Help Stop The Passing of the NICA Act

American intervention is threatening progress in Nicaragua, and American friends & readers can help by contacting your senator. Please ask your them to vote against the NICA Act. Here is a link to find your Senator.

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Continued loans from global lenders are needed to build new school buildings in Nicaragua

 

Most expats living in Nicaragua enjoy the climate, food and culture and are friends with Nicaraguan neighbours and colleagues. We see that the country is slowly but steadily reducing poverty, and we enjoy the peace and stability the country enjoys. The country has problems, of course, like anywhere, but only Nicaraguans themselves can sort those problems out. Although the country is still the poorest in Latin America, the economy is growing at a rate of 4.5% p.a. and the rate of crime is only a fraction of that in neighbouring Honduras and El Salvador. These are important achievements.

But this stability and growth is threatened by interference from the USA. In October the US Congress approved the Nicaragua Investment Conditionality Act, known as the NICA Act. If approved by the Senate the NICA Act could see the US block all major international lending institutions from lending to Nicaragua. Institutions such as the World Bank, IMF and Inter-American Development Bank will be blocked from giving loans that fund improvements in roads, ports, electricity and other infrastructure.

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World Bank loans are used to improve infrastructure, such as these storm drains

 

You can put an end to this interference in Nicaraguan affairs by writing to your senator. Ask him or her to vote against the passing of the NICA Act. If the act is passed it will reverse the progress Nicaragua has made in the last few years and will end the improvements we have seen in roads and infrastructure. Schools and health facilities would become even more run-down – so the effect of choking off loans will make life harder for the poorest.

Just yesterday the World Bank, meeting in Granada, Nicaragua, approved a loan of over $400 million for Nicaragua. Over the last three years loans averaged around $100 million a year, but over the next three years that will increase to about $150 million p.a. The World Bank said that this is because previous loans have been carried out efficiently and on-time, by the government and the private sector working together, and with good accounting.

The NICA Act has met with near unanimous condemnation in Nicaragua from the government, the National Assembly, the Private Sector, almost all political parties, and most religious leaders. The Organisation of American States (OAS) electoral mission that was in Nicaragua for the elections last November described the Act as ‘Counter-productive’.

Mural in Managua. Nicaragua has unhappy memories of USA intervention in the 1980’s

If you are from the USA please email, ring or write to your senator now.  Phone number is (1 202) 224 3121, and using skype or a similar package this will hardly cost you a dime.

If you have never lobbied your representative before you can get good advice from RESULTS, a grassroots advocacy agency. I used to work for RESULTS in the UK, and our representatives were always happy to receive polite emails or phone-calls from constituents. Here is a link to find your Senator.

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Long-term investments from lenders will improve rural transport & reduce poverty

 

And this link gives you excellent advice from RESULTS. about advocacy (in general) in the USA.

For those readers who are not from the USA you can still help by signing the petition on the link at Nicaragua Solidarity Campaign and Change.Org

So –  Use your vote, use your voice, tell your senator you live here and have an opinion. Please let us know how you got on, using the Comments Box below.

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Mural shows that Nicaragua doesn’t want interference in their affairs from the USA (or others)

 

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Deaf in North and South

For the second of my blogs about deaf children in Nicaragua, I interviewed two North American deaf activists who came here recently to visit deaf programmes. Even thirty years after the Sandinista revolution, there is a still some solidarity with Nicaragua from the USA and Europe. Brigades visit the country to see the reality here. Kath and I helped organise a brigade of interpreters for the deaf, who visited the Special School in Estelí for a week. It was a great chance to see the lives of deaf people in Nicaragua through the eyes of people in the deaf world in the USA.

Learning Nicaraguan Sign Language with local instructor Heydi

The brigade came from Oregon Western University, and was supported by the deaf education charity Manos Unidas. I interviewed Professor Patrick Graham, the coordinator of the Deaf and Hard of Hearing programme, and Erin Maue, a student in the interpreting programme who aims to work as a teacher of the deaf. Both are deaf and use American Sign Language as their preferred method of communication.

 

 

I asked about their impressions of the deaf community in Nicaragua from this brief visit. ‘It’s very different to anything I’m used to’, said Erin. ‘There is a huge lack of resources here, the students deserve a lot better. Most of the children are really language-deprived – it’s a shock to see 15 year olds so far behind’.

