91 ~ 92   93

p THE RADIO BROADCASTS I MONITORED THAT DAY left little doubt that the guerrilla assaults had failed. The voter turnout was huge and only in isolated instances had the elections been disrupted at all.

p I began to worry more and more about my own safety. What if the column didn’t return or had to retreat by a different route? There was no chance I could find my own way back to Salitre. For all I knew, the entire Guazapa Front had fallen in a government counteroffensive. I had visions of hobbling down into San Salvador, mud-caked and bearded, covered with sores, in search of refuge.

p About dusk, the first few of the fighters returned. Among them was Comandante Paco.

p "What happened to the others?" I asked. He shrugged and mumbled. "We became separated."

p Comandante Raymundo, I learned, was dead; a burst of machine gun fire from a Huey had cut him in half. But there was no word of Lupe and the other sanitarios, of Arlena, or of most of the sixty or so guerrillas who hadn’t yet returned.

94

p They had left me next to no medical supplies, just the few items I carried in my personal kit. As the wind and rain picked up with the coming of dark, the only thing I could do was boil a T-shirt for sterile bandages.

p One of the wounded was Jorge, a teen-ager who had been among the very few people kind enough to personally welcome me to Guazapa. Jorge had four bullet holes in him—one in his neck and three in his calves—and all from a downward trajectory.

p "What happened?" I wanted to know as I began to clean the wounds.

p "A helicopter strafed us,” he said, "soon after we entered the barrio."

p "How’d it go?"

p "Not well."

p "How many losses?"

p Jorge hesitated.

p "Some. We don’t know how many."

p It was nearly midnight before all the survivors were back. Twelve of them were wounded, three seriously. Thirteen other companeros lay dead in San Antonio Abad. Arlena, I was told, had taken a mortal wound to her abdomen and couldn’t be evacuated. She shot herself in the head rather than face capture. According to my later information, the soldiers’ vengeance against her corpse was to cut off her breasts.

p Lupe and I and the two sanitarios worked through the night and into the next morning to debride and bandage the casualties. Those that would talk spoke of their surprise at the enemy’s preparedness. Most would say very little except that two government M-16s had been captured. They didn’t mention that six of their weapons had been lost, that fully a third of their number were dead or wounded.

p Several of the companeros foraged for bananas as we attended to their comrades. Lupe, especially, showed her mettle with the injured, performing extremely well under the conditions. She and the two sanitarios moved from patient to 95 patient, injecting local anesthesia, removing huge chunks of traumatized, burnt, or otherwise damaged tissue. Once a wound was clean, it was daubed with honey, a practice I’d read of but had never seen done. For reasons unknown to me, the substance does seem to enhance healing.

p What few details I could gather about the mission made me wonder at their strategic planning. San Antonio Abad, it turned out, was prepared for an assault. Why had they attacked a well-armed and numerically-superior foe at his strongest point?

p Paco was acting peculiarly, as well. Late on the twentyninth, as we prepared to move out with our wounded, the other surviving comandante, Luis, suggested we try stealing a truck and then driving at least part way back rather than take the larger risk of moving slowly, on foot, with all the injured companeros. It seemed a reasonable idea. We knew government forces were searching for us.

p Paco, though, would hear nothing of it. He delivered a long speech to the camp, full of rhetoric, about the struggle being more important than our lives, patria o muerte (the motherland or death) and all the rest. It was a calculated appeal to macho instincts, a call to manly sacrifice that most of them found difficult to resist. Luis bowed to Pace’s rhetoric, and we pushed off at dark on March 29. Ten formed a vanguard, twelve companeros shouldered the six hammocks bearing the injured, then came the walking wounded and our rear guard.

p When we started out from Salitre, we’d been fresh. There had been great hope and expectation. But now we were all dog-tired, hungry, and understandably deflated by the failed attack. Discipline broke down, as people shouted back and forth to one another, lit cigarettes, and cursed. At times, the column stretched over as much as a mile and a half of terrain.

p Moving back up into the hills, we passed several huts where the guerrillas would break off and go in to beg a 96 tortilla. I remember Lufs pulling one young fighter from a kitchen table.

p "But I’m hungry!" the youngster moaned.

p "We all are,” Lufs replied and pushed him back into line.

p The pain in both my feet exploded again. Since my days at the Academy, I have often used self-hypnosis to overcome physical obstacles. I used it, for instance, to smooth and lengthen my stride in the last turn of the 440 when I was on the mile relay team. But self-hypnosis didn’t do much good while we were marching. The pain was a maddening presence. After having played no significant role as a physician and, worse still, feeling that I’d been duped, the physical discomfort seemed far harder to bear. Only the groans of the wounded reminded me of my relative comfort.

p In the middle of these pained reflections, someone handed me an M-16 in the dark and motioned for me to relieve a companero in the vanguard. It wasn’t a moment for quibbling. I accepted the rifle, but decided not to chamber a round. I don’t know if I would have used it to defend the wounded if we had been attacked.

p As we shuffled on, the sight of me with a weapon seemed to alter the companeros’ attitude toward me. Whereas before they’d ignored me or muttered irritably about my slowfootedness, they now made me feel like one of them. If I stumbled in the dark, someone would grab my arm and curse for me.

p "<jPuta! Eh, Camilo?"

p Or I was passed a piece of fruit. It never ceased to amaze me how, in those pitch-black canyons, their sense of smell alone guided them to fruit trees that they stripped while hardly breaking stride. My state of mind being what it was, their acceptance of me was heartening. If nothing else, it eased my isolation and discomfort.

p After our first night’s return march, we were still well outside the Cuazapa Front in government-controlled territory. The stretcher cases doubled the time it would take to get 97 back. Just before dawn we passed within a few hundred feet of an army outpost that, luckily for us, was then under attack. Otherwise, we surely would have been detected.

p In this zone, it was extremely dangerous to abet the guerrillas. Nevertheless, as we rested under some trees that day, the local campesinos made two excursions to our camp bringing tortillas and beans and some fruit and water to the companeros. I imagine anyone would be responsive to the needs of sixty armed guerrillas, but this aid was offered, not solicited.

