Search

International medical aid after natural disasters may take various forms, ranging from self-sufficient military forces to single experts or specialists who function primarily as advisers. A model integrating foreign and local medical staff has not previously been reported. In response to the call for international aid by the Honduran and El Salvadorian governments in the wake of Hurricane Mitch in November 1998 and the San Salvador earthquake in January 2001, Israel sent medical supplies and 10 member teams of medical professionals to each country. The aim of the present paper is to describe the unique Israeli approach to providing healthcare in disaster areas by integrating foreign and local medical staff, and to discuss its advantages and disadvantages. The paper focuses on the experience of the two emergency medicine physicians on the team who were assigned to the Atlantida General Hospital in La Ceiba, Honduras. The same team in San Salvador subsequently applied the same approach.

This paper summarizes those factors that have contributed to the degradation of the mangroves in El Salvador, and examines the implications of proposed changes in property rights to the mangroves for poor coastal communities. Current patterns of extraction and conversion in the mangrove ecosystem in El Salvador can be viewed through an entitlement lens that confers property right upon some actors, for certain uses, and denies them to others. Unfortunately, the present system of laws and regulations that governs resource use in the mangroves is contradictory and confusing. A number of laws currently are active that give entirely different directives about the use and transformation of the ecosystem. The rational and sustainable management of the mangroves cannot be secured without a redefinition of entitlement rights. This redefinition of entitlements, however, should take into account the needs of those whose livelihoods are intimately connected to the health of the ecosystem.

Current health reform proposals in most developing countries stress health gain as the chief evaluation criterion. Essential service packages are formulated using cost-effectiveness methods for the selection of interventions without sufficient regard for other factors that are significant for successful implementation and acceptance by the needy. This paper presents the results of research undertaken in Mexico and Central America to test the hypothesis that population groups view health gain as only one among several benefits derived from health systems. The goal at this stage was two-fold: (a) to identify through qualitative methods the range of benefits that are significant for a wide cross-section of social groups and (b) to classify such benefits in types amenable to be used in the development of instruments to measure the benefits intended and actually produced by health systems. Fourteen focus groups were undertaken in Costa Rica, El Salvador, Guatemala, Mexico and Nicaragua representing diverse age, gender, occupation and social conditions. Six major types of health system benefits were identified besides health gain: reassurance/uncertainty reduction, economic security, confidence in health system quality, financial benefits derived from the system, health care process utility and health system fairness. Benefits most often mentioned can be classed under health care process utility and confidence in system quality. They also have the most consensus across social groups. Other benefits mentioned have an affinity with social conditions. Human resource-derived utility stands out by its frequency in the range of benefits mentioned. Health systems and health sector reform proposals must emphasise those aspects of quality related to human resources to be in accord with population expectations.

Ignorance about the costs, case loads and case mixes of different hospitals within the public health system constitutes an important obstacle to reforming health care spending in many developing countries. National (tertiary) hospitals generally receive significantly larger budgets, per patient, than lower-level (district) hospitals. One reason for these differential allocations is the widely held belief that national hospitals treat persons with more difficult illnesses and persons who are more severely ill than do other, non-national, hospitals. This belief is but a presumption and one that warrants investigation. This paper analyzes expenditures among public hospitals in El Salvador over a 12-year period to address this question. While controlling for patient morbidity, outputs and other characteristics, district hospitals are found to be substantially underfunded relative to national hospitals. Four policy options to redress this situation are examined.