An activity in the Special School run by the brigade from Oregon

The Special School, where the brigade worked for a week, (painting murals and making educational materials), is a school for children with all types of disabilities – deaf, blind, cerebral palsy, autistic spectrum, and other behavioural problems. Patrick remarked ‘I get the idea of inclusion, but so much time is lost to teaching. We saw that some of the deaf children can read or can recognise colours, but there are so many interruptions. And there are so few materials. Deaf children depend a lot on visuals, on touch, movement, even smell. Chairs and desks are less important than resources are, to play with, and learn from. I don’t get the impression the teachers take the kids out to explore the world around them. There could be much better training of the teachers’.

We talked about priorities. This is partly because Nicaragua is the poorest country in Latin America. But it’s also a perennial discussion topic for the deaf community in any country. Signing, or hearing aids? Deaf culture or integration? These are polemical questions in the North and also discussed here in the South. ‘The top priority for me would be teach deaf people here to sign’, said Patrick. The health service in Nicaragua is free, but doesn’t provide hearing aids. ‘Even if you have aids, the batteries can run out, or the aids can break – but you always have your hands’.

Erin painting with one of the school students

‘Children should have both opportunities’ agreed Erin, ‘to be taught to sign, but also to have hearing aids’. But for deaf schools there are many more costs and demands. There will be problems of sound-proofing and more equipment. Patrick said ‘I’d love to come back and be able to build a school with sound-proofing, with aids and signs, and an outside area where the children could learn…and where the deaf community can see role models… successful deaf people …. It’s all connected.’

The other crying-need is an early identification programme for the deaf. Hearing babies are learning language from the day they are born. The first four years of life are the most crucial for learning a language. But in Nicaragua most children don’t start school until age 5 or 6. Depending where you live, there is either no system for identifying deaf children, or the system is extremely weak and haphazard. Yet if you can identify a child with hearing loss when they are young, it’s possible to provide language (either through signing or with hearing aids, or both). ‘Early intervention is the bread and butter of deaf education … the early years are much more important than age five to 18’. But sadly it barely exists here.

Patrick & Kath building rapport with Shoskey through sign language

‘We saw one young child in the school who was identified at age three and is now being helped’, said Patrick. ‘That’s fantastic, early ID is working for him. He is learning to sign, he wants to come to school because that’s the only place where he can communicate… He could be a leader of the deaf-community in the future. But only if his mum brings him to school and encourages him’.

I finished by asking what impressions they would take back to their lives in the USA. Erin said she would use her phone less, try to be more patient with people, and walk more. ‘I realised that if the school is a mile away, then you can just walk there…. It’s not the end of the world.’

Patrick emphasised the disparity in wealth and resources: ‘Maybe in the North we have too many materials…. we could be more inventive? The teachers here do so much with so little. There are no educational toys in the school – if the teacher buys one she has to buy it out of her own salary. In Oregon University we just built a new state-of-the-art building and apparently it has 11,000 feet of cables. Here they can’t even afford to photocopy worksheets. All they can do is write on the board, and the children copy it down, whether they understand it or not. When the board is full the teacher rubs it out so she can continue.

The Oregon brigade met American ambassador Laura Dogu (back row in blue top) who is supportive of deaf education in Nicaragua

‘But it’s not only about resources’, said Patrick, ‘it’s about identity. At the moment in Nicaragua adults are ashamed to have a disabled child. Many hide them away. We need more role models like some of the deaf adults we met here, to go knocking on doors and bring the deaf children to school. The state shouldn’t look at deaf people as disabled, but as a cultural minority with their own language. Deaf children need to learn their identity first as being deaf, and then as being Nicaraguan. Proud deaf people here are the ones who can take the community forward’.

 

Education for Deaf Children in Nicaragua

Last month I met Laura Dogu, the American Ambassador for Nicaragua. In the past I would have wanted to ask her about 50 years of U.S. intervention in Nicaragua, but instead we discussed Nicaraguan Sign Language! My wife is a volunteer here, trying to support the deaf community in Estelí and Jinotega, while taking a career break from her work in the UK as an Implant Teacher of the Deaf at St Thomas’ Hospital. We spend a lot of time visiting the ‘Special School’ (i.e. school for the disabled) and accompanying some small NGO’s that work with deaf children.