p What impressed me was that the guerrillas insisted upon paying for the provisions. Such a scene, I knew, would have been unthinkable in Vietnam for either a troop of GIs or the South Vietnamese Army. These villagers, at least, saw the companeros as their friends and partners.

p I cannot convey the physical torment of our next two nights of marching back to Salitre; I won’t try. Suffice it to say we made Guazapa— territorio libre—at about daybreak and were met by a relief column bringing food and fresh help to carry the wounded.

p I was light-headed from exhaustion. In the last hour and a half of daylight hiking to Salitre, the column began to stretch out two, maybe three miles. All was quiet and peaceful in the early morning sunlight.

p Maybe it was the daylight that allowed me to walk more carefully and therefore with less pain. Maybe it was because I’d made it back whole and alive while a third of us hadn’t. It could simply have been my utter fatigue. But all the walls around my emotions were suddenly breached. My eyes began to fill. Tears, real tears such as I had not been able to shed for ten years after Vietnam, poured down into my matted beard. It was a wonderful, cathartic release of emotion.

p IN SALITRE, WE’D BEEN CALLED “THE LOST COLUMN”; until W6 neared the control zone, it had been feared that the entire detachment was wiped out. Radio stations in San Salvador 98 announced three times the actual guerrilla casualties; we surmised they counted every civilian victim of the “clean-up” operation as "subversive.” As it was, the number of casualties (thirteen dead, twelve wounded) was the highest ever sustained by one of their columns. Of the eleven other detachments sent from Cuazapa against San Salvador on election day, none lost more than a single companero.

p The radio reports continued to affirm the early news of the offensive; it was a propaganda victory for the government. Only later as the actual results of the showcase voting became known could I see how they added up to a potential embarrassment for the United States.

p The American hope had been to excise both the left and the extreme right from El Salvador’s political spectrum and to install a tractable centrist government. The clone of any state legislature would have suited United States strategists fine. Once in place, the United States would be duty-bound to defend such a client, paving the way for more military aid to crush the guerrillas for good.

p However, the Salvadoran radical right and its leader, Roberto d’Aubuisson, emerged from the balloting stronger than ever. D’Aubuisson, a founder of the ultra-right National Republican Alliance (ARENA) party, was widely known as a death squad organizer and probable participant. Most people assumed he helped plan the 1980 assassination of Salvadoran Archbishop Oscar Romero. Whoever he accused of being “subversive” was apt to die or disappear soon thereafter. In the months following the election, d’Aubuisson would lengthen his announced list of leftists and their sympathizers to include Ambassador Deane Hinton and the whole of the United States Congress.

p President Carter’s Ambassador Robert White had called d’Aubuisson a "pathological killer.” Now the Reagan administration had to bring enormous pressure behind the scenes to keep him out of the president’s chair. In the end, a moderate banker named Alvaro Magana, labeled a "Jewish Communist" by d’Aubuisson, was given the figurehead title of provisional 99 president. D’Aubuisson took the less-visible post of Constituent Assembly president, and another election was planned.

p My own post-election resolution was to clarify my position on the Front. The mission to San Antonio Abad had convinced me I had been too hesitant in asserting myself and too cautious where issues of great importance to me were concerned.

p The long march back gave me an opportunity to reassess; it was the first time since my arrival in Cuazapa that I had a chance to reflect. I knew I had to accept the possibility of being killed there, but I was not going to die with a weapon in my hands. As soon as I found Jasmine, I told her I wanted to meet with someone with authority, possibly even Raul Hercules, to whom I could explain a few things.

p In the meantime, the guerrillas themselves conducted a post-mortem of their failed election day offensive. In an open review called a balance, they gathered in their camps all over Guazapa and posed some very tough questions to their leadership.

p The survivors of the San Antonio Abad assault column met under a eucalyptus stand near Salitre. Before them, comandantes Luis and Paco at first tried to paint the day as a triumph. But the companeros were having none of that. Fighter after fighter rose to criticize the choice of target, the lack of maps, the poor advance scouting, and the bickering between Luis and Paco.

p Several column members were upset that two prisoners, National Guardsmen, had been executed that day. Usually, POWs were given the chance to join the guerrillas or were relieved of their uniforms and other useful equipment before being released in their underwear. At the balance, the failure to follow this standard practice was attacked as a case of unnecessary barbarity, even if the executed prisoners were members of the hated Guard.

p The meeting lasted for three hours. The companeros discussed each other’s actions that day as well as my and the sanitarios’ performance. Lupe got in her licks; she accused 100 me of not helping enough with the wound dressing. Others criticized her for being too bossy and uncooperative.

p The next day, Jasmine summoned me by radio to Palo Grande. When I arrived, she took me to an adobe house close by the hospital, a house I had noticed before to be filled with children and assorted adults and presided over by a gentle, gaunt giant called Salvador.

p Actually, he stood only a little over six feet, but that was at least four inches higher than the next tallest man in Palo Grande—me. I found him cordial and diffident in a way similar to Ramon; he was respectful of my skills and grateful I had come to help. Only after talking for some time did I learn that he was a former secretary of the National Union of Day Laborers, now acting as head of all civilian authority in Guazapa.

p Salvador listened with surprise to my story. He said that no one had informed him of any conditions of service and for that he was apologetic. Had he known, I would not have been sent out with a column.

p Our meeting went well. Salvador later came by the hospital to inform me that I was thenceforth to concern myself exclusively with civilian medicine. Jasmine would see to the combatants. While a teen-aged sanitaria named Dorita would be official responsable for public health, I was free to plan its organization and implementation. I would consult with him and Jasmine, and she would present our proposals and initiatives before the many committees established to pass on Front policy. From what I’d seen already of their structures, I could guess how many hours of wrangling and debate this arrangement would save me. I was pleased.

p I BEGAN BY RECONNOITERING THE FRONT. In its full, irregular extent, Guazapa was about the area of Denver, Colorado. Traveling north from Palo Grande to the farm villages of Delicias, Chaparral, and the rest was relatively easy; all could be reached in a few hours’ walk over level ground.

