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Refuge and Return : Stories of a Resettled Community in El Salvador

Sister Ana Manganaro

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Angélica Serrano

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In this oral history, Angélica Serrano describes her experience participating in the popular health movement during and after the Salvadoran civil war. For many years, Angélica has participated in the popular health movement as a community-based health care worker system in the resettled community of Guajila, El Salvador. She describes the healthcare training she received and what it was like to treat those wounded during the war. She goes on to tell how, after Guarjila was resettled by refugees coming from Mesa Grande in 1987, Sister Ann Manganaro provided training to healthcare workers and established the community clinic in Guarjila. As Angélica explains, the clinic has expanded and become more sophisticated over time. Finally, she discusses how community organizing and international support have resulted in other critical community-based projects that have improved living conditions in Guarjila, such as the potable water project and the community radio station.

My name is Angélica Serrano, I am from the hamlet of Portillo del Norte, which is part of the municipality of San Isidro Labrador, and I am 52 years old.
I joined the guerrilla in 1980. I was seventeen. Everyone in my hamlet had joined; about 150 people of around the same age. We became fully a part of the guerrilla in 1981 for the first offensive. They took us from Portillo del Norte to a place that is now desolated, but at the time was called Veragua. There we were camping for three days before going to the offensive, which was supposed to be the last one the guerrilla was preparing.
Three days before, they taught me how to inject and stabilize a fracture. They taught me how to attend head, chest and abdominal wounds, which were the three essential things they taught us to help those coming out of the offensive. That was my first experience. They taught me how to inject an orange; they gave us a syringe and we inserted it to suction out the liquid, to learn exactly the places we should inject, which were the butt, arms, and legs. They taught us three ways to treat wounds; how to treat wounds in an injured person’s head, chest and abdomen. Those were the three things that they taught me.
On the third day, I was incorporated into the offensive here in Chalatenango. I went with a squad, and I did not have a weapon with me. At that time the guerrilla did not have many weapons. There were soldiers that had guns, a 22 gun, and some had bigger ones like the FALs and E-13. So, we went to the offensive with cannons, since we did not have many weapons and we had no experience in combat. That is how we began to train ourselves as a guerrilla.
That is how I became a sanitaria. Sanitarias were people who would take care of the wounded soldiers who would come out of combat. When we went to the offensive, there we were integrated into a platoon. There I was also the first sanitaria for the first platoons of the guerrilla, and we started combat with the municipality of Chalatenango. The doctors that were in the guerrilla, who were few, taught us how to treat some problems such as headaches and flus in the encampment.
At that time, malaria is what hit the soldiers the hardest. So, we learned the treatment by heart. We would get a small first aid kit, where we had acetaminophen, amoxicillin, chloroquine. The last one was for malaria, but they don’t use it anymore. And it was then that we were trained to cure some small illnesses. But the essential part was first aid.
That was my first experience, giving IV fluids. It was in an attack in Nueva Trinidad where a comrade came out hurt. He got shot in the chest and was in critical condition. I said to myself, “I am going to learn how to give IV fluids here.” There weren’t any supplies. We had to inject it with a needle, and if a patient moved too much, we could rip the vein. Thank God I had practiced before, and I did it on the first try and was also able to seal his chest wound. They taught us that we had to seal thorax wounds fast because if any air went into the lungs it could make it smaller. We had to seal it quickly to send them to the second stop. Since I was a sanitaria of the platoon, I was a sanitaria in the line of fire. I was taught to retrieve the injured from the line of fire. During that time, I was thin, not like now. I am chubby. But I did learn a lot and I saved many soldiers from the line of fire.
After six years in the guerrilla without leaving the mountains for one day, I had my first child and left for Honduras. Ten days after getting to Honduras I started to work in health care in the encampments. I was there for a year, and I learned to work in a clinical laboratory, to see patients, and I learned about many illnesses.