This paper examines how physicians' beliefs about risk factors for cervical cancer compare with Mexican and Salvadoran immigrant women's views (hereafter Latina immigrants). Between August 15, 1991 and August 15, 1992, we conducted ethnographic interviews with 39 Mexican immigrant women, 28 Salvadoran immigrant women, and 30 physicians in northern Orange County, California. Physicians and Latina immigrants converge on their beliefs that sexual behavior is a predominant risk factor for cervical cancer. They diverge, however, on their reasons. Latina immigrants' perceptions of health risks are embedded in a larger set of cultural values centering around gender relations, sexuality, and morality. Latina immigrants also emphasized men's behavior as risk factors. Physicians' views, on the other hand, are largely based on the epidemiology of cervical cancer risk factors. They emphasized beginning sexual relations at an early age, multiple sexual partners, and infection with sexually transmitted viruses. Some physicians, however, displayed moral interpretations of the sex-based risk factors for cervical cancer through the use of the culturally-loaded term "promiscuous" in place of "multiple sexual partners," through specific references to morality, and through characterizations of women at risk for cervical cancer. Both the physicians and the Latina immigrants in our study paid considerably less attention to socioeconomic factors. Our results have important implications for physicians who provide health care for Latina immigrants. Physicians should be clear to point out that women need not be "promiscuous" to get cervical cancer.

Most Latin American social security institutes are direct providers of medical care services to their beneficiaries. As many of the institutes have developed serious financial problems over the course of the last decade and a half, they have come under increasing attack for (a) exacerbating inequalities in access to and use of health care, (b) further heightening the geographic overconcentration of services, (c) focusing a disproportionate amount of resources on high technology, curative care to the near total exclusion of primary health care, and (d) being administratively top heavy and, more generally, inefficient. In the past few years, many Latin American countries have begun searching for methods to ameliorate these problems. This paper analyzes three recent efforts, all of which involve some degree of privatization: (1) El Salvador's partial privatization of specialty physician outpatient consultations, (2) Peru's minor surgery and its decentralized ambulatory care programme, and (3) Nicaragua's "administrative services only' approach wherein social security beneficiaries choose to join a certified public or private provider organization for one year, and, on behalf of the individual, social security pays the organization a fixed, annual, per capita fee to provide all health care for the enrollee. The paper also identifies political and technical considerations, as well as health care market characteristics that have shaped these efforts and that condition their likelihood of success, including: the size, composition, level of capacity utilization, degree of organization and geographic distribution of private sector resources; relative prices in the private vis-a-vis the public sector; and the size and nature of the private health insurance market. Other Latin American countries would do well to examine these factors and characteristics before embarking on efforts to reform their own social security health care delivery systems.

This paper explores the impact of a workshop on the formulation of community mental health diagnoses in El Salvador. The author taught the process of diagnosis from the NANDA framework and explored diagnostic decision making through Caplan's Crisis Model. An epidemiologic framework was also incorporated in the diagnostic process so that host, agent, and environment could be scrutinized. The workshop resulted in the formulation of three universal community mental health diagnoses for this (then) war-torn country: depression, aggression, and anxiety; the development of a proposal for the implementation of mental health services; and an invitation to explore implementation of community mental health care services in five rural communities in El Salvador. Although the politics of El Salvador have changed, this example is typical of many Third-World and war-torn countries.

The paper presents new estimates of infant mortality for Colombia and El Salvador for the years 1950--1970. These estimates are obtained by using a technique which improves on Brass's method in that it suppresses the assumption of constant mortality and introduces instead assumptions about linear and nonlinear changes in mortality risks affecting various cohorts of individuals.

"This paper tests for the dynamic causal connection between real income per capita and the birth rate for a subset of developing countries. These countries are Costa Rica, El Salvador, Guatemala, Mexico, and Uruguay. Our empirical findings show that, for the historical period under review, in several countries real income per capita affected the birth rate. Virtually no evidence is found to support the hypothesis that the birth rate affected real income per capita.", (excerpt)

In Central America huge amounts of persistent organochlorine pesticides are being used. This paper presents data on organochlorine residues in human milk. The samples studied were collected from areas with different spraying patterns. The results show very high contamination rates with organochlorine pesticides, especially with DDT. The highest levels were found in cotton-growing areas. Compared with residue levels in areas where cotton is not grown the difference was found to be statistically significant. Many of the quoted values are among the highest reported for the Western World. However, very high residue levels were also found even in Guatemala City, suggesting that other than agricultural uses of pesticides are important contamination sources. It is believed that these high levels of pesticide residues in human milk reflect a high contamination among the population in general.