101

p Access to the eastern part of the zone was another matter. The Suchitoto highway cut Guazapa nearly in two. It was heavily patrolled and could be crossed only in the dark. Yet unless a person was willing to try the even riskier boat ride across Lake Suchitlan, there was no other way to reach Copapayo, Tenango, Guadalupe, and the rest of the eastern settlements. Even then, there remained the "Grand Canyon" to negotiate. In the dry season, it was arduous. When the rains came, the stream running along its bottom would swell into a torrent, wide and deep enough to uproot trees and roll one-hundred-pound boulders along its course.

p There was very little local military action initiated^ by either side during April of 1982. As I toured the zone, getting to know both the villages and clinics, I noticed the fields were filled with farmers preparing the soil for the ’May rains and planting time. Among them were companeros from the San Antonio Abad column, fighters happy to take advantage of the shooting lull to put down their rifles and pick up a machete or planting stick.

p Many hailed me as I passed. I didn’t know their names yet, but I found they’d given me one. Because of my limp, my gray hairs, and the fact that I was the only member of the column over thirty, they had nicknamed me abuelito (little grandfather) and cheerfully called out, "Hola, Camilo, abuelito,” when they saw me. I guess I looked as used up to them as poor Joaquin in Salinas had to me, and sometimes I felt that way.

p On the first of May, the skies opened. Slanting torrents turned Guazapa into a mire. In no time, the dusty trails became tricky mud-slicks; in places the goo was knee-deep. Along them, the bare earth exploded with weeds first a foot high, then a yard. By the end of the rains in July, the foliage had grown to eight feet and more.

p My boots, for which I’d paid one hundred dollars in Tegucigalpa, would sink into the mud, then come sucking up with an obscene glop! sound at each step. They were the most expensive item of apparel I’d ever purchased; my 102 previous record was seventy-five dollars for a suit from Sears. They were sold to me as the ultimate in rugged footwear, the sort of thing men wore to build skyscrapers, run Arctic oil rigs, chop timber in Oregon. These all-world boots didn’t withstand two weeks of the Salvadoran rainy season. One sole and then the other tore from the uppers. I mended them with thread and wire or plastic filament, but still they came apart. Glop glop glop through the mud and then flap flap flap as I trudged into a village. My blackened, nailless, and mildewed toes stuck out through shreds of sock and the gaping fronts of the boots.

p May’s first droplets were the farmers’ cue to hit the fields with their planting sticks and bags of seed. Everyone was out planting, from the individual campesinos to the elementary school classes and health collectives who each tended their own hortiliza (garden), as they called it.

p It wasn’t yet apparent to me how close to starvation the Front was, or how deeply the campesinos’ spirits were tied to the earth’s cycles of fertility. One morning in May, I came squishing and grunting up the eastern side of the "Grand Canyon" near Tenango to encounter an old man stooped in the rain with his planting stick, concentrating fully on the small holes he made and then sowed with three or four kernels of corn.

p I introduced myself, breaking his reverie. When he looked up and offered his name, Chepe, I could tell he was mostly Indian. After we exchanged pleasantries, I asked why he had seemed so absorbed in poking holes in the wet soil. Chepe answered that like his Pipil Indian ancestors he must stop and apologize to the earth each time he wounded it with his stick.

p Once the crops, mostly corn and beans, but also radishes and cabbages and squash, were planted, the farmers fought the weeds and prayed for a bountiful July harvest to end their increasing hunger. The previous year’s crops, usually enough to sustain them through the winter dry season, the rainy season, and planting time, had been largely destroyed in the 103 spring offensives against them. Not only Chalatenango to the north, but Guazapa too, was quickly running out of food.

p Rationing became necessary and then increasingly severe. First, we were cut to twice-a-day meals of two tortillas and a half-cup of beans. Then there were no beans. The tortillas, now made of yucca root, kept shrinking and growing coarser, too. By June, these virtually indigestible disks and cups of a clear, thin soup were all that sustained us.

p As always, the children suffered the most. Nearly half the population of Guazapa was under twelve, yet less than one hundred scrawny old cows provided fresh milk for them. As the rest of the food disappeared, I saw more and more of the youngsters with the distended bellies of serious malnutrition and the flag of blondish hair, a sign of protein deficiency.

p I had with me, as a special reserve, one hundred dollars donated by Los Ninos, a California-based child welfare agency. The money was earmarked for pediatric crisis. We decided to buy milk with it. One of Salvador’s most reliable aides was sent to Suchitoto, where an army officer agreed, for an outrageous price, to sell him a sack of powdered milk that was clearly labeled as a United States government donation and not to be sold.

p I was hungry all the time, a condition made less tolerable by the restaurant advertisements I heard over my radio. Just twenty miles away in San Salvador, I was told, " Americanstyle" hamburgers were available, along with chicken and barbecue. I had come into the Front a vegetarian, but it was torture to listen to the announcer linger seductively over the word B-A-R-B-E-C-U-E.

p Even the wildlife in Guazapa, what there was of it, seemed to be going hungry. One night, the Salitre village skunk sneaked away with my hat for the salt in its sweat band.

p Several weeks later and hungrier than I ever believed possible, I was crossing the "Grand Canyon" with my escort when we encountered another skunk and dispatched it with a machete. He sprayed us all before expiring, a minor nuisance 104 to starving men. We skinned, spitted, and roasted him on the spot. As I savored my share, two spoonfuls, I briefly contemplated replacing my hat with his hide.

p Along with the hunger and discomfort came misfortune. One night, a flapping boot sole caught on a root or a stone and I took a header down into the canyon. Slaloming through the muck on my butt, I stopped my slide after a hundred feet and counted myself lucky that the only damage was a few cuts and bruises and a shredded workshirt—my last shirt.

p When my watch crystal was shattered, I learned how to live by local time.

p "How long is it to the next village?"

p "Abuelito, the sun will be hot before you get there."

p In May, it became, "You’ll never make it before the next rain."

p Then I lost my flashlight. I didn’t mind this so much until I contracted amoebic dysentery. At night in the rain, there was little time to grope my way to the bushes.

