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Health Care and Solidarity in El Salvador and Nicaragua in the 1980S

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Health Care and Solidarity in El Salvador and Nicaragua in the 1980S University of Massachusetts Amherst ScholarWorks@UMass Amherst Masters Theses Dissertations and Theses July 2020 Treating the Revolution: Health Care and Solidarity in El Salvador and Nicaragua in the 1980s Brittany McWilliams University of Massachusetts Amherst Follow this and additional works at: https://scholarworks.umass.edu/masters_theses_2 Part of the History of Gender Commons, History of Science, Technology, and Medicine Commons, Latin American History Commons, United States History Commons, and the Women's History Commons Recommended Citation McWilliams, Brittany, "Treating the Revolution: Health Care and Solidarity in El Salvador and Nicaragua in the 1980s" (2020). Masters Theses. 897. https://doi.org/10.7275/17243974 https://scholarworks.umass.edu/masters_theses_2/897 This Open Access Thesis is brought to you for free and open access by the Dissertations and Theses at ScholarWorks@UMass Amherst. It has been accepted for inclusion in Masters Theses by an authorized administrator of ScholarWorks@UMass Amherst. For more information, please contact [email protected]. Treating the Revolution: Health Care and Solidarity in El Salvador and Nicaragua in the 1980s A Thesis Presented by BRITTANY L. MCWILLIAMS Submitted to the Graduate School of the University of Massachusetts Amherst in partial fulfillment of the requirements for the degree of MASTER OF ARTS May 2020 History Treating the Revolution: Health Care and Solidarity in El Salvador and Nicaragua in the 1980s A Thesis Presented By Brittany McWilliams Approved as to style and content by: _______________________________ Kevin Young, Chair _______________________________ Joel Wolfe, Member _________________________________ Christian Appy, Member ________________________________ Audrey Altstadt, Chair Department of History ABSTRACT TREATING THE REVOLUTION: HEALTH CARE AND SOLIDARITY IN EL SALVADOR AND NICARAGUA IN THE 1980S MAY 2020 BRITTANY MCWILLIAMS, B.A., NORTHEASTERN UNIVERSITY M.A., UNIVERSITY OF MASSACHUSETTS AMHERST Directed by: Professor Kevin A. Young Health care played an important role in the revolutions of El Salvador and Nicaragua. Both the Sandinistas and the Farabundo Martí National Liberation Front (FMLN) prioritized popular health throughout the 1980s. Clinics and hospitals served as sites of revolution that drew healthcare solidarity activists from the United States. These health internationalists worked to build community-level networks that relied upon trained medical volunteers. In both El Salvador and Nicaragua, women comprised a bulk of the community health workers. These women chose to interact with revolution by building on radical promises of universal healthcare access. Healthcare solidarity activists trained community volunteers and encouraged women to pursue their own needs within the revolutionary frameworks. Health internationalists actively undermined United States’ policies toward Central America. In the 1980s, the United States implemented economic policies and supported military violence that targeted healthcare infrastructure. In training community health workers, treating civilians, sharing knowledge through international exchange, and sending funds and medical supplies, health activists mitigated some of the damage being done. This thesis posits that health care was an important site of revolution for Central Americans and internationalists alike. By choosing to mend iii bodies, medical activists stood in direct opposition to the violence of the decade. They also served as fundamental to the revolution because they helped carry out the will of the people. The revolutions rested on the hope of improving the lives of every day Nicaraguans and Salvadorans. As the violence of the 1980s forced the guerillas of El Salvador and the leaders of Nicaragua to focus on war, the people continued to implement revolutionary health goals at the community level. This thesis argues that understanding how health internationalists, women, and community activists engaged revolutionary ideas of medicine is vital to the study of 1980s Central America. iv TABLE OF CONTENTS Page ABSTRACT……………………………………………………………………………...iii LIST OF TABLES…………………………………………………………………….…vii LIST OF FIGURES……………………………………………………………………..viii ABBREVIATIONS………………………………………………………………….…...ix CHAPTER 1. INTRODUCTION……………………………………………………………………...1 A. Background on El Salvador and Nicaragua……………………………………4 B. Scholarship……………………………………………………………………10 C. Thesis & Methodology………………………………………………………..15 2. SALVADORAN AND NICARAGUAN HEALTHCARE SYSTEMS………………19 A. Nicaragua: Sandinista Healthcare Reforms…………………………………..20 B. Salvadoran Health Care: A Split System……………………………………..33 C. Healthcare Access for Central American Refugees…………………………..44 D. Conclusion……………………………………………………………………53 3. HEALTHCARE SOLIDARITY……………………………………………………...55 A. “Working in the Solidarity Model”…………………………………………..56 B. The Work of Health Internationalists………………………………………...57 C. Solidarity Based in Central America…………………………………………65 D. Cultural and Economic Struggles for Health Internationalists…………….