After that, the return to Mesa Grande started. I got to Guarjila more prepared to work in health care, by then also as a promoter—I wasn’t a sanitaria anymore—we were called health “promoters” at that time. We got to Guarjila with Marlene, Esperanza, and other comrades, and we formed a small health group. There weren’t any houses there, no living places, just one location where the market is now, and we formed a small sick bay where doctors also came to join us.
We had the repopulation in 1987, and 1988 was when Ana Manganaro got here. She was with us and trained us in first, second and third levels, and she trained about another 150 health promoters of all of the Chalatenango province because at that time there wasn’t any medical attention available. We were desolated. That is where we saw patients. We did treatments with Sister Ana.
Ana had a talk with Father Jon Cortina, and they decided that it was necessary to have a referral clinic in Guarjila so the health promoters she trained could send the patients they could not help to the clinic in Guarjila. That is when Father Jon and Sister Ana looked for money to build that clinic. Ana would go with the health promoters to the municipalities of Arcatao, New Trinidad, Las Vueltas, and others to offer care once a month and to give shots, too. Unlike today, back then the kids would get shots once a month, but in the company of Sister Ana. And that is how the community, with help of Sister Ana, Father John and other people built the clinic that was inaugurated in 1991. When we got there, Ana assigned a job to each of us in the communal clinic.
When we got to the clinic, Sister Ana started to give each of us chores. She would say “Esperanza will be in charge of small surgeries,” because we learned to do those with Ana and Victoria. Another one would be responsible for chronic patients who we needed to go visit in the community, since they couldn’t come to the clinic once a month. And another one would work in the lab, since there was a lab available to do the basic patient analysis. Marleny and I worked there, since we had experience working in the labs in Mesa Grande. Someone else was in charge of doing the monthly visits to the community with Ana from 1991 to 1993.
After the Peace Accords were implemented, Ana left due to her illness, and Victoria came along. We all continued with our assigned jobs, but Victoria would continue to train us. We took classes in medicine and on how to oversee a birth in the health unit. There were midwives in the community, but most women would come to the clinic to have their babies. About 250 children were treated by the promoters who were trained to oversee births; they gave prenatal and infant checkups. And the promoters could refer the patients to see a doctor.
Victoria made contact with the National University so that a doctor could come and do their social service internship here. The health unit never was without a doctor and never would run out of medications. Why? Because we had the support of the United States, England, Germany and Spain to keep it running. For 23 years the health unit kept going thanks to solidarity and the community. I believe some people remember that there was a social security system implemented in the community in 1992. Families with low income paid monthly—at that time, five pesos—and could get a checkup, vaccines and medication. And those with more money did not pay for that insurance but paid for the checkup and medicine. So, we could contribute to those who had helped us, and the community helped keep the health unit going.
Well, Victoria told me privately, “It is important that you study”; for her all the promoters had to study. Some got a degree. In my case, I started studying nursing in 1997, and I graduated in 2002. And to honor her for having encouraged us to study, we stayed in the health unit. We used to get an incentive before we started at the Health Ministry. We always received an incentive, recognition for our work from the NGO, not the Ministry. We did not have insurance, but we had a cash bonus. I feel happy that I was able to study, to learn more and work in the community. For 23 years we gave all we had to the community, and we still do but in a different way. At that time, it was that way because it was the Clinica Comunal Ana Manganaro, and now it is the Unidad Especializada Ana Manganaro; it kept the same name, but since 2010, it has been part of the Ministry.
Eight months ago, we began with some innovative work at the Radio Sumpul. That is a station we have here in the community since 1992. We have been evaluating the jobs of those working there, their performance, and making some projections for the radio about what we can do, and what needs to be done in the long run (ten years) with the radio so it can keep working. We keep working on this process for the radio station, which is on the air for now. We have had some difficulties, because the transformers have burned, and we have not had any constant funding for the people who work there. Most of it has been volunteer work, and we want the radio to self-finance itself so that the people working there can have an incentive and feel satisfied with their job working for the radio station.
Radio Sumpul was founded in 1992 as a community radio. The radio stations that were operating in the mountains, Farabundo and Venceremos, had to leave that area after the Peace Accords. But we needed to start a radio station at the community level so that the department could share community-oriented information. In this case, the health care unit has benefited from being able to orient the community with the benefits of health. So, there was a need to create the radio and incorporate some tools we had already, and it was decided that it would be built here in Guarjila since we had a big community that defended projects for the common good. That is why it was built in Guarjila and it has been kept going since 1992, now with some difficulties, but we want it to continue.
Water! Because without water no one can live. Health, because if people are sick they can’t work. They need their health. The housing projects that we had, the latrine project has been beneficial, and on the side, we have the radio project. The Tamarindo project has been working with younger people. We have always wanted young people to have training.
Since we came from Mesa Grande, there has been a big change. When we got here there was no water plan, no housing plan, no electricity, and everything has been a process that the community itself has worked on, with some help. It is not the same Guarjila from 1987. It is more modern, from the housing to the water plan we have now. The health unit has been remodeled. It has more rooms. There is a wider capacity of attention because there are more specialists. There is a gynecologist, there are interns, it has pediatrics, odontology–and that is a lot of progress. We also became part of the Ministry, so the community doesn’t pay us anymore. We have a salary, not a big one, since it depends on how much time and work you put in.
And the water plan is almost done, which was financed by SOLIDAR-SUIZA. We were able to present part of the project to the mayor’s office, so they could help us. The community helped a lot with this water project with physical labor. This project is something the community will be very happy with, since everyone will have access to water. The only problem we have is that some places will get less water—they have gone between four to five days without water. But now we hope everyone has access to it.
We also have intentions to create a tourist center here in the woods. We are hoping to do that. And we want to have a cultural center, and we already have some connections with people who can help us with that and recover memories of the history of Guarjila.
There is also a sewage system project. We have always wanted that for the community, because the area is very difficult to work on since it is flat. The waters of the ponds, the bath water, and rain invade the area; that is why we have that project.
Two years ago, we resumed getting the community organized. We are meeting with all the sectors of the community, every 15 days in the sectors and with the sector representatives. We are having meetings every 15 days to conduct evaluations of the sectors and check if there is anything that needs to be done, so that the sector is involved with issues and needs. That is where we are now.

Currently, the structure is like this, there is an ADESCO with seven members: the President, the Vice President; a Legal Issues, Education, and Health Representative; and a representative for women. But besides the ADESCO we have a committee called el Comite de Convivencia y Seguridad Ciudadana (Committee of Coexistence and Citizen Security) where we have a representative of the ADESCO, one from the community, one from the PRODESOL corporation, one from the Sumpul radio, and a previous ADESCO attendant. There we discuss all the issues from the community, all the projects we want to work on, and these are later taken to the sector. We have representatives from the sectors there too, two or three of them from all eleven sectors, and with them we meet every 15 days to evaluate the works they have done, and what needs to be done in the community.