p My Air Force survival training was of no help. It did not contemplate situations of institutionalized deprivation and hardship. I was unlikely to lose my way on the Front or have the leisure to set snares for game animals long since eaten by the campesinos. Besides our hunger was collective, not individual. Knowing how to root for edible insects was useless because for all their great numbers, the bugs of Guazapa were too small to efficiently exploit as a food source for even one, let alone thousands of people.

p The year I spent in India was more useful to me. I had gone back there on leave from medical school and the experience had taught me patience and sensitivity to the poor’s perceptions of their would-be benefactors. High-yield strains of wheat and other grains are fine, if you can afford the fertilizers to make them grow and the pesticides to save them from insects. Gasoline motors to power irrigation systems are an improvement over ox power only if you can afford the fuel. Birth control pills make sense as an appropriate, low-tech method, but until a woman’s fear of abandonment in old age 105 is conquered, she will continue to have children. As that first day in Quipurito had demonstrated, to neglect such lessons was to imperil my credibility.

p Before urging measures like latrine-building, garbage disposal, water sterilization, and personal hygiene, I strove to foster trust by providing acute-care doctoring, pills, and injections, to the extent that my meager supplies would allow. It wasn’t always necessary to have the requested drug; bright red vitamin pills had a powerful placebo effect for a wide range of psychosomatic complaints ranging from headache to otherwise inexplicable toe trauma.

p There could be problems, however, even when I had the drug of choice. American medicine may be rightly faulted for concentrating too much authority in the hands of physicians. Many useful medicines would be much more widely accessible, and probably cheaper, if prescriptions weren’t necessary to obtain them.

p Still, the system does restrict the possibility of abuses such as are common where people are free to purchase nearly any medicine they like. I saw it in Salinas where farmworkers and refugees would arrive at the clinic with their ampuls of injectable vitamins or cold remedies they’d acquired over- the-counter in Mexico.

p A Salvadoran example was Miguel, whom I met one afternoon while holding a clinic in Copapayo. His arthritis was advanced and quite painful. When I offered him the indicated four aspirin to ease the condition, he demanded butazolidina, an extremely potent anti-inflammatory agent. It probably was effective in his experience. The difficulty is that it can dangerously interfere with red-blood-cell production in the marrow. In the United States, its use is confined to very specific cases and then only with concurrent laboratory monitoring.

p Yet Miguel was insisting on itl He wouldn’t consider taking aspirin or drinking willow bark tea, which contains the same active ingredient. His wife, he told me, used to 106 regularly buy butazolidine ampuls from a pharmacist in Suchitoto and to administer them by injection every two weeks.

p I imagined what her shopping trips were like.

p "I’ll take this bolt of cloth, a sack of salt, and a few candles,” she might tell the store owner. "And, oh yes, give me a six-ampul pack of butazolidine, lOcc size please. Don’t forget the syringes!"

p In time, Miguel came to accept that aspirin was the proper medicine for his arthritis, and he even begrudgingly agreed to try the willow bark tea recipe. Once converted to this “new” medicine, he became an effective advocate for its use.

p Miguel was one of several people in Copapayo to whom I became closely attached and whose memories I’ll always carry. Copapayo was the first village I encountered on the Front and, as it turned out, it would be my point of departure a year later. In between and since, I associate it with my finest—and saddest—hours.

p FROM THE LATE 1960s through the mid-1970s, Copapayo came under the influence of Father Jose Alas, a Catholic priest who introduced liberation theology to parishes in much of north and northeast Guazapa. Along with Father Rutilio Grande, since murdered by uniformed assassins, Alas awakened the campesinos to the power of unity and the possibility of thisworld relief from their suffering.

p His ministry provoked retaliation: Alas was repeatedly threatened by the death squads and was once beaten nearly to death. In 1977, he was finally driven from the region, but his teachings and the example of his courage left their mark on the people. Copapayo remained a spiritual legacy of the Christian base communities he founded.

p When I later met Alas in the States, where he was working as a loan consultant to the World Bank, I told him how the first question I was asked in Copapayo was if I knew him and had I seen him lately. They were surprised when I 107 answered no. The campesinos assumed that" the Father would be well-known wherever he went.

p Alas was eager for news of Copapayo, particularly word of a remarkable family, the extended clan of Frederico, the village’s most prominent citizen.

p There were fourteen of them in all, ranging from tenyear-old Noe, a Down’s syndrome child, up to the venerable Frederico and his wife, Isabel, who ran the house as well as led the local Association of Salvadoran Women. In the immediate family there was Janet, twenty-six, the responsable for health care in the eastern sector. One brother, Selvin, who was a little older, acted as head of agricultural production m the same area. His wife, Lia, was a seamstress, in charge of the village shop where hats, packs, and uniforms were sewn. Another brother, Aurelio, was a guerrilla. Sister Lola, about twenty, was a schoolteacher in Copapayo. Two younger brothers were members of the local militia.

p At one time or another, I treated them all. Frederico, for instance, was nearly crippled by arthritis. Selvin carried in his neck two .22 slugs from a death squad pistol. Janet and I removed them using local anesthetic.

p It was very unusual in Guazapa for an entire family to be intact and living under one roof. It was also rare for every single member to be incorporated. This family’s commitment to the revolution was total.

p Frederico was the son of a pioneer; his father had settled their land. The several acres they owned, plus some livestock and a rather large, by local standards, three-room house in Copapayo, was property he held in trust for the fourth generation, Selvin’s son. The family had suffered relatively little before the revolution. They were not as dependent upon the local dueno, and there were enough colones in the family bank account to provide a few amenities.

p Unlike the vast majority of their friends and neighbors, this family couldn’t expect much material gain once the revolution was won. If his family’s safety and well-being were 108 Frederico’s only concern, he might have evacuated them long ago to the States.

