Lifeline to health.

• Author: Bronner, Michael Eric
• Position: Health program in Morazan, El Salvador

In El Salvador's war-torn department of Morazan, local leadership and initiative are injecting vitality into a health program begun by an international team of doctors

It is an overcast afternoon in Morazan, and rain is already visible in the next valley. The Chiquito River, a major tributary of the mineral-blue Torola River, is slightly swollen and chocolate with erosion. Laughter from the rocks above the river precedes the sound of small feet running, then two young boys in faded bathing suits fall through the humidity. Muddy water swallows them, then runs from their faces as they swim to shore.

One hundred yards upstream the boys' fathers carry cement and heavy stones that will form the trusses of a permanent bridge across the Chiquito. At least five people have drowned there since 1994, and many more before them. Until a temporary bridge was erected last year, children would routinely swim the river to attend school. Midwives traveling to assist in births, the elderly, and anyone else passing through the region would also swim or wade, depending on the day. Now the guarantee of safe passage between the Chiquito's banks has become the cornerstone of plans to establish five community day-care centers and a new health clinic. The local builders and lead engineer are among the many volunteers working with Medicos del Mundo - El Salvador (Physicians of the World - El Salvador; MDM-ES), the Salvadoran mission of the French physicians group, Medicins du Monde (MDM-France).

MDM-France established its presence in Morazan as an emergency response team in the thick of war. MDM-ES, a unique extension of that group, has remained to help infuse sustainable health and community-oriented primary care into the shaken rural communities of this particularly imperiled department in northeastern El Salvador, the setting of the war's greatest conflicts.

Some sixty miles east of San Salvador, Morazan is mountainous and rough. Valleys are flecked with adobe and bamboo homes, stitched with crops, and veined with cloudy rivers. There are two small harvests of corn a year, in May and August, and a steady supply of pita, a fiber of the henequen plant used to weave hammocks and handbags. In the rainy season, wild vegetation and rainwater work incessantly to erase the impressions that humans have made here, from their cultivated rows and stony roads to the residual craters of bombs. When there is no rain the land is desiccated by the sun. All this is exacerbated by deforestation, with the result that soft in Morazan ranks among the poorest in El Salvador.

In contrast, however, is the rich resolve of much of Morazan's population to improve living conditions; indeed, local leadership and initiative are the lifeblood of MDM-ES's efforts. The fact that there was prolonged war in the region is still evident, in the eyes of anemic children and in homes that are missing husbands and brothers. These effects of war place the people of Morazan in...