Advocacy, Climate Change, Disasters

Phase II: Rehabilitation

According to the Environmental Minister, more than 1500 millimeters (59 inches) of rain fell between October 10th and October 20th, almost double the rain accumulation of any other weather disaster in El Salvador since 1969. Now the rainfall is coming to an end, or at least diminishing, as a cold front moves in from the southwest. Rivers are expected to remain high, but gradually start to fall. The Environmental Ministry reports that the September 15 Dam is releasing 1800 cubic meters of water per second and that the water level of the Lempa river remains above river banks.

However, even the short-term problems are far from over. The ground remains supersaturated with water. Civil Defense authorities report that approximately 2,000 square kilometers, or 10 percent of the national territory is flooded. 4 bridges have collapsed and another 14 are damaged on key routes, limiting accessibility.

The Pan-American Health Organization (PAHO) reports that there are 38,682 Salvadorans evacuated to shelters. Although Civil Defense authorities announced today that some evacuees might begin to return home, approximately 12 percent of evacuees will need temporary housing for 4 to 6 months, according to the PAHO.

In the Lower Lempa many families have at least gone to visit their homes, but most are not yet ready to return until there is potable water.  The shelters are urging people to stay until water is restored, especially families with young children.  The water project, the collectively owned and administered water service in the Lower Lempa, said that the tubes were damaged in three different places, and one of the ruptures is still submerged in flood water.  Two different community associations and Oxfam are working to install different water tanks throughout the communities in the mean time.

Advocacy, Climate Change, Disasters, El Salvador Government

Public Health Concerns Following Flooding

As floodwaters continue to recede, communities throughout El Salvador are starting to consider the short and long-term impact of the 1400 milimeters (55 inches) of rain that has fallen in the past week. One of the most immediate issues is public health.

According to Eduardo Espinoza, Viceminister of Health, the most immediate public health concern in El Salvador is the 2,200 community wells contaminated by flooding, which threaten the availability of safe drinking water. The Health Ministry announced yesterday that it is distributing ‘Puriagua,’ a chlorine solution used to disinfect contaminated drinking water. Other organizations are also distributing chlorine-tablets and purified water. Although the wells pose a significant health concern, “the risk of outbreaks can be minimized” through prompt action to identify wells and provide clean drinking water, according to the World Health Organization (WHO).

Flooding can increase the risk of communicable diseases in a number of ways – contaminated water can cause gastrointestinal diseases; floodwater can bring disease-carrying animals such as dogs, rats or mosquitoes into closer contact with humans; direct contact with waste carried by floodwater can cause skin disease; and exposure to weather conditions can lead to respiratory ailments.

The most prevalent health concerns, so far, seem to be respiratory and skin problems, judging by the number of consultations at shelters nationwide. Out of 9,139 health consultations made by October 17th, 2,395 dealt with respiratory problems, primarily among the very young and the elderly. The Health Minister recommended that special care be taken to wrap these vulnerable groups warmly. Another 1,231 consultations dealt with skin problems. However, according to the World Health Organization, neither problem is “epidemic-prone.” 145 consultations dealt with gastrointestinal diseases and diarrhea.

Other “epidemic-prone” diseases are being monitored closely. The Panamerican Health Organization (PAHO) has donated diagnostic kits to monitor the spread of H1N1, dengue, malaria, and a disease called leptospirosis carried by rodents and dogs. Espinoza reported five cases of chicken pox in the Municipality of Cojutepeque, which have been addressed with “isolation measures and antiviral treatment to contain the spread of the disease.” Espinoza also reported six cases of the H1N1 virus under isolation. “So far, there has been no case [of H1N1] in the shelters,” says Espinoza.

Another public health problem is that flooding has damaged 138 health establishments, according to the Health Ministry. As just one example, the PAHO reports that the infrastructure at the Kidney Health Unit in the Lower Lempa has been “completely damaged” by more than two meters of water, “losing the medical equipment vital to treat renal failure.” The organization writes, “This unit treats 350 patients with chronic renal failure, who, currently, have no other alternative.”

Dr. Anne Daul, a fellow with the the George Washington University department of Emergency Medicine, added that flood victims also need to be concerned about the psychological impact from loosing a home or even loved ones. She also warns that major catastrophes such as this can break down the social fabric, which puts women at risk of gender-based violence.

The international community, government officials and local partners must all work together in the coming weeks and months to minimize the impact of the flooding on the health of the people. It will be an issue that we at Voices will be monitoring closely.

Economy, Public Health, violence

Cities: El Salvador’s Growing Problem

Urbanization is something that every country faces at one point or another in its development. The US, for example, experienced urbanization during the industrial revolution and on to the early 20th century. Today, many developing countries are also experiencing it. Because it is part of the path to development, urbanization is an indicator worth analyzing in the context of El Salvador as it becomes increasingly problematic, specifically in terms of poverty, violence and health.