Young leaders of the deaf community in Esteli speak with the American ambassador at the beginning of the school year.

The Ambassador was in Estelí to inaugurate the new school year for ETAVS,  an Arts and Media project for the deaf.  The founder, Famnuel Ubeda, welcomed us all to his mother’s house, where two small dark rooms are used to run Sign Language classes at weekends. They teach both deaf people and hearing students (teachers, parents, medics) to sign. The house is in a poor barrio of Estelí, with mud floors and a pit latrine.

Audiology testing service in Jinotega. Few children in Nicaragua have their hearing tested, and even fewer can be provided with hearing aids.

Sign Language is the mode of communication for the deaf here because Nicaragua cannot afford to provide hearing aids to children. And the quality of education, even for hearing children, is sadly poor. In the UK all deaf children can be provided with hearing aids or cochlear implants on the NHS. In Nicaragua the basic health care system is free, but it is basic provision, and does not include hearing aids for the deaf. The hospitals in Estelí and Jinotega can provide a basic audiological assessment, with technical support from a U.S.-based NGO, Mayflower Medical Outreach. But without a hearing aid, a child with only a moderate hearing loss will not be able to access the sounds of speech to learn an oral language.

The first four years of life are crucial, when a child’s brain is geared for language learning. At that age a child can soak up learning like a sponge, and could learn either an oral language or a sign language. But in Nicaragua there is no mechanism to identify babies with hearing difficulties. (In the UK there is a Newborn Hearing Screening programme. Parents can be told at only ten days that their baby has a hearing loss; and the NHS will fit hearing aids on babies at only 2 months).

Children do far better in school if they have learnt language while young.

Outreach services rarely reach isolated areas, such as this village in Miraflor, outside Esteli.

Academic provision for the deaf is very weak in state schools across Nicaragua. Most deaf children are included in mainstream classes with no extra support or help. We met ‘Prof Julio’, a teacher in a primary school in rural Miraflor, who told us that he teaches a deaf child in third grade. “She doesn’t speak and I have no idea if she understands the curriculum. She copies down what I write on the board, but I have no way of assessing if she knows what it is about”.

 

Unfortunately, the truth is that she probably doesn’t understand, she just copies the words letter by letter, having no knowledge of Spanish language. However, she causes no problems and enjoys the social interaction of being in school. So, Prof Julio says he is not too worried about her.  We are – because the girl will go through school and come out having learned very little and have almost no communication skills at all.

Nicaraguan Sign Language dictionary

Nicaragua has put its’ focus for the deaf entirely into developing sign language.  The good news is that Nicaragua’s deaf community is remarkably developed, considering the level of poverty in the country. This is largely due to the emergence of Nicaraguan Sign Language (NSL) following the 1979 Sandinista revolution. With NSL, deaf people in towns are now far less isolated and have a recognised language, if they manage to access it. However, in rural areas, deaf children are still very isolated, with very few opportunities to develop a language. For example, we know Gerald, who came to live with a cousin in Estelí at the age of fifteen. He had spent all of his life until then in the countryside with his direct family, hidden away. He had never been to school and had spent every day in the fields doing manual work. He is now attending the class for deaf students in the special school in Estelí, where he is growing in confidence and beginning to use NSL with his deaf peers. This story is a common one.

Nicaragua is the poorest country in Latin America, and there is a crying need for more resources for deaf education (and indeed for most education). Some NGOs, such as Manos Unidas fund small programmes and also recently brought down a delegation from Oregon Western University*. Mayflower, mentioned above, have a very good Hostel for Deaf Children in Jinotega. Granada has a café that provides work experience for deaf youngsters coming out of education. But all of these, at present, reach only small numbers of young people.

Rural school in Jinotega. Few of these children will ever have had their hearing tested

Nicaragua urgently needs support to establish or strengthen its Early Identification Programme, to take advantage of those magical early years when children can learn so quickly. If hearing-impaired children can be identified young, then they can be helped. Even if the identified children have little chance of getting a hearing aid, they and their parents could then be taught to sign.  If you have any ideas for how an Early Identification Programme could be supported, please write on the comments below.

