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75 bbbbbbbbbbbbbbbbbbbbbbb The power to heal is the existential antithesis to the power to kill, and healing has been a common site of religious and political transformation in many cultures (Glick 1977). In Marxist traditions, Friedrich Engels’s 1845 study, The Condition of the Working Class in England, was the first scholarly effort to examine the health of the public as both materially related to capitalist expansion and a site for revolutionary struggle. For its part, Catholicism has traditionally regarded healing as representing the sacrament—“a sign of the healing Christ.” Hence, health institutions have long been central to the Church’s service to the community (Burghardt 1981). Contemporary Catholic teaching asserts that health care is a human right and an essential component of social welfare for the protection and promotion of human dignity (Quinn 1981). Looking through the window of health in northeast Chalatenango provides insights to how new practices shaped collective identities. Popular health, as the system in conflicted areas came to be known after the war, arose in part out of necessity, and in part out of the openness to new ideologies created by the polarization and the influence initially of church workers and later of urban and “internationalist ” health professionals who incorporated within FPL-controlled zones. 3 Insurgent Health How Liberation Theology and Guerrilla Medicine Planted the Seeds of “Popular” Health I believe the world is beautiful and that poetry, like bread, is for everyone. And that my veins don’t end in me but in the unanimous blood of those who struggle for life, love, little things, landscape and bread, the poetry of everyone. —Roque Dalton, “Like You” (1983) To reconstruct these fraught beginnings, I conducted oral history interviews with seventy-one residents of the Chalatenango war zone, including twenty-two lay health promoters (most former FPL sanitarios [paramedics]) and nineteen health professionals who worked in the war zone clandestinely (most of them former FPL internationalist doctors).1 I also drew on memoirs of two internationalist volunteers, Dr. Charles Clements (1984) and Francisco Metzi (1988), and the diary of a U.S. pediatrician and nun (now deceased) who worked in Guarjila from 1987 to 1993. The liberation theology movement led to a variety of local self-help and development initiatives, including health projects inspired by the World Health Organization (WHO) pledge to bring “Health to All,” which emerged from the 1978 Alma Ata conference. The approach to health adopted by the social secretariat of the Salvadoran Archdiocese combined a focus on social causes of illness with Paolo Freire’s (1982) hands-on, interactive pedagogy for adult education. Church workers in rural CEBs were frequently called on to help obtain medicines and provide emergency medical transport for sick or injured patients. In the polarized atmosphere of the late 1970s, demands for better health services were added to the Church’s political agenda. Just as the CEBs laid groundwork for training lay catechists to address the shortage of rural priests, in health, lay volunteers were recruited to attend courses on basic sanitary practices and how to diagnose and treat common illnesses. In remote areas the same individual sometimes performed both catechist and health roles in the 1970s. CEB Origins of Lay Health Organizing Fernando, a soft-spoken, articulate man in his late forties, was one of the first health promoters trained by the church in the zone. In mid-1992 I caught a ride with him to San José Las Flores in the back of a pickup. It was dusk, and halfway between Guarjila and Las Flores a large flatbed truck in front of us lost part of its load of building materials in the road while ascending a hill after crossing a lowlying creek. There was no room to go around, so we talked for an hour and took turns holding a flashlight and helping the men reload the truck. Fernando reminisced about his health work prior to the war: There were some Ministry [of Health] clinics that had been built in rural areas. But the government doctors never talked to people about the causes of their illnesses. Some medicines they gave away free, but others had to be bought by patients. In [CEB] meetings we talked about the need for lower prices for consultas [doctor visits]. To see a doctor in those days cost two colones, but a man was only paid one or two colones for a day’s work, so imagine, someone would have to work one or two days to...

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