As nations’ economies move from rural farms to more modern technologies, cities begin to form as hubs for commerce and other economic activity. Urbanization’s momentum grows when even more poor people then decide to relocate to the city in an effort to find better opportunities. This can be seen from Mexico City to Shanghai. Problems arise, however, when cities begin to get overcrowded and the poor create squatting communities along the outside of the cities. Often times these individuals have no rights to the land; more so, living conditions in these communities are terrible.


El Salvador has cities that are not unlike those of other developing countries. In fact, about 60.3% of Salvadorans now live in urban areas. El Salvador’s main urban hubs are San Salvador, San Miguel, and Santa Ana. While Salvadorans decide to go to cities to pursue better lives, city life is often not that glamorous. Typically, urban homes are made out of bricks and cement. Homes in the slums however, are essentially huts made out of aluminum, plastic, and cardboard. It is important to note that these homes are especially susceptible to constant flooding in the rainy season. There are also instances where the single water source in these communities is contaminated.


Urban poverty in El Salvador currently stands at 56%; that is, more than half of those living in cities are barely able to afford to survive. Fewer job opportunities and high costs of living explain why urban poverty is so widespread. Even so, the urban population in El Salvador is growing by about 1.9% each year while the rural population is only rising at 0.6% each year. It becomes a problem when far too many Salvadorans are living in the cities because the government is not able to provide the necessary services to everyone.


Another problem related to urbanization is urban violence. Poverty alone does not explain why crime in cities is more common. It seems that inequality, which is more distinguishable in urban areas, is also a key indicator of crime. Inequality, coupled with daily living conditions, is likely to result in conflict and violence. Violence specifically affects developing countries by stifling necessary economic growth. Urban conflict drains financial capital by requiring greater investments in judicial services and healthcare. Human capital is also reduced by the presence of persistent violence. Deaths and reductions in life expectancy, lower levels of personal security, fewer educational opportunities and lower productivity in the workplace all function to weaken the labor force. Lastly, social capital is also reduced through the ongoing fear and lack of trust within communities that result in less coordination.


Health is yet another problem affected by urban growth; slums are inherently unhealthy living arrangements. Because these individuals do not own the land and are residing in informal communities, they cannot demand better living standards from the government. Living in city slums, like those in San Salvador, Santa Ana, and San Miguel, where there has been little to no urban planning also facilitates the spread of illnesses. More than that, traffic accidents and pollution, two seemingly trivial consequences of urbanization, account for an alarmingly high number of deaths and illnesses.


While the government has not done much to address the issue of living conditions in the cities and slums, it has attempted to address the issue of crime. As a result of its high crime rates, El Salvador has passed a substantial number of laws aimed at reducing crime. With mixed success, the government has remained dedicated to fighting crime since El Salvador became one of the ten most crime-ridden countries in the world. With that said, the government has done little to address the issues of poverty and health in the growing urban areas.


Indeed, urbanization signals progress, however it comes with its own unique set of problems. El Salvador does not have the necessary mechanisms in place to offer everyone in the cities the resources and services they need to pursue a better life. Instead, urban poverty is growing and living conditions continue to deteriorate. Poverty, violence, and health are all variables that interact with one another to create the reality of city life in El Salvador today. As such, one of these factors cannot be remedied without the other two being addressed as well. The government will be forced to address it in the coming years as more and more Salvadorans continue to move to the cities.


Public Health

Epidemic of Bacterial Conjunctivitis Declared in 12 Departments

In addition to the increase in cases of dengue and repertory illnesses the Ministry of Health has stated that El Salvador is also experiencing an epidemic of Bacterial Conjunctivitis, commonly known as pink-eye. Conjunctivitis is a microbial infection involving the mucous membrane of the surface of the eye.  It is usually a benign, self-limited illness, but can be serious or signify a severe underlying systematic disease. Occasionally, significant ocular and systematic morbidity may result.

The Ministry of Public Health and Social Welfare (MSPAS) reports that the increase in cases of Bacterial Conjunctivitis led them to them to declare an “alarm” in 12 of the 14 departments of El Salvador. The only departments not included in the declaration were San Salvador and San Miguel.

As of August 2, 2010, 38,358 cases of Bacterial Conjunctivitis have been reported, compared to only 2,400 cases in 2009. Additionally, authorities have noted that the greatest increase in cases observed has occurred in the last few days. The Director of Health Surveillance, Julio Armero explained, “just on Sunday (August 1st) 76 cases were reported and on Monday we had 56.” In response the ministry has begun to work on a campaign to prevent further spread of this illness.

Violet Menjivar, the Vice Minister of Health clarified that the alarm was only declared in the 12 departments where an epidemic of Bacterial Conjunctivitis is present. People living in these departments should therefore undertake proper precautions to avoid catching the illness these include, washing ones hands and not touching ones eyes or mouth. These precautions are similar to the ones recommended to prevent respiratory illnesses.