…69 E. Clinics and Hospitals: Sites of Revolution…………………………………...74 F. Conclusion……………………………………………………………………77 4. GENDERING SOLIDARITY AND HEALTH CARE………………………………78 A. Scholarship…………………………………………………………………...79 B. Gendered Impacts of Healthcare Instability………………………………….82 C. Women Working in Health…………………………………………………..88 D. Motherhood in Revolution…………………………………………...…........96 E. Gendered Solidarity in El Salvador and Nicaragua…………………………101 F. Conservative Backlash……………………………………………………....105 G. Conclusion…………………………………………………………………..107 v 5. CONCLUSION: AFTER THE REVOLUTIONS…………………………………...108 APPENDICES A. POPULAR HEALTH WORK DAY PROGRAM………………………….114 B. NCAHRN PAMPHLET ……………………………………...…………….119 BIBLIOGRAPHY……………………………………………………………………...123 vi LIST OF TABLES Table Page 1. Nicaraguan Health Statistics from 1977 to 1984……………………………………...27 vii LIST OF FIGURES Figure Page 1. Evolution of El Salvador’s Health Infrastructure……………………………………..35 2. Share of El Salvador’s Health Budget Allocation………………………………….…38 viii ABBREVIATIONS AMES – Asociación de Mujeres de El Salvador (Association of Women of El Salvador) AMNLAE – Asociación de Mujeres Nicaragüenses ‘Luisa Armanda Espinoza’ (Association of Nicaraguan Women Luisa Armanda Espinoza) CHRICA – The Committee for Health Rights in Central America CISAS – Centro de Información y Servicios de Asesoría en Salud (Center for Information and Advisory Services in Health in Nicaragua) CISPES – The Committee in Solidarity with the People of El Salvador CODIPSA – Comisión Diocesana de la Pastoral en Salud de Chalatenango (Diocesan Health Commission of Chalatenango Province) FMLN – Frente Farabundo Martí para la Liberación Nacional (Farabundo Martí National Liberation Front) FSLN – Frente Sandinista de Liberación Nacional (Sandinista National Liberation Front) IMF – International Monetary Fund MCAF – Medicines for Central America Fund MINSA – Ministerio de Salud de la República de Nicaragua (Sandinista Ministry of Health, Nicaragua) NCAHRN – National Central America Health Rights Network STISSS – Sindicato de Trabajadores del Instituto Salvadoreño del Seguro Social (Union of Salvadoran Social Security Institute Workers) USAID – United States Agency for International Development WP – Witness for Peace ix CHAPTER 1 INTRODUCTION “I understand health care as a window through which one can discover more concretely the multiple layers, old and new, of a society in the revolutionary-controlled zones, forming itself through numerous trials and errors.”1 –Francisco Metzi Italian doctor Francisco Metzi first travelled to El Salvador in 1983. After spending three years in the guerilla-controlled territories of the country, he documented his experiences in an attempt “to describe the immense difficulties and the exhilarating successes, the bitter disappointments and the real growth processes” of the Salvadoran people.2 Metzi, like so many others who travelled Central America in the 1980s, stood in solidarity with the people and against the United States, by offering his medical expertise. U.S. nurse Susan Classen, too, spent time in El Salvador in the 1980s. Moved by the physical and mental trauma of El Salvador’s poor, she helped treat patients and train health workers at the community level. Others spent time in Nicaragua, where they helped train and disseminate the new health programs of the Sandinista government, and where many helped in the war zones of that country as well. Each person who dedicated their life to aiding the Nicaraguan and Salvadoran people put themselves at risk; this was especially so for those who spent time in war zones and dared to engage in medical practice. 1 Francisco Metzi, The People’s Remedy: The Struggle for Health Care in El Salvador’s War of Liberation, trans. Jean Carroll (New York: Monthly Review Press, 1988 Medical Aid for El Salvador), 2-3. 2 Ibid., 1. Despite the international laws regarding medical neutrality in war zones,3 the practice of targeting healthcare workers and facilities seems ubiquitous in conflict. This fact remains as true in today’s conflicts as it was in the Central American conflicts of the late twentieth century.4 Despite the dangers, solidarity workers, alongside the incredible volunteers of Central America, worked to provide healthcare services to the civilians most deeply impacted. Both countries went through major civil conflict in the 1980s, which manifested in violence against civilian populations, displacement within the region and abroad,
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