Days 1-4

                After 3 and a half days of being in El Salvador, we have seen and heard more than we can remember. Two events stood out in particular.

 The first was a meeting between us and the 5 directors of Pastoral de la Salud. Margarita is the team coordinator, Fatima is the director of Pastoral’s parochial clinics, Mercedes focuses primarily on maternal and infant care, Clelia is a social worker who focuses on finding community leaders, and Ruth is a nutritionist. They told us about the health situation in the country, in which the majority of the population cannot afford private hospitals. The new socialist government has universal health care as one of its primary objectives, and has built clinics across the country, but these are chronically short of supplies, and attendance of the medical staff is far from guaranteed. Furthermore, due to key political connections, pharmaceuticals in El Salvador are among the most expensive in the world. Against this background, Pastoral de la Salud has 45 parochial clinics which cooperate with those of the government. These clinics are reliable and affordable, if not free. They have also built 35 ‘health houses’, each staffed by a volunteer community health worker who focuses on educating the local community about good practices and their health care opportunities. The conversation itself began in a formal tone, but soon the women were almost speaking over each other, passionately telling us about how bad the situation is, and how Pastoral is filling in the gaps left by the government. Their commitment to the cause of universal access to health care, and empowerment of the people to protect their own health, was truly inspiring.

                The second event was a visit to COAR, a Catholic organization sponsored in part by Pastoral, which has built a community for the children in desperate need. It began as a shelter for displaced children during the civil war, taking in survivors of massacres, those who had lost their families, and those in extreme danger of attack. Now that the war is over, they take in children who have had their human rights violated, or whose lives are under threat. Some suffered from sexual abuse, physical violence, or extreme poverty. Others have found themselves the targets of gang warfare. Each child has his or her own story, and has suffered traumatic experiences, but in the community all the children appear well-adjusted and well-behaved. It is easy to see how much care is put into assessing the needs of each individual, and helping them flourish in the new environment. COAR ensures that the children have a family structure and strict discipline, which, compared to our foster care system in America, is an amazing feat. They provide a quality education and vocational training. Their goal, however, is to ultimately reintegrate the children into their original families, or to reunite them with relatives, and then to counsel the families on how to better raise their children. Their work finds its purpose in their belief in universal human rights for children, for which they advocate tenaciously. These include the right to an education, freedom from abuse, child labor regulations, and safety.

Over the past few days, a few things have become evident: The country is suffering from vast and complex economic and social problems. The Pastoral team has told us about the high unemployment, crime, gang violence, and poverty. Everywhere, there are communities of tiny adjacent homes with dirt floors and ceilings of corrugated iron, many precariously built on hillsides prone to mudslides. In contrast, much of the middle class lives in fortress-communities surrounded by walls, electric barbed wires, and armed guards. The ubiquitous presence of security reassures us that we are protected, but reminds us that there is always the threat of violence. Pastoral’s influence in the areas in which it works has an enormous effect, however. By combining grassroots work with cooperation with the government and advocacy for human rights, they are inspiring change both from the bottom up and from the top down.

Philip Hendrix