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An Interview with Jean Schmitz, MSF Head of Mission in El Salvador
February 21, 2001
Jean Schmitz, Doctors Without Borders/Médecins Sans Frontières (MSF)'s Head of Mission (general coordinator) in El Salvador, has had no rest since August 2000. Nor has his team. El Salvador has suffered one emergency after another. First there was a dengue epidemic, then a gastroenteritis epidemic caused by rotavirus, and finally two major earthquakes within one month. A third serious earthquake, which may have caused no deaths or injuries, struck yesterday.
And as though matters were not complicated enough, the rainy season will start in May, bringing with it the yearly floods and the risk of epidemics-mainly cholera and dengue. This has been a cycle in which one disaster seems connected to the next; the population is never able to gather itself and return to any sense of normality. Getting back to a sense of routine will be a challenge for the country.
In the short term, the challenges are many: to help a health care system to restart basic activities (25 percent of the health care structures have been destroyed or severely damaged by the two earthquakes), to ensure the population's access to water and sanitation services, and to design a preparedness plan for the emergencies that are to come.
What Is the Current Situation in El Salvador?
Since mid-2000, the country has been involved in one emergency after another. The last two earthquakes have affected 75 percent of the country. If El Salvador had deficient water and sanitation infrastructures before, the situation now is even worse, which increases the risk of water-borne epidemics, such as cholera and other diarrhea-related diseases. On top of this, with so many emergencies, the Ministry of Health has had no time to develop long-term health care policies; and furthermore, its finances are in the red, which could lead to a lack of medicines and medical material. In addition, there is the risk of malnutrition within the population, as many people have lost their jobs. The majority of the population lives in poverty.
In addition, El Salvador's specific characteristics have to be factored in: there is high demographic density (300 inhabitants per square kilometer), a lack of access to water, deforestation, and high risk for earthquakes, floods, and epidemics-mainly cholera and dengue. The earthquakes in January and February 2001 have aggravated the situation, revealing the real underlying situation in the country.
With this series of disasters, one after another, this country currently is dependent on international humanitarian aid.
What Activities Is MSF Undertaking to Respond to the Earthquake Emergencies?
Our activities are divided into two phases: the emergency and the post-emergency. The emergency phase will last four months. There are too many needs, but MSF will define its priorities. At this point, 85 MSF volunteers, both national and international, are running medical activities in the most affected areas of the country. These range from primary health care, vaccinations, surgery, and mental health care, to epidemiological and nutritional surveillance, prevention of sexually transmitted diseases, and the implementation of universal precautions in an emergency context, particularly to avoid transmission of HIV and Hepatitis B.
As to water and sanitation, we are building latrines, places to wash, and showers in the shelters where displaced people are living, as well as installing provisional water distribution systems in towns. We are also distributing plastic sheeting for temporary shelters and family tents, as many people have lost their homes. We are also distributing tents so that damaged health units can restart medical activities.
MSF is working in coordination with the Salvadoran Ministry of Health, municipalities, and national and international NGOs, as well as victims of the earthquakes themselves through their community leaders and United Nations bodies, especially UNICEF, Pan American Health Organization (part of the World Health Organization), and the World Food Program (WFP).
What Will MSF Do in the Post-Emergency Period?
Jean Schmitz: In about four months, the objective will be to reinforce the health care system in the most affected areas, working at national, departmental, and local levels. Also, the epidemiological surveillance system we are now implementing will help us to get early warnings about possible epidemic outbreaks of endemic diseases such as dengue, cholera, and leptospirosis.
On top of this, we need reinvigorate the activities of the medium-term HIV/AIDS program we were organizing-a program that has been given secondary importance because all human resources have been focused on assisting the victims of the earthquakes.
We are also seriously thinking about the idea of developing a disasters mitigation and prevention program. MSF has experience running this kind of program in Guatemala and Nicaragua in the aftermath of Hurricane Mitch. Given our continuous presence in El Salvador, we want to duplicate the experience here, determining high-risk areas so that we are able to act before disasters occur.
What Conclusions Can MSF Draw from this Intervention?
I think we can be positive. We've shown that MSF can provide a rapid and effective response to these kinds of natural disasters. We have to say that MSF was already present in El Salvador at the time of the emergency, which facilitates the response. You know the country, you have teams on the ground and the necessary contacts with the authorities. Furthermore, there was the issue of MSF collaboration. MSF teams in neighboring countries, especially Guatemala, Honduras, Nicaragua, Costa Rica, and Colombia, quickly mobilized human and material resources to support our intervention.
Something new we have introduced in this emergency is the so-called "team life" initiative. Organizing and managing an 85-person team in an emergency is not an easy task. Therefore, there is one person in charge of welcoming and providing accommodations to the volunteers upon arrival; organizing the food; and taking care of our people. This, together with the good character of the teams, has made it possible to keep a relaxed and cordial atmosphere, despite tensions, 3,800 aftershocks, and long working days, which are never less than 16 hours.
Jean Schmitz has been working with MSF since 1992 and has been the Head of Mission in El Salvador since August 2000. Previously, he worked with MSF in Cameroon, Guatemala, and Peru.