Thursday we woke up in Cinquera, packed our bags, and had breakfast. I was thankful to see eggs, beans, and plantains. During breakfast, we watched an episode of Friends (the one where Ross gets married and says Rachel’s name instead of his wife’s) and laughed a lot about who knew the storyline and who did not. It was strange how we all got sucked into the television.
After breakfast, we walked down the street to meet some other community members. Our first stop was at the ARMC? office. They are the local committee of organizers who provide scholarships and community building projects. They are also the sponsors of the Cinquera preservation and education. Next, we continued down the street to the Unidad de Salud or local public health clinic.
Public Clinic in Cinquera
My first impressions of the clinic were that it was very clean, cool, and empty. In the meeting room, the walls were filled with informational posters about preventing different diseases and statistics and maps of the community. We met with Blanca, a promotora de salud nurse, who was responsible for seeing the patients. The doctor is only in the clinic Tuesday, Thursday, Saturday, and Sundays and in the community the other days. When the doctor is in the clinic, Blanca is out in the community doing home visits. Blanca started by reviewing the statistics (I did not write these numbers down so some of them are not exactly the same). Some 1,200 people live in Cinquera in 422 homes. There are approximately 60 unoccupied homes. 26% are illiterate, 89% of the homes have latrines, 67% of homes have potable water, and their homicide rate was at 4 deaths in 2010. The graphs provided by the ministry of health for plotting vaccinations were complete and reflected success in vaccinations in the community as well. The maps divided Cinquera into two zones, one for each promotora de salud on staff. Each house was marked with a red dot (health risks), yellow dot (pregnancy), or green dot (no known risks). Schools, churches, rivers, and roads along with other landmarks were included as well. It is the responsibility of the promotores to go house to house to collect information about the community at create these maps. This representative of the new shift in the health care system in El Salvador. The ministry has decided to follow the Cuban health care systems approach with community-oriented preventative medicine. This results in more access to health services in rural areas and health providers visiting homes in each community.
We spent the rest of our time asking questions. I had a million. I was so impressed by the organization of the clinic, the availability of information for their patients, and passion Blanca had for sharing with us. According to Blanca, the most common illnesses are diarrhea, respiratory, and gastritis related diseases – mostly caused by working conditions and water contamination, I would predict. As a level one clinic, they treat general complaints but need to refer patients to the regional hospitals if there disease is too advanced or they have a fracture requiring an x-ray. The clinic is supposedly has sufficient medicine and materials to provide the appropriate care to the patients. All of these services and medicines are provided at no charge to the patients. The clinic orders supplies based on the demand expected in the community. The local people have confidence in the clinic and do not rely much on traditional medicine (tea, herbs). The clinic however is responsible for treating patients who live up to an hour away and do not have financial support to reimburse transportation costs. They do have an ambulance service to take patients the hour drive to the hospital but this requires gasoline expenses. We also learned that Cinquera has not had any malaria cases but has had a few dengue cases, these are marked on a separate community map.
Blanca also gave us a tour of the clinic. First, we stopped at the archives of patient records. Each house has a folder and all of the household members documents are collected in the same folder. Each family member is also numbered (01 for father, 02 for mother, 03 oldest child, etc.) to keep track. Additionally, the family names are organized in notebooks by cantones or communities to make it easier to find patient records. I was super impressed by this system – way better than what we used at Salud y Paz!! Second, we visited the dentist. He is in the clinic 4 days a week to provide oral care. I asked him about my observation that oral hygiene was much better in El Salvador than in Guatemala. He attributed it to a health standards taught kindergarten through sixth grade about oral hygiene and teeth brushing. I was impressed (and he complimented my Spanish J). Next, we saw a series of smaller rooms for different purposes – vitals, doctor’s consult, vaccinations, rehydration, and nebulizer – each labeled and very clean. Each room had much more equipment than any clinic I had seen in Guatemala. Overall, I was very impressed by the level of care that seems to be available to everyone in the community. I am skeptical about how widespread the organization is within the various clinics, how much medicine and equipment is available on a regular basis, and how the people feel about the type of care the receive.
University of Central America
We returned to the hostel, used the bathroom, and Christy bought us all ice cream. We boarded the bus and headed back to San Salvador for an afternoon at UCA, the Universidad de Centroamerica. We ate lunch in an outdoor dining hall. I had a chicken tamal (lacking much chicken) and a salad with dressing. This was the equivalent of dining hall food – not the best.
After lunch, we had a small tour of the campus. We visited the bookstore, the chapel, and the museum. UCA has great significance in the history of El Salvador. In 1989, 6 Jesuit priests and a housekeeper and her daughter were brutally assassinated. 26 mercenaries entered the grounds around midnight and sought out the fathers. In addition, they destroyed books, lit fires, and destroyed everything in their path. The mercenaries did not expect the two women to be there but killed them anyway. The museum displays the clothing worn by each victim and some of their personal effects – watches, bibles, IDs, and books. There are also grass samples with each of their blood and the bullets that killed them. The archives contain several photo albums of the massacre. These were taking the following morning to document and remember this brutality. The husband of the housekeeper was the first to find them the morning after. He later planted roses where they died – red roses for the priests and yellow roses for the women. The roses were not in bloom when we passed through the garden but I remember this very vividly from my past visits.
We were joined in after our tour by a current professor, Pauline Martin. She is a US citizen who teaches at UCA and has been living in El Salvador for the past 19 years. She traveled through the 5 Central American countries in a semester abroad and was drawn to El Salvador. She shared with us her path to her work in El Salvador and some lasting thoughts. Her presentation was geared to answer “now what?” about what to do with our experience. She referenced the strong bond that we now all share after this experience and that we will need to continue to talk to one another and other’s with a similar experience who will understand what we have seen and learned. She also emphasized that guilt is not the correct reaction. Any little thing you can do to contribute with help. It was a great way to end our trip with some self-reflection. I felt stuck the first time I returned from El Salvador. I had learned so much and could not convey all my emotions and experiences effectively to others. When I returned, I did find a connection to new friends with similar experiences. I also still feel a strong connection to the people I traveled with. Now with medical school admissions looming, I have been thinking a lot about working with latinos living in the States as well as traveling back through Central America (sorry, mom and dad).
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