me caí means I tumbled - but with the shading "I was tumbled." And was I ever tumbled.

The house has a winding staircase, and I was coming down it with an electric broom today when - somehow - I was tumbled, and I ended up in an undignified heap at the bottom of the stairs. Left shoulder and arm, right elbow and hip all sporting considerable bruises, but nothing broken, thank God, except the electric broom, which is now in three pieces and headed for the garbage.

In the course of the day, before me caí, I found out that yesterday's immense traffic tie-up was caused by a big event at the national stadium, Flor Blanco, to welcome home and honor the Salvadoran soldiers who fought in Iraq. There probably aren't many in the U.S. who are aware that tiny El Salvador has had an Army unit in Iraq since 2003. The last troops from El Salvador (also the last from Latin America) returned February 7th. "El Salvador says the troops carried out 353 water treatment, education, health care, road and electricity projects"- skills we hope they'll continue to use at home, where they are badly needed.

Primero Díos

Yesterday PeaceHealth President and Chief Mission Officer Alan Yordy and his wife Joan flew in to spend a few days with our Comasagua mission. This morning, because Alan has a noon telephone conference, I'm here at our Base House so I can drive him up to Comasagua after his conference finishes. Happily, this gives me time to do a little longer posting on the amazing experience of our health mission.

Primero Díos. Yesterday I logged in 14 candidates for cataract surgery during our April 20-24 surgical mission - and because Eleanor was picking up Alan and Joan at the airport, I did this on my own, with only occasional need for help from one of our interpreters. A bit of a baptism of fire, as each candidate was a senior citizen, a couple were hard of hearing, others had strong campo accents, and I had to explain the whole process of the surgery - getting to the hospital, what happens in the surgery, and the after care - in understandable Spanish. It all went well, and was quite a boost for my confidence in Spanish. At the end of each interview, I said "nos vemos 22 abril" - we'll see each other April 22nd. And each Salvador responded, "primero Díos," God first. God first, meaning that our seeing each other in April is first of all in God's hands. God first, meaning let's not get too invested in our plans and programs. God first: what a great lesson for a North American who's used to making plans and carrying them out.

When I wasn't logging in cataract patients, I was delighting in watching our PeaceHealth volunteers connect with the people of Comasagua. Their loving, respectful attention to each person is the very essence of great healthcare - and it's healthcare at its most essential, stripped of the technology and supports that all our providers are used to in the United States. The love and respect is joyfully returned, as can be seen in these photos - of Dr. Dale Heisinger being hugged by a young patient and 4th year medical student Jenny Semadeni-Malcom consulting with a family. It's hard work, long hours, lots more patients in a day than our providers are used to seeing - and everybody loves it.

We've also been blessed with great local volunteers who log in our patients, keep the lines organized, keep people moving through the process, and cook delicious lunches for us (yesterday was bean soup, rice, avocados, and glorious local fruits). Doctora de Larios, the Executive Director of the Comasagua Unidad de Salud, where our clinics are located, has completed many referencias so that patients whose health issues are beyond what we can diagnose and treat will get attention at the national hospital.

Will those who have been referred really get the attention they need? Health budgets are bare bones in this country, and poor patients often have to pay for their medications (which means that they are likely to go without). We can't do everything. Reforming the Salvadoran health system is not within our scope. We do follow up with particular cases when we learn that crucial care cannot be provided (for example, our optometrists will be taking home glasses prescriptions for several patients whose needs can't be met with our donated glasses). We do what we can. Primero Díos.

Elections, part 2

A quick note: I promised to say more about the outcome of the legislative and mayoral elections, and forgot to do that. The basic story is that the two major parties, ARENA (right) and FMLN (left) both came away with bragging points, while the country continues to be sharply divided. For more detailed results and an excellent analysis, visit Tim's El Salvador blog. Now the focus is on the Presidential election, to be held on March 15th: Mauricio Funes, of the FMLN, has been in the lead, but recent polls show ARENA's Rodrigo Avila gaining ground.

Salvadorans share the hard times

Hard times in the United States are hard times in El Salvador for a number of reasons. First, a lot of families in El Salvador depend on their relatives in the United States to send money - this has been the country's biggest source of income. And now the jobs available to immigrants, with or without papers, have dried up. CNN had a story yesterday about the desperate situation of Latinos, many of them Salvadoran, in New Jersey. Those men aren't sending any money home, and the families here that have depended on them are hurting.

I can't begin to understand all the ways the global recession impacts a small, poor country like El Salvador. But one story in this week's La Prensa Grafica gives a clue. "Faces of Scarcity" talks about people who are postponing chemotherapy or going without post-surgery medications because Hospital Rosales, one of the country's largest hospitals, is out of stock on 85 basic drugs. The alternative is for patients to buy their own medications from a commercial pharmacy. Vitelio González found that it would cost him $600 to purchase for himself the antibiotics he has to take for two chemo sessions. His brother helped find the money for one batch, but that's all that was possible. He's hoping those sessions made him better, because there's no money for more antibiotics.

In the next day's paper the government denied that there was any scarcity.

Law and injustice

I heard a sad story tonight about some vigilantes (guards) who hadn't been paid in three months because the woman who owned the guard service was in financial trouble. They've been showing up to work faithfully, hoping that something would work out, because it seems that even a job with three months' arrears in pay is better than no job here in El Salvador.

There are laws that require employers to pay their employees, and to pay social security, and to give their employees health coverage, and to give their employees an extra month's pay as a bonus in December. From what I can tell, El Salvador's laws in this and other areas are excellent. But they aren't enforced, and so they aren't followed. An employer who's reported to the the equivalent of the Labor Department might get a slap-on-the-wrist fine - I heard $50 was the likely sum - with no followup to see if the mistreatment of employees had stopped. This kind of law is like a pretty poster covering an ugly hole.

I'm reminded of the words of the English renaissance poet, Samuel Daniel, in an Epistle to the Lord Chief Justice of England (which I'm remembering by heart, probably not entirely accurately):

....even injustice may be regular
And no conjunction can there be betwixt
Our actions which in endless motion are
And the ordinances which are ever fixed.
Ten thousand laws more cannot go so far
But malice lives within and is enmixt
So close with justice that it ever will
Confine, confound and counterfeit her still.

Regular injustice seems to be a hallmark of life here.