Like most of you, I have followed the reports of the civil war in El Salvador with growing apprehension and concern. And like most of you, I have felt the frustration of not being able to judge the merits of the policy debate because of my lack of firsthand experience with that country or that part of the world.
So I have done what reporters tend to do under these circumstances--read and clip and squirrel away the descriptions of other observers, and try to fathom the shape of the situation from their accounts. When I read of President Reagan's recent decision to send two dozen military doctors to El Salvador, it triggered a recollection of a report on health services in that country that was put in the Congressional Record in May by Rep. Robert W. Kastenmeier (D-Wis.).
It came from the New England Journal of Medicine of April 28, and was written by Dr. Alfred Gellhorn of the Harvard School of Public Health, one of four health service professionals who visited El Salvador early in 1983 to see what was happening.
Their report explains a good deal about why there is a crisis in health care in the country--and it illustrates again the moral and political dilemmas that attend America's increasing role in El Salvador.
On the face of it, such humanitarian aid would seem to be the easiest kind of intervention to justify. But listen to what the medical mission reported to their fellow physicians:
"The persecution of health personnel is real. It began in 1979 and intensified through 1981, when a group of doctors, nurses and medical students protested the killing and kidnapping of patients and doctors in hospitals-- sometimes even during surgery. Retaliation against this group by death squads, suspected of being government forces, was swift and brutal. The group's members 'disappeared' or fled to avoid death, or were killed.
"We came to El Salvador with a list of 20 health workers and scientists who had disappeared in the previous 12 months. Our investigation revealed that only seven could be accounted for: four were in prison, two had been freed, and one was confined to a mental hospital outside the country. There was no trace of the other 13. Moreover, while in San Salvador, we were given documentation on the disappearance of 20 additional health workers during 1982. From frightened families and colleagues, we also learned of a number of other physicians, nurses and paramedics who had disappeared or been killed."
I should make clear that I do not know Gellhorn or his three colleagues, who went to El Salvador representing the National Academy of Sciences, the Institute of Medicine, the American Association for the Advancement of Science, the New York Academy of Sciences and the International League for Human Rights.
But between the lines of what is clearly intended as a dispassionate communication to fellow professionals, there is a warning cry.
"In July 1982," they note, "the International Committee of the Red Cross threatened to leave El Salvador because of its growing concern over human-rights abuses by the Salvadoran armed forces--particularly their practice of not taking prisoners alive. Officials of the International Red Cross told us that, although these problems have not been resolved, they have decided to remain in the country because, on balance, they believe they are a force for decent human behavior."
The American team described what the war has done to El Salvador: "The Ministry of Health has suffered a 50 percent reduction in its budget during each of the past two years and is finding it difficult if not impossible to provide adequate staff and medical services for the 6,000 beds under its jurisdiction. . . . The rate of endemic diseases is rising dramatically, as social programs are sacrificed so that funds can be allocated to the military. Infant mortality is climbing. . . .
"We visited the only public maternity hospital in San Salvador. . . . The patient turnover is very rapid, but even so, up to three women are assigned to a single bed. . . . Dr. Roberto Rivera Martelli, a senior obstetrician who was our host at the hospital, and a man deeply committed to the care of the poor, was taken from this clinic on Feb. 10, less than a month after our visit with him, by three armed men in civilian clothes and has not been heard from since. Since then, cables have been sent to our embassy in San Salvador and to the colonels who head the National and Treasury police by our sponsoring organizations, members of the U.S. Senate, the human rights division of the State Department, and individual U.S. citizens, but Dr. Rivera Martelli remains 'disappeared.'"
As of this week, Martelli was still missing. And the New England Journal of Medicine has received no rebuttal or response from the Salvadoran government. It all adds to the worry an average citizen or journalist must feel about where we are headed in El Salvador-- and why.