p But Frederico had a dirt farmer’s obstinacy about staying on the land. With his family, he also believed that the Christian and patriotic thing to do was to stay and contribute to the struggle. They didn’t see this commitment so much as a responsibility as an opportunity to help build a better, more just society in El Salvador. From Uncle Gabriel, a leader in one of Copapayo’s base Christian communities, or CEBs, to Isabel, who gave pet names to all her pigs, it was unimaginable to desert their homeland.

p There was no revolutionary rhetoric heard at Frederico’s table. Rather, there were stories. He told me how proud he was the time Father Alas had asked his opinion on some question; no one except another campesino had ever asked Frederico’s view on anything. He recalled how in 1969 the National Guard had surrounded the church in Suchitoto, demanding that Alas leave town. Peasants from all the surrounding base communities converged on Suchitoto, shouting for the soldiers, not the priest, to go away.

p To Father Alas, my most welcome recollection was of Frederico saying the priest armed the people of Copapayo with courage, not weapons. The guns came after Alas was driven away. His legacy was the campesinos’ dignity and self-esteem.

p Of Frederico’s family, I got to know Janet best. She was the ablest and most helpful of all the village medics, a tribute to someone with only a third-grade education. She took her responsibility for health care in the eastern sector very seriously, working long days and somehow also finding time to attend adult literacy classes. Her limited ability to read and write were an embarrassment, a handicap Janet meant to overcome.

p Because of this diligence, the eastern sector of the zone was a model of organization and achievement for the rest of Guazapa. Without her, the public health campaign would have floundered.

109

p She showed me how leadership was exercised by example on the Front. To get a campesino to dig a latrine, you first had to persuade the village sanitarios to dig one for the clinic. Likewise for the treatment of infant diarrhea. We taught the health workers that diarrhea kills because of dehydration, and showed them how to mix a rehydrating fluid of boiled water, sugar, and salt. They took the remedy into the campesinos’ homes where mothers, at first skeptical, soon found that the liquid worked. There was just as much diarrhea to contend with, but suddenly it wasn’t so deadly.

p LIKE THE CAMPESINOS THEY SERVED, the sanitarios required demonstrable, preferably instant, proof of an idea’s utility. In the rainy season, for example, it might take two hours to search around for the wood for a fire to boil the contaminated water. In the dry season, by contrast, some households would have to travel up to a half-mile to the nearest source of water. In either case, it was difficult for them to appreciate why the children should be given some to wash their hands.

p Record keeping -was another alien concept. We established sixteen clinics in villages around the Front. Unless my schedule was seriously disrupted, I could visit each of them once every two weeks. Between fifty and one hundred peasants would line up for treatment. Afterward, we held classes for the medics. I explained to them that with 9,000 people in our care, we could not remember each one’s case history. We had to take careful notes and keep them for reference when the patient came in again. The sanitarios seemed to understand the concept, but they didn’t practice it. With paper scarce on the Front, pages of the notebooks were used to light fires or for trips to their newly dug latrines.

p They did put the paper, including our records, to one ingenious use. To sterilize gauze or one of its substitutes for debriding wounds (diapers, mosquito netting, old clothes) the material was cut into two-inch squares, then rolled and folded into a piece of paper. These and anything else that was to be 110 sterilized were sealed in a large tin. It was placed inside an even larger can, packed with sand, and then baked for several hours over a low flame. A temperature high enough to achieve sterilization, but below the flashpoint of paper, was attained in this way. When the cans cooled, the sterile pads were removed and stored for later use inside their protective paper envelopes. By this method, we were able to sterilize and recycle disposable surgical gloves up to twenty times.

p The peasants were skeptical at the introduction of natural remedies. Their forebears, like Miguel’s mother, had been conversant with the pharmacopoeia growing wild around them. Almost any of their grandparents had ten times the knowledge of natural medicine that I possessed, but that lore had been lost with the advent of easily available drugstore remedies.

p The willow bark tea was slow to catch on, as was the sedative we showed them how to brew from the leaves of the moek orange tree. Despite the fact that stomach gas, acidity, and ulcer-like pain were common complaints, they showed little interest in learning how to prepare an antacid from the fine ash of their cooking fires.

p They resisted expanding their diets, as well. As hungry as they were, the campesinos dismissed as "rabbit food" the papaya, yucca, and other fresh leaves I urged on them for their vitamin content.

p My "nail cocktails" received the greatest initial contempt. Anemia was a very serious problem. There was anemia of chronic childbirth—most women by age forty had experienced a dozen pregnancies. There was anemia due to intestinal parasites as well as malaria, which destroys red blood cells. There was anemia due to blood loss from wounds. The most common anemia, though, was the simple anemia resulting from the iron-poor diet of beans and tortillas. Soaking several nails for twenty-four hours, cleaning them with a piece of lemon, and then drinking the rusty water provides a small quantity of absorbable iron. You’d have thought they were being asked to drink turpentine from the initial reactions. 111 Some of the mothers suspected I was trying to induce abortions with the drink.

p I tried to address these fears at the pre-natal sessions. The first few hours of every visit were set aside for the needs of pregnant women who didn’t have the strength to stand all day or who were too shy to be examined with men around.

p An important requirement for preventive medical care during pregnancy is a thorough history. Among other things, I needed to know how many pregnancies they’d had, how many miscarriages or abortions, and how many stillborns. To alert me to the possibility of perinatal deaths or fatal birth defects, the last piece of information I needed to know was how many children were still living and how the others had died.

p I soon learned that asking these questions, especially the last one, often stirred the women to paroxysms of grief. Camila, thirty-eight, was not atypical. She said she had had nine pregnancies including her current one. There had been one miscarriage. Her composure gave way when I inquired about the others.

p Three children survived. Two others, a boy and a girl, had died of a fever and diarrhea, respectively. Both had been lost in the years when Camila and her husband had chosen to pay their mortgage, a sum equal to half the value of their crop, rather than keep the money to feed their children. Each year, the choice was always the same. If they paid, the children’s lives were endangered. If they didn’t, their land could be repossessed.

p Another two children were killed in a massacre during the early months of the civil war. Their memory haunted her.

p "Why didn’t you flee?" I asked.

p "Because we didn’t know then,” she answered through her tears. "We had never been to a demonstration or belonged to an organization. We didn’t know we were the enemy."

