July 21, 2005

Doctors without Borders - El Salvador, After the Earthquake

Just yesterday I completed an interview with Doctors Without Borders/ Médécins Sans Frontières (MSF) and while researching their website, I found that some of the volunteers at MSF had written really interesting stories about their experiences in foreign countries. MSF gave me the permission to republish some of these stories, I think you'll find them very interesting since they shed light on the situation of the local population and the experiences of the volunteers in some of these far away places.

El Salvador, After the Earthquake
By David Morley

Thursday 25 January 2001

In the morning the team meets in the MSF house in San Salvador. The teams have come from around Central America, volunteers who were working on AIDS projects in Guatemala, water projects in Honduras, from the Emergency Preparedness Office in Costa Rica, and the people who have come here for this emergency. They plan the day's activities; who will go to Armenia - one of the hardest hit towns - to support the building of a little cholera centre in the hospital there; who will go to Cafetalon, to continue our mental health and water programs for the 7,000 people from Santa Tecla and neighbouring towns who are living in the football field and who, unless things change, will be there for quite a while yet.

Vincent Brown, who has come here from Epicentre, the MSF research centre in Paris, briefs us on the data he has collected on diarrheal and respitorial problems in the country, and how these figures should help the team plan the next steps.

Then we are off to Armenia. Armenia is just 40 minutes from San Salvador, but it could be on another planet. The busy boulevards of San Salvador, with their MacDonald's and Pizza Huts and car dealerships, look like any other bustling Latin American capital. Armenia, before the earthquake, would have looked like a provincial Latin American town. The Central Square dominated by its church, one storey buildings made of brick and adobe. A sleepy place.

Now, it looks like the aftermath of an aerial bombardment. There is rubble everywhere in the streets. In every block of houses one is gone, replaced by a pile of bricks, mortar, wood, and tin. Occasionally you can see broken pieces of tables and beds. You would never ever guess that these piles could have ever been homes full of life. They look like they have always been this way, piles of useless rubble. For street after street after street the destruction goes on.

The destruction is even worse than it first appears. Many of the fronts of houses are still standing, but behind them there is just rubble. Many people are sleeping in the streets, underneath makeshift plastic roofs. It will take 2,000,000 sheets of zinc to provide the most rudimentary reconstruction. The largest manufacturer here in El Salvador produces 100,000 per year. How long will it be before these people have their homes again?

A bookcase peeps out of one little green plastic tent in front of a pile of rubble - a student must live there. Down another street a group of mourners sit around a coffin. They are bathed in a blue light cast by the plastic sheeting which has been strung above them as an awning. An elderly man tosses great chunks of stone from the wreck of his house into the street while his grandson diligently works beside him trying to rebuild his tricycle. And everywhere you see beautiful red, purple and white blooms of bougainvillea looking impassively over the rubble surrounding them.

I cannot imagine the power that it must have been to wreak such havoc, to turn so many homes into nothing. I have been in earth tremors, and they are frightening, but this earthquake - what can it have been like to see your home, your street, your community shaken and shaken until it falls apart? It was on a Saturday morning, a day no different than any other, and suddenly your daily life is destroyed.

Some people are living in makeshift camps. MSF provides the water in San Martin. "Everyone pitched in," says Claudine, an MSF volunteer from Belgium. "We shared the work in this camp with Unicef and Action Contre le Faim."

In the middle of town MSF is supporting the work of the local clinic. We will use a garage to build a little centre to treat diarrhea. Pierre, a French engineer who drove supplies here from the MSF emergency stockpiles in Honduras, works with the Salvadoran health staff how the centre will look. "We'll use plastic sheeting to make the walls and divisions for the men and women. We have to make channels for the water so it doesn't contaminate that cistern over there. We need to string 2 by 4s there so we can hang the rehydration IV bags." They draw rough plans in their note books. "Do we have the cement we need to make the channels? It's in San Salvador, we can bring it tomorrow morning and we'll be done by Saturday."

A Health Official comes up and asks Claudine if we can help them do a fumigation of areas at risk of dengue fever. "We did a dengue campaign here in the fall, we have trained some local health promoters. It's good to see that they have seen the signs and are taking the initiative to come to us for help."

Then we go to Santa Tecla. This is the community that was hit with the mudslide, the town whose suffering has been on TV screens around the world. The victims are living in a football field. "When we arrived last Monday," says Pierre, "everyone was living in makeshift huts. We got the water system running with the tanks and the plumbing supplies we brought from Honduras, and the Red Cross brought in some tents. This is the kind of place where, if you don't get the sanitation down fast, cholera can kill before you know it." In two days a cholera centre was built on a basketball court beside the soccer field, with all the different sanitation zones, drainage, water supply and tents. Latrines and washing stations were built at different places around the football field - which is now home for more than 7,000 people. MSF built a hut and distributes Oral Rehydration Solution and we are also running a mental health program to try and help people deal with the psychological trauma of this catastrophe.

So far, there is only one suspected case of cholera. "If we are really lucky," says Pierre, looking around the empty cholera centre, "we will never have to use this place. We moved fast here, and maybe there won't be a cholera outbreak. But in 1986, last time there was an earthquake here in El Salvador, some people had to live in tents like this for six months, so it is good that we've built this well. If it doesn't have to be used for cholera, we will find another use for it. It could be used as a school or a community centre." The great thing is that almost all of this material is re-useable. The tents, the plastic sheeting, a lot of the wood - when this crisis is finished we will store it all again and be ready for when the next emergency hits.

"Basic hygiene is so important," he says. "In our emergency kits we include soap, towels, washing up things, plates and utensils. These help keep people healthy."

At the end of the day, people come back to the MSF office in San Salvador. It has been a hot day, and everyone is sticky and dusty. In one room the water and sanitation people work on the design for a latrine. In another, people pour over health statistics from another community and ponder if we can help there, too. The mental health team sits quietly together, debriefing after the day's work. The sun has set, and the temperature cooling off. Another day is over.

By David Morley
www.msf.ca

Related Articles:
Read my interview with Doctors without Borders
Doctors without Borders: Visiting an Afghan Refugee Camp
Doctors without Borders: El Salvador, after the Earthquake
Doctors without Borders: Water for Ixtahuacan
Doctors without Borders: Visiting MSF in Sierra Leone
Doctors without Borders: Lost between River and Sky
Doctors without Borders: Journey into the World of Humanitarian Aid