 

 

 

 

*Next month on this blog we will interview some members of the brigade from Oregon Western University, and ask how deaf people from the USA see the issue of deaf education and deaf identify in Nicaragua.

Buenas noticias: salud mejorada en El Salvador

Iniciemos el año 2017 con algunas buenas noticias. Te presentaré a mi amiga Graciela. La historia de Graciela nos muestra que la vida está mejorando en la mayoría de los países en desarrollo, que la ayuda externa funciona, y que la mayoría de la gente en los países pobres están más saludables ahora de lo que solían estar. Ellos están tomando control sobre sus vidas.

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Graciela, en campaña de vacunacion

Desde 1991 a 1994 viví en una villa rural en El Salvador con mi esposa Catalina. Avelares fue una de las villas que visité varias veces, tratando de apoyar el servicio de atención primaria de salud en un lugar muy pobre. Es una pequeña comunidad en lo alto de los cerros, y en 1991 el territorio estaba controlado por la guerrilla del FMLN. La gente local estuvo tratando de proveer un sistema de educación y salud muy rudimentaria, con jóvenes voluntarios de cada comunidad. En esa época en Avelares, Graciela trabajaba como voluntaria en atención primaria de salud. Ella solo recibió unas pocas semanas de capacitación y algunas medicinas otorgadas por la diócesis católica y una excelente organización no gubernamental (ONG) llamada Concern America.

En noviembre de 2016, Catalina y yo visitamos las comunidades nuevamente y estuvimos encantados de encontrar a Graciela, quien todavía ofrece cuidados de salud en Avelares y en tres villas de los alrededores. Después de veinticinco años ella se ve un poquito más vieja—pero para decir verdad, ¡nosotros también! Ella aún vive en la misma casa y trabaja en la misma clínica de un solo cuarto hecha de bloques de adobe. Pero lo que ha cambiado significativamente son los indicadores de salud. Graciela nos contó con gran orgullo que ningún niño ha muerto en su comunidad en los últimos once años. Estuvimos muy asombrados.

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Graciela en su puesto de salud

En los años 90 en El Salvador la taza de mortalidad infantil fue 60 muertos por 1000 nacidos vivos. Hoy ha caído a 16. Pero en áreas rurales los muertos de infantes era aun mas común. Catalina y yo vimos, probablemente, un muerto en la comunidad cada dos meses. Hubo poco cuidado prenatal, mucha desnutricion y mal acceso al hospital, debido a la guerra y la pesima condicion de la carretera. Todos nos bebes nacieron en la casa, sin electricidad, y con solamente una partera tradicional para ayudar al parto. Como una estimación aproximada, yo diria que un niño en diez murio antes de la edad de cinco años en las comunidades de Avelares. La taza de mortalidad maternal tambien fue muy alta en la década de los 90.

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Nuestro vecino, Adan en 1993. Sus gemelos nacieron en la casa, pero murieron adentro de 24 horas. Reina, la mama, no tuvo ningun apoyo profesional.

El mes pasado, Graciela nos explicó con orgullo sobre las mejoras hechas ahora por el Ministerio de Salud. Nos explicó — Ahora todos los niños nacen en el hospital. Es mi trabajo dar asesoría prenatal, tomar el peso y medidas de salud. Pero dos semanas antes de la fecha prevista para el parto, se lleva a la parturienta al pueblo en las tierras bajas, para esperar en la “Casa Materna”.  Para mi asombro, aprendí que en los últimos doce años solo un niño había nacido en la villa. — Esa vez no pude encontrar transporte oportunamente, explicó ella.

Habiendo sido apoyada anteriormente por la iglesia y ONGs, hoy en día Graciela está empleada por el Ministerio de Salud bajo el sistema de Atención Primaria en Salud (APS). Esto ha sido una iniciativa muy positiva por parte del Estado para retener la experiencia rural de los promotores de salud. En algunos departamentos, los ex-promotores de salud constituyen la mayoría de la fuerza de trabajo pagada en salud comunitaria. Uno de los viejos colegas de Graciela, Dagoberto Menjívar, es ahora médico y administrador. Sin embargo, comenzó como promotor de salud con quince días de formación en el “Curso Básico”. Una verdadera historia de éxito.