p My diary became a receptacle for this pain as well as for my personal frustrations. My handwriting became a furious 112 scribble as I complained that I’d be happy to dispense all the analgesics and iron pills in the world if we only had them, In a few brief weeks, I’d seen a dozen deaths that could have been prevented with an adequate store of medicines. Hunger gnawed at my spirit, too, as did the daily deluge of the rainy season and the dysentery that was slowly robbing me of my strength. I didn’t have the proper antibiotic for it; neither tetracycline nor sulfa tablets had any appreciable effect in controlling it.

p THE DE FACTO TRUCE WAS LIFTED IN MAY. We began to see government Hueys appear between the cloudbursts.

p One afternoon, a crowd of fifty patients was standing outside the clinic in Guadalupe when the dread chop of an approaching Huey came from over the valley rim. I ran to the door to see the helicopter bearing straight down on us at a tremendous speed.

p This was a flight profile, or angle and speed of attack, that I had been familiar with in Vietnam; a full-tilt, treetop boogie with the "gookmobile’s" M-60 machine guns blazing. Until that moment, I’d never seen a Salvadoran Huey flown that way.

p We all froze, transfixed by the thunder of his huge rotor, and expected at any instant to see the fire and lead of his port guns.

p "So this is what it’s like,” I thought. "We’re caught in a free-fire zone, and here comes a Top Gun."

p The episode was over in an instant. The Huey screamed right over us and continued south. Some of the campesinos feinted. Many of the children began to wail. Thankful for their safety and mine, I could only surmise that the Huey had been returning from Chalatenango, his ammunition spent.

p For a long while, the violence—or the threat of it—was like that: random, unexpected. Sometimes, the government soldiers would infiltrate the Front from their command posts along the Suchitoto highway. They would lie in wait along the 113 well-traveled paths between Palo Grande and the farming villages to the north. When a target appeared, they would fire a few rounds and then run before the guerrillas or militia could engage them.

p We were always alert to the possibility of a sniper attack on these trails, but not always alert enough. One afternoon in May, I was trudging through the sector when a woman not twenty-five yards in front of me dropped dead to the ground with a single bullet through her heart.

p Her toddler stood screaming on the trail. I ran to him, cupped a hand over his mouth and pulled him down into the mud beside his dead mother. For fifteen seconds I cradled him there as he put up a ferocious struggle. The bearded foreigner scared children all the time, and perhaps he thought I was the one who had shot his mother.

p I picked him up under my arm and ran bent at the waist through the sodden underbrush until I had him safely out of the way. I waited a few moments and then returned to the trail to confirm his mother’s death. I then hid her body lest the soldiers come and mutilate her.

p Her orphan and I then cautiously picked our way around the scene of the ambush and made our way to Llano Rancho. The little boy’s father had already been killed some months earlier. With his mother now gone too, his care and that of his brothers and sisters fell to an aunt, herself a widow.

p The campesino families of Guazapa were continually shuffled and mended in this way. The house where I would later live, for instance, was headed by a widow with five children. Besides myself, residing in its one room were her aunt and a female cousin, an elder uncle, a niece from yet another arm of the family, an old man who had been the mother’s father’s longtime friend, and two more children whose relationship to the rest was never clear to me.

p With the notable exception of Frederico’s clan in Copapayo, intact nuclear families were almost unknown in Guazapa. Western sociologists, concerned about the effects of divorce, the trials of single-parenting, or the plight of latch-key children, 114 might learn a lot about broken homes if they visited El Salvador.

p Not long after I had witnessed the murder on the trail, a sniper round whizzed past my ear in a similar ambush. In the same period, Janet and I were set at by a rabid mongrel dog that we killed with a club.

p The three incidents prompted concern among my patients and the health workers that their doctor might get killed. Until this time, I’d only accepted an armed escort when crossing the Suchitoto highway. Now, they wanted me to be guarded at all times.

p At first, I yielded to their wishes and permitted an escort to accompany me on my rounds. But I felt like a hypocrite. If my Quaker principles kept me from defending my own life, how could I ask someone else to? If my body ended up on some Salvadoran roadside, so be it. Martyr, fool, or anonymous statistic, at least I would have remained true to my conscience. After one-and-a-half circuits, I persuaded my protectors that I could manage on my own with a pistol. I carried an old Smith and Wesson .22, like my grandfather’s, for two weeks and then passed it on to a sanitaria. Nobody seemed to notice, or else they figured I was hopelessly beyond reason.

p The subtler challenge was to my neutrality, part of my commitment to non-violence. On one level, it was impossible not to be sympathetic to these people who, for decades, had been used as the Salvadoran national doormat. Peaceable protest had brought them nothing but more repression. They at least had a rationale for fighting; they wanted their land back and they wanted their freedom.

p I saw no counter-justification behind marauders like the Ram6n Belloso Battalion, the death squads, or the intensifying air war against the villages of Guazapa. A system that must make war against its own people, that defends itself by murdering its priests, its professors, and its physicians can hardly claim to be civilized, much less to have staked out the moral high ground.

p In a practical way, my neutrality was undermined by 115 circumstance. Leaflets dropped on the Front announced a reward of five thousand colones (about $1,500) for anyone who brought in a foreign subversive, dead or alive. I might not be willing to defend myself, but I certainly wasn’t about to endorse efforts to eliminate me. Try as I might to avoid taking sides, I found myself writing “we” in my diary for the campesinos, and “they” for the government. In time, “they” yielded to "the enemy."

p The brutality of the Salvadoran,government forces provoked implacable hatred among the guerrillas and their supporters, but something else was needed to account for the people’s disdain. From my first day in El Salvador when young Nico explained the importance of fighting more bravely and more honorably than a government soldier, I heard nothing but contempt for the military among the campesinos and companeros. They regarded the soldiers as cowards and called them chuchos, slang for "little dogs.” I was told that the troops rarely searched for the insurgents and that every one of the many invasions of the Front had been conducted against the villages where the soldiers knew no guerrillas were to be found.

