El Salvador Rising (Page 4)

Tom Hayden has traveled to El Salvador three times, has written extensively about cross-border street gang issues and, as a California state senator, passed legislation authorizing creation of the first Central American studies program on an American campus, California State Northridge, in 1999. Research, translation and photographic assistance for this article came from Jessica Levy and Jason Cross in San Salvador. See Jessica Levy's photos of Tom Hayden, Eduardo Linares and Eduardo Espinoza at tomhayden.com.

How will they govern?

The new Salvadoran government may be the most complex of the new arrangements in Central and Latin America. The majority is slender. Funes is a television commentator, not an executive. The FMLN has a relatively weak record of governance. The unity that was achieved in the electoral campaign may break down on the terrain of governing. The right-wing, like the Republicans here, relishes a nasty oppositional role. The outgoing ARENA government left a $1 billion debt, its corrupt extravagance symbolized by the outgoing president taking 300 people on a goodbye tour of the Middle East.

For answers, I turned to the case of healthcare and the role to be played by another FMLN revolutionary from the war period, Eduardo Espinoza, vice-minister of health in the Funes government. During the war he was "Felipe Dubón," the FMLN's specialist in "battlefield medicine," charged with tending to wounded fighters as well as civilian populations living in zones controlled by the FMLN, all under conditions of aerial assault and guerrilla war. When President José Napoleón Duarte's daughter was kidnapped and held hostage by the FMLN in 1985, Dubón's name was number two on the list of prisoners the FMLN demanded released, an exchange that took place forty-four days later.

I interviewed Espinoza in a leafy open-air coffee shop at the Sheraton Hotel, near the spot where two American labor attachés were killed along with a Salvadoran land reform official, in January 1981. Shocked as a young man by police murders of students at his university in 1975, he felt that "the 1970s started the dream just being realized now," as he prepared to address El Salvador's healthcare crisis in the role of top adviser to the new health minister, the FMLN's María Rodríguez.

I wondered if addressing the institutional healthcare crisis would be harder in some respects than the battlefield medicine he improvised in the jungle. Espinoza certainly was prepared. After the war, he returned to teaching and became dean of medicine at the national university, where his boss, Rodríguez, served as president. During the campaign, Funes promised to expand the share of economic resources going to healthcare from 3 percent to 5, so Espinoza was gearing up.

Dominating the public health crisis are poverty and institutional corruption. Espinosa's research reveals that El Salvador has the highest prices for medicines in all of Latin America and among the highest in the world, adjusted for purchasing power. "It takes $30 to give birth in a hospital, which is impossible when you make a dollar a day. It can mean thirty days without feeding your family, so you don't go to the hospital," he said.

Every year there are fewer doctors per person, so young doctors have to become unemployed or leave for the exclusive private sector of medicine. "It's not a question of having enough doctors, it's a problem of not having enough employment for them in the public sector," he added.

Espinoza said he shows Michael Moore's movie Sicko--chuckling and savoring the pronunciation of the word--to his medical students as the best overview of the current crisis.

Of the four main distributors of medicines, those who broker between manufacturers, hospitals and pharmacies, three are owned by a cousin of the outgoing president, Antonio Saca, and the other by the family of a former president, Alfredo Cristiani. It gets worse: sometimes the system purchases medicines, including cancer and HIV medications, just before they expire and can no longer be given to patients.

Funding for increased access therefore will have to come from wringing efficiencies out of a system in which power is both bloated and maldistributed, a very difficult task. CAFTA worsens the crisis by extending patents, fostering market prices and "not considering healthcare a human right but a service." There still is room for negotiations over CAFTA, according to Espinoza, but it's a long way to his dream of a national healthcare system for Central America as a whole. As a leader of the recent battles against further privatization, he believes a greater social movement will be necessary "to address the social determinants of health." As for the public, he says it wants "total" and "radical reform" in the direction of universal care, and that its voice will be heard.

Now that relations with Cuba are being affirmed after fifty years, might Cuban doctors and medical schools help the transition in El Salvador? "They could be a good resource now that we are trying to revamp everything, because they have a different perspective," Espinoza replied; but the problem remains a Salvadoran one, of the power of social movements and former revolutionaries to change a system still designed to benefit a few.

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