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El centro de salud en Avelares (a la izquierda de este edificio)

Graciela nos dijo que el Ministerio es muy exigente. Ella tiene que visitar cada hogar en sus comunidades según un cronograma y llevar a cabo una serie de controles y vacunas en cada casa. – Una vez la madre ha regresado a la villa después de dar a luz, tengo que visitar el hogar cada día por la primera semana, luego una vez por semana por un mes, luego cada quince días, etc. Si un niño muriera en mi área de trabajo, yo podría ser llevada ante un tribunal y poder ser detenida como responsable. Si un niño muere de una enfermedad prevenible en la infancia, yo podría ir a la cárcel.

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Todos los bebes hoy nacen el un hospital

No solo se ha reducido rápidamente la tasa de muerte de bebés y madres en los últimos 25 años. En El Salvador y casi en todos los países latinoamericanos, ha habido progreso constante en la esperanza de vida y en otros indicadores de salud. Ya más seguros que sus hijos tendrán una vida saludable, las familias han estado tomando más control sobre su fertilidad. Cuando vivíamos en la región, la mayoría de las parejas tenían 6, 8 o incluso más hijos. Conocimos a una vecina quien nos dijo tristemente que ella había dado a luz a 18 niños “pero solo cinco están vivos ahora”. En 1990, únicamente la mitad de las mujeres a nivel nacional usaban la planificación familiar y en nuestra área rural el porcentaje fue pequeñísimo. Hoy en día en El Salvador cerca del 75% de las mujeres en edad fértil usan algún método anticonceptivo. Graciela explica los beneficios de hasta seis métodos y puede entregar la mayoría de ellos por sí misma.

En 1990, en nuestra zona, calculo que las mujeres locales tuvieron un promedio de seis partos. A nivel nacional en El Salvador tuvieron un promedio de 3.8 partos. Ahora la cifra ha caído a un poco menos que dos. Esto es un buen presagio para la futura salud de la familia. Desde que asumió el poder el FMLN por la vez en 2009, los servicios de salud materno-infantil bajo el sistema estatal son gratuitos, lo que fomenta su uso, especialmente en las zonas rurales. Los países donantes en las décadas de los noventa y los 2000 que apoyaron a El Salvador pueden sentirse orgullosos de este progreso.

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El paisaje alrededor de Avelares. Graciela camina por todas las casas en sus campañas de vaccinacion

Hay muchos problemas en El Salvador todavía, como la violencia las pandillas, y estos problemas reciben atención en los medios de comunicación mundialmente. Pero el país es una democracia (y el actual Presidente es un ex-guerrillero del FMLN). Países como el Reino Unido, y donantes como Estados Unidos y el Banco Mundial apoyaron a El Salvador para recuperarse de la guerra civil y construir capacidad en el sistema de salud. Ahora El Salvador cuenta con un servicio de atención primaria en salud activo y efectivo, con personal local como Graciela y Dagoberto, que conocen sus comunidades. Me complace mucho saber esto. Detrás de los titulares en los periódicos, los indicadores de salud en América Latina están mejorando constantemente.

Traduccion: Con agradecimiento a Fidel Campos.

Sea bienvenida escribir sus comentarios sobre este blogpost o en español o en Ingles

A good news story: Improved health in El Salvador

img_3049Let’s start 2017 with some good news. I will introduce you to my friend Graciela. Graciela’s story shows us that life is getting better in most developing countries, that foreign aid works, and that most people in most poor countries are healthier now than they used to be. They are taking control of their lives.

From 1991 to 1994 I lived in a village in rural El Salvador with my wife Kath. Avelares was one of the villages we visited often, trying to support a primary health service in a very poor area. It’s a small community high in the hills, and in 1991 was in territory controlled by FMLN guerrillas. Local people were trying to provide a very rudimentary health and education system with young volunteers from each community. In Avelares back then, Graciela was the volunteer providing primary health services. She had just a few weeks of training and some medicines and bandages provided by the Catholic diocese and an excellent NGO named Concern America.