p They also rarely fought at night. On the last day of April 1982, a group of us climbed up from the "Grand Canyon" and prepared to make our usual night crossing of the Suchitoto highway. This was the most hazardous zone around the Front. Not only was there a substantial government garrison in Suchitoto, but several permanent outposts, as well as constant patrols, were maintained along the whole length of the road.

p Yet unless there had been an alert or recent skirmishing nearby, we always took the same trail and crossed at about the same time of night. It was so routine that a person could almost set his watch by us. "What an invitation for an ambush,” I thought. In Vietnam, the trail would have long since been mined and monitored.

p We passed close enough to several government camps to hear their radios playing music in the night. I wondered if 116 the soldiers were trying to lure us into a fight, and asked the companero behind me if he thought we might be walking into a trap.

p He just laughed at me. "Camilo,” he said, "the chuchos play their radios so we’ll know where they are. If they didn’t, we might catch each other by surprise, and they’d have to fight. This way, we can cross the highway, and they don’t get hurt. They are cowards."

p The next day was May Day, and we all celebrated at the hospital in Palo Grande. As galas go, it was a pretty tame affair. Everyone received an extra tortilla, a piece of candy, and a couple slices of mango.

p I remember it, though, for the discussion I joined that afternoon. Gathered around the small porch in Jasmine’s hospital, several campesinos and companeros offered their understanding of the day’s significance. The more political of the companeros thought of it as a sort of worldwide proletariat day celebrated with military parades and speeches in communist countries. One campesino was sure it was a celebration of the spring rains and planting season in El Salvador.

p Few of them were at first ready to accept that the May Day was celebrated not only in socialist countries, but elsewhere to mark an event that occurred in the United States more than thirty years before the Russian Revolution. It is, I explained, a commemoration of the Haymarket Square Riot in Chicago. There on May 4, 1886, eleven people were killed and one hundred others injured when workers demonstrating for the eight-hour workday clashed with police. When I further explained that American labor’s traditional day of celebration is not May Day but in early September, the group was even more lost. Yanqui ways puzzled them greatly.

p PERHAPS MY MAJOR SURPRISE in El Salvador was the low number of civilian war wounds I encountered. While the guerrilla columns were filled with those carrying shrapnel and old bullet wounds, the civilians seemed remarkably free from such traumas.

117

p Since civilians were the most common targets of government invasions, I didn’t understand their relative freedom from injuries. When warfare returned to Guazapa, I would learn the horrible answer to this mystery.

p For the time being, it was chronic ill health that concerned me most. Take, for instance, the widespread incidence of malaria.

p I could have practically eliminated malaria on the Guazapa Front for ten cents per week per person; that’s the retail cost of a prophylactic course of chloroquine tablets. Unfortunately, ’ the only person regularly supplied with chloroquine was myself. I carried this personal supply under the assumption that I was worth more to the civilians on my feet than supine and riddled with fever.

p I lived by this rule until a May afternoon in Tenango where I was taken to see a pregnant woman shaking so violently with malarial chills that even strong boys couldn’t keep her on a cot. I gave the woman a full dose of ten chloroquine tablets, a five-weeks’ preventive supply. In a short time other emergencies consumed my entire stock.

p The only recourse was to exploit the local source of quinine, the quina (cinchona) tree. I walked up to Copapayo and found Miguel, who remembered using quina bark to dose malaria and knew how to find the trees.

p According to him, his mother used "three fingers" of bark per cup of quina tea; three fingers being a single plane equal to that of three closed fingers.

p I planned to take an epidemiological approach with the quina medicine. Peasants in separate villages would be given one of three strengths—two fingers, three fingers, or four fingers—and we would then adopt the most effective as the standard for the Front.

p As usual there were problems. We had no microscope, so each case had to be diagnosed clinically. Not only did I have to train each of the sanitarios to differentiate between the chills and fever of malaria and the similar symptoms of so many other common tropical diseases, but the peasants 118 themselves had to be taught not to assume every headache or fever meant the onset of malaria.

p Since our paper always disappeared, record keeping was impossible. Nor were follow-up examinations complete because the people came to the clinics only if they were sick, or if they knew we had medicine.

p On top of that, a summertime outbreak of dengue fever, similar to malaria and also mosquito-borne, skewed the project even more. Hundreds of campesinos with dengue were initially diagnosed as malarial and given quina tea or chloroquine, neither of which has any effect on dengue.

p So much for science around the volcano. Without case controls I had no way of being certain if the quina helped or, if it did, what the most effective dose was. My guess is that we achieved some amelioration, but only a slight one. By autumn, quina bark tea-lover Camilo came down with malaria, too.

p In some regards, my advent on the Guazapa Front was like introducing a food processor to a campesino kitchen; I could whir and spin and effect wondrous things in their eyes. Yet I often questioned my overall value to them.

p One afternoon, a government air attack on the farm village of Chaparral left several people dead and a thirteenyear-old boy critically wounded with a piece of shrapnel in the side of his chest.

p Jasmine and I examined the boy at the Palo Grande hospital. His lung exam was negative and pulmonary function seemed normal. His abdomen was tense, but that was probably because of the pain he complained of.

p We debated performing a laparotomy, or exploratory surgery, to search for internal damage. Had I seen him in an American emergency room, x-rays of his abdomen and thorax would have been routine, as might have been a peritoneal lavage, a procedure in which fluids are pumped in and out of the peritoneal cavity. If they return red with blood, then internal damage has occurred and you operate.

p No such procedures were possible in Guazapa. My only choice was to risk the laparotomy or to trust that clinical diagnosis of a superficial wound was correct. With our stock 119 of general anesthesia about gone and his condition apparently stable, I decided not to operate.

p Jasmine monitored the boy through the evening, then I stayed with him from midnight on. By dawn, he was able to sit up with no pain and was talking about how he wanted to go home.

p I was immensely relieved. His mother, six months pregnant, had lost another son just two days before. Her older boy had been caught by government troops in a town south of Salitre and his mutilated body found on a trail hours later. They had been burying him when news of the younger boy’s injury came over the village radio.