Public Health

Chronic Renal Disease in Lower Lempa of Usulutan, El Salvador

In recent years, chronic renal disease (CRD) has become a serious public health concern throughout agricultural communities in Latin America.  The Lower Lempa region of Usulután, often referred to as El Salvador’s breadbasket, is no exception. Over the past ten years or more, farmers are diagnosed with CRD, a disease in which the kidneys fail to function adequately, at an rate of 30-45% of men above age 30. The number of cases has risen in recent years, and doctors and researchers are puzzled, as their patients are not traditional candidates for CRD.  Though similar epidemics of CRD are appearing worldwide, few in the public health field have undertaken in-depth or conclusive studies to determine its causes.  The World Health Organization (WHO) and Sri Lankan government recently began to investigate CRD in Sri Lanka, but they have yet to publish any findings.


These abnormal cases of CRD are most prevalent among male farmers, often young, who do not have the pre-existing illnesses, such as hypertension or diabetes, that are traditionally associated with the onset of CRD. In a 2001 study done in Jiquilisco, Usulutan, 71% of 132 men with CRD showed no signs of hypertension, diabetes, or other known risk factors, and suffered from the disease seemingly without cause. Studies conducted in Sri Lanka indicate that renal disease could be linked to any one of a number of factors, such as use of low quality aluminum utensils, cadmium ingested through food, fluoride in the ground water, and consumption of poor quality alcohol, but no decisive conclusion has been reached.

Many in the medical community believe that the most likely of these is the presence of cadmium in the environment. These farmers may be ingesting cadmium from any number of sources. It is used as an artificial phosphate in fertilizers and is also a byproduct of mining. If present in the soil or water, cadmium may be ingested by livestock and fish, or absorbed by crops, and then ingested by humans. Cadmium is also linked with other chronic and acute illnesses that include:

  • Diarrhea, stomach pains and vomitingDSC02014
  • Reproductive failure
  • Damage to the central nervous system
  • Damage to the immune system
  • Psychological disorders
  • Cancer development

CRD in the Lower Lempa

As mentioned, the 2001 Jiquilisco study found that 30-45% of men over age 30 in the municipality of Jiquilisco suffer from CRD. In 2005 the Fondo Social de Emergencia de Salud (Emergency Social Fund) reported that 23 people, in a population of about 40,000, died from renal failure, while the Salvadoran Ministry of Health reported only one death. Similarly situated communities in countries such as Sri Lanka and Nicaragua report as many as 200-300 deaths a year, indicating that the occurrences in Jiquilisco are likely to be under-reported.

Despite such high rates of CRD in the region, the local hospital and clinics rarely have the appropriate medications or dialysis machines necessary to treat patients.  The government-run clinic in La Canoa (a small community in the Lower Lempa of Jiquilisco), for example, rarely has the high-blood pressure medications used to treat CRD.  Even if the resources for detection and treatment were readily available, most patients are unable to afford them.  Though El Salvador’s Ministry of Health and other government agencies have neglected the problem, communities have begun to help themselves.  For the past few years, the Fondo Social de Emergencia de Salud has been educating people about the causes and prevention of renal disease. Their small size and few resources, however, limits their impact.

Patients diagnosed with CRD often require hemodialysis, but the government clinics and hospitals have so few machines that they are generally put on waiting lists. An alternative to hemodialysis, which must be done at a hospital or clinic, is peritoneal dialysis, a procedure in which the abdominal cavity is filled with dialysis fluid that removes toxins from the blood. Peritoneal dialysis can generally be done at home, but there is a shortage of supplies for patients, and most cannot afford the permanent abdominal catheter. In order to have the treatment, patients must go to a clinic twice a week to have their abdomen punctured for a temporary catheter.  The logistics of getting to the clinics, and having an abdominal catheter are significant for farmers in the Lower Lempa, and many stop treatment after a couple visits.

The public health and medical communities have yet to decide on recommendations for combating CRD among young, seemingly healthy farmers.  In Sri Lanka, the government is being proactive and testing all farmers for CRD.  In addition to more testing, government and non-profit health providers ought to take steps to prevent further cases, but because the cause of these CRD cases remains uncertain, its difficult to inform farmers how they may avoid contracting the disease. Ideally, communities ought to be testing and changing their sources of food and water, and using organic fertilizers. Already impoverished and marginalized, such steps are daunting for communities such as those in the Lower Lempa. Until the medical community is able to provide more complete prevention programs, the Ministry of Health ought to invest in the medications and machines necessary to provide adequate treatment.  In 2007 and 2008, Hospital Rosales in San Salvador opened two new wings to treat CRD patients, but they are hardly sufficient.