In November 2016 Kath and I visited the villages again and were thrilled to meet Graciela, who remarkably is still the provider of health care in Avelares and three surrounding villages. Twenty five years on she is looking a little older now – but then again so are we! She still lives in the same house and works in the same one room clinic made from mud bricks. But what has changed significantly are the health statistics. Graciela told us with great pride that no child has died in her community in the last eleven years. We were astonished.

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Graciela in her health post

In the 1990’s in El Salvador the Under Five Infant Mortality Rate was 60 deaths per 1000 live births. Today it has fallen to 16. But in rural areas deaths of children were much more common. Kath and I probably saw one child death every couple of months, when we were living and working there. There was little antenatal care, very poor nutrition, and no access to hospital, due to the war and the very poor road to the lowland areas. All babies were born at home, with no electricity, with only a local midwife to help. At a rough estimate I’d say one child in ten died before the age of five in the area around Avelares. And maternal mortality rates in the 1990’s were also very high.

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Our neighbour Adan in 1993, holds his deceased newborn twins before their funeral. They were born a month premature. Reina,the mother, gave birth at home with no professional health attendance.

Last month Graciela explained to us with pride the improvements made now by the ministry of health. ‘All children are born in hospital now’ she explained. ‘It is my job to deliver antenatal advice, and take weight and health measurements. But two weeks before the birth date the mother-to-be is taken down to the town in the lowlands, to wait in the ‘Casa Materna’, the maternity home. I learnt to my amazement that in the last dozen years only one child had been born in the village. ‘That time I couldn’t get transport in time’ she explained.

Having once been supported by the Church and NGOs, Graciela is now employed by the Ministry of Health under their Primary Health Care system. This has been a very positive move by the state, to retain the rural experience of the community health workers (CHWs). In some provinces ex-CHWs make up the majority of the paid primary health workforce. One of Graciela’s old colleagues, Dagoberto Menjivar is now a senior doctor and administrator. Yet he started as a CHW with fifteen days training on the ‘Curso basico’. A real success story.

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The room on the left-hand side is the Avelares health post. On the right-hand side is a community centre

Graciela told us that the Ministry is very demanding. She has to visit every house in her communities on a regular timetable and carry out a series of controls and vaccinations in every house. ‘Once the mother has returned to the village after giving birth, I have to visit the house every day for the first week, then once a week for a month, then once a fortnight etc. If a child were to die in my area, I would be taken before a tribunal and can be held responsible. If a child dies of a preventable early-years illness I could go to jail…”

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All babies now are born in hospital. Graciela arranges an ambulance for them two weeks ahead of their due-date.

It is not only infant and maternal deaths that have diminished rapidly in the last 25 years. In El Salvador and nearly all Latin American countries there has been steady progress in life expectancy and other health statistics. With more certainty over the health of their children, families have been taking more control over their fertility. When we lived in the region most parents had 6, 8 or even more children. We knew one neighbour who told us sadly that she had given birth to 18 children “but only five are alive today”. In 1990 nationally only half of women used family planning and in our rural area the percentage was miniscule. Today in El Salvador nearly 75% of women of a relevant age are using contraception. Graciela explains the benefits of up to six methods and can administer most of them herself.

In 1990, in our zone, I estimate local women had on average six births. Nationally in El Salvador women had an average of 3.8 births. Today the figure has fallen to just under two. This bodes well for future health of the family. Child and maternal health services under the state system are free – which encourages take-up, especially from rural areas. Donor countries in the 1990’s and 2000’s which supported El Salvador can feel proud of this progress.

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Graciela outside her health post. She provides all routine vaccinations as well as family planning and all preventative child and maternal health services.

There are still many problems in El Salvador, such as ongoing violence from youth gangs, and these problems get covered in the global media. But the country is a democracy (and the current president is a former guerrilla leader from the FMLN). Countries like the UK, and donors such as the EU and the World Bank supported Salvador to recover from the civil war and build capacity in the health service. Now El Salvador has a working and effective primary health care service, staffed by local people like Graciela and Dagoberto, who know their communities. To me that is a pleasure to hear. Behind the headlines, the health of poor people in Latin America is steadily getting better.

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The hills above Avelares. Graciela walks from village to village up these slopes. Throughout Latin America Community Health Workers provide the health service in remote rural areas.