I have led 12 missions to El Salvador and, as a result, I have grown to love it and its’ people, culture, and natural beauty. I consider it “mi segunda casa”, my second home. Yet the hard truth is that it is routinely listed as one of the most dangerous countries in the world due to the extremely serious gang situation there.
Two dominant gangs control parts of the capital city San Salvador and many towns in various regions of El Salvador. They are an ever present and brutal part of life for the typical El Salvadoran. These gangs are the result of a terrible civil war that occurred in El Salvador during the 1980s which resulted in the death of over 300,000 civilians. Subsequently, thousands of orphans were left. Their only chance of survival was to come together as a “new family” and thus the gangs came into existence. El Salvador is now seeing the next generation of gang members some of who have been born and raised within their ranks. This generation has no conscience. The members are brutal beyond compare and will do any despicable act in order to exert control, power, and fear over the people. They routinely make demands upon the El Salvador government and if these demands are not met, quick and usually deadly retaliation occurs against the people of El Salvador.
During the many times I have been to El Salvador, I have always felt safe. The government, and my host partners, do all they can to ensure our safety. We always have at least three armed national policeman, especially trained in gang activity, with us 24/7. Whenever the team travels we are escorted by police vehicles that leapfrog back and forth to ensure we do not stop at intersections or in traffic, thus becoming a more likely target. Of course, the safest routes are always chosen and no precaution is left undone. The policeman become an intimate part of the team and are much appreciated!
My last mission to El Salvador, though, was an exception. Gang violence had significantly increased due to the governments’ refusal to meet their latest demands. As a result, the gangs chose to attack public bus transportation, especially in those areas under their control. The day my team of 69 people arrived in San Salvador, six bus drivers were killed. Fortunately no passengers were. The next day, another driver was killed just blocks away from the hotel where we were staying. Another bus driver was later to be killed. We were traveling on the buses normally used for public transportation. Our guards were on high alert and as a team leader I took extra measures to ensure the safety of the team and our young high school El Salvadoran interpreters. Many of our interpreters had to drive home with their parents through gang controlled territory every day. Despite all this, we remained safe and the mission was one of the best!
During the week, I had the opportunity to talk a great deal with my host partner, Rene, a man I have known over 10 years and is like a son to me. I received an education in the mindset and activities of these gangs that shocked me to my core. For brevity’s sake, I will not go into all the details of the terror tactics and brutality used by the gangs on the people of El Salvador. It is heartbreaking, incomprehensible, and worldview changing. As a result, the members on this mission came back changed. The needs of the rest of the world had become more than real to them, they had become personal.
Imagine, then, how I felt when on my first day back to work I had the following brief encounter with a physician on the medical staff. I came in very early that morning and as I was walking toward the hospital’s main entrance, I saw a physician whom I have known for many years, leaving the hospital. He likely had been called in for an emergency and thus tired and probably not too happy. I said hello and asked how he was. As he got to his car, he responded, “Just another day in paradise”. My first inclination was to let it pass but with all that I had just experienced in El Salvador, and my years leading medical missions, I couldn’t help but respond. I said, “If you had been where I have just come from, this is paradise”. I probably should have kept quiet. Thinking back on it though, I have no regrets. Is any hospital, or for that matter our healthcare system today, really “paradise”? Of course not. However, each of us is truly fortunate to work in a healthcare organization that provides us with a beautiful place to work, amazing technology, wonderful support staff, and a safe environment. Things can always be better, things can always improve. I understand this very well. For me, though, this is “paradise” when I consider all I have seen and experienced.
I know how hard you work and the challenges you face every day. I have been there, too. Sometimes I needed to be reminded how fortunate I was to do what I did when I became discouraged or frustrated for whatever reason. My intent with this story is not to lay a guilt trip on anyone but to provide a gentle reminder that, yes, things could be worse and, in fact, for the majority of the world, things are far worse, unimaginably worse. In light of this, we do experience to some degree, “paradise” every day whether we recognize it or not.
As always, you are much appreciated!
Andy Lamb, MD