p This son, I was pleased to tell her in the morning, was doing fine. Every vital sign was stable except for a slight tachycardia, or fast heartbeat. I left him to go prepare an IV solution. When I returned he was dead. The sanitaria reported the boy suddenly sat straight upright in bed, complained that he was hot, and expired. There had been no warning, no hint at all that his life was endangered.

p Here was a stark instance of my impotence as a physician. For all my education and training, all the slick, high-tech doctoring I could do, I’d been helpless to save this boy. In the United States, the loss of such a patient would be totally unacceptable; in Guazapa, we encountered God’s will more frequently.

p I guessed that the young boy died of a ruptured spleen, or perhaps an embolism. I’ll never know because his mother, still traumatized by the mutilation of her other son, refused. to allow an autopsy. She wouldn’t talk to me. She just sat there in the hospital, holding her dead child and praying.

p Over time, I learned to adjust my expectations. I was the product of a medical system that puts extreme emphasis upon absolutely correct diagnosis. In the United States, a doctor will order every conceivable test to arrive at a diagnosis rather than risk peer criticism, a malpractice suit, or a patient’s life. The patient price is inflated by this caution, but cost is no object when your career is at stake. In Guazapa, there was no such thing as a second opinion, no CBCs, EKGs, CAT 120 scans, or anything else. While no one was about to sue me if I made a mistake, the patient would be just as dead.

p One case in point was an old man I examined in El Zapote, a village about two hours’ walking distance northwest around the volcano from Palo Grande. David stood on his crutches outside the clinic for an entire day, waiting until all the other patients had been seen. Then he came hobbling in and asked that the female responsable leave the room along with the young girls who assisted her.

p His embarrassment had been more acute to him than the pain of a right testicle swollen to the size of a tennis ball, so inflamed and tender that David winced even in anticipation of my touch. With the women gone, I tried to elicit a medical history from him. An old hernia scar suggested one diagnostic possibility, while the swelling and inflammation suggested another. The old man might be herniating again, or he could be suffering from a torsioned testicle in which the organ twists on its pedicle, threatening strangulation of vessels and tissue. The third possibility was epididymitis, an inflammation of an excretory duct.

p To differentiate among these diagnoses, I needed old David’s help.

p "Do you have regular bowel movements?" 1 asked in Spanish.

p "Si."

p "Does it hurt to urinate?"

p "Si."

p "Is the swelling recent?"

p "Si."

p David’s answer to everything was "Si,” no help at all in arriving at a very serious decision as to his probable condition. I did the best I could with him and decided after an hour’s interview and physical exam that he most likely had a treatable case of epididymitis. A five-day course of tetracycline was indicated.

p The most difficult part was next. David’s condition could require emergency surgery. He had to be monitored in my absence. Someone had to be shown what symptoms to look 121 for if it was a hernia or a torsioned testicle. Someone had to watch him and notify me instantly by radio if there was a change. That someone would be Sara, the sixteen-year-old responsable or one of her equally young assistants.

p I don’t know if the old man or the women were more embarrassed as I explained how his testicles should hang and how to watch them for a change in angle, etc. He stared up at the ceiling in mortification, and they stared down at my demonstration in dread obedience to their duty. Never was a medical lecture delivered under more trying circumstances.

p For six days afterward, I heard nothing. The afternoon of our May Day discussion, I hiked back to El Zapote to learn that no one had seen David since the examination. The news angered me. Sara knew as well as anyone that David might not be able to make it back to the clinic, that he could be dead or dying. Despite all my precautions, he had been left to his fate.

p Following her directions, I set out for his house, a strenuous four-mile trek that exhausted me and must have been torture for him to negotiate on crutches. All the while, I was certain old David was dead.

p His house was deserted.

p "They’re probably out burying him,” I thought.

p But off in the distance, I could make out a figure with a hoe in a cornfield. As I drew nearer, I saw David vigorously working his milpa. He looked up at me with a huge grin, gave a satisfied pat to his scrotum, and offered profuse gratitude for the tetracycline cure.

p After resting overnight, I walked back to Palo Grande to find Jasmine busy with several wound cases. An overnight guerrilla sortie had not gone well.

p She directed me to the village radio room where I was handed a stack of garbled messages from Delicias. From what I could make out from them, a young mother apparently had fallen into a coma or convulsions or both. They needed a doctor immediately.

p My first fear was eclampsia, a condition observed among young mothers in which high blood pressure leads to 122 convulsions. Eclampsia is a mystery; no one knows what causes it. If untreated, it begins as a hyper-reflexive state and quickly moves into convulsions and then complete, constant muscle spasms and occasionally death.

p The medicine of choice for eclampsia is magnesium sulfate, which acts to relax the muscles. I, of course, had none and so prepared to treat the woman as best I could with intravenous fluids and tranquilizers.

p Time was critical; eclampsia attacks swiftly. A campesino saddled a bony old nag that I mounted and spurred north toward Delicias at a wobbly gallop. Three hours later, I reined into town like Don Quixote atop Rocinante and was directed to the patient’s house. Another mile and a half over some corn stubble and through a canebrake and I had arrived.

p I walked into the adobe hut and was delighted to see the mother alert, if stark raving mad. She was spitting and screaming, throwing food at her frightened husband and parents, crying.

p The scene was disturbing, but it wasn’t eclampsia. I quickly diagnosed her condition as postpartum psychosis, a self-limiting affliction that would pass in a short time. Provided she could be made to eat and was kept from harming herself or her child, she would recover.

p Her family did not share my relief. They were halfconvinced she was possessed by demons and thought me very brave indeed to approach the woman, put my arm around her shoulder, and try to comfort and calm her.

p She fixed me with intensely curious eyes, a frequent symptom of psychotic states. The woman spit on herself and me, rubbed the saliva over both of us, and continued to rave. But gradually, she calmed down, the first sign of control she’d shown in two days.

Her family’s terror was understandable; madness frightens everyone. Even I, a doctor, might have been more wary of her, less likely to risk having an eye poked out, had not the Air Force schooled me in the ways of the insane. After all, I was once diagnosed a head case myself.

123