She had heard that the American army doctors were coming. And so she waited.
The temperature rose to 115 degrees. Buses dropped off patients dressed in party clothes and flip-flops. They joined the line.
And still, Vasquez waited.
By late morning, it was finally her turn to talk to the medical team. She was weighed, then questioned.
“What types of problems are you having?” a translator asked in Spanish.
“I can’t see very well,” she said. “And sometimes I have aches.”
Her problems were noted, and she moved through the line to see a doctor.
Vasquez was among more than 5,000 patients the New Hampshire National Guard Medical Command treated during a medical readiness exercise in rural El Salvador in late April. Stories like hers were central to the team’s experience.
“You know what’s amazing?” asked 1st Lt. Jim Piro, 46, a nurse from New Boston. “For people to spend hours waiting in the hot sun for Tylenol and Motrin and things that we can just go to the store and buy at home. People are coming in with bare feet and mud and waiting. It chokes me up.”
At a time when New Hampshire soldiers are serving and dying in controversial missions in Iraq, Afghanistan and beyond, the medical command was on a peaceful goodwill trip. Its goals were simple and straightforward: to help people in a poor, rural environment, to train for future missions, to work together as a group and to strengthen ties with El Salvador.
Along with the satisfaction of helping thousands of people with medical needs great and small came the frustration of knowing that some of their fixes were temporary – and that some patients who needed help most desperately were beyond their reach.
The work was hard, and the hours were long.
“You have to have a very selfless attitude – the kind of person that feels that doing their job is more important than enjoying a high quality of life while they’re out here,” said Sgt. Jen LaClaire of Concord.
‘Level one’ care
The medical team met Vasquez and her neighbors in Chilanga, a brightly painted town with cobbled streets surrounded by ancient volcanic hills. Their two-week mission had already taken them through Tablon, Quatajiagua and Chapeltique. This was the fourth and final destination for the doctors, dentists, nurses and other medical personnel.
Their mission: “level one” care – medical and dental screenings and treatment of basic concerns.
“We can’t do any major surgeries or anything serious, but we can identify issues, provide some prescription drugs and refer treatment to hospitals as needed,” said Capt. Mike Moranti, 32, of Manchester.
The 30-member team pulled 446 teeth, fitted 241 pairs of eyeglasses, treated thousands of aches and pains, and saw, among other things, a goiter the size of a cantaloupe, an infected toenail and injuries from an attempted suicide.
“We can kind of be like a Doctors Without Borders,” said Moranti, the medical command operations officer. “Most medical professionals want to help people, and that’s exactly what we’re doing.”
The group’s primary function is to support the National Guard at home.
Members provide medical screenings for soldiers and track those who are deploying or returning from active duty. They can be deployed themselves but are generally sent overseas individually, attached to other units.
“This gave us an opportunity to train as a group . . . doing a mission together, getting used to wearing the uniform, sleeping in tents and stuff like that – in a more relaxed atmosphere than going straight to Iraq and not knowing anybody and not even knowing how to put your Kevlar on,” Moranti said.
Many members have done tours in Iraq, Afghanistan and Bosnia. Some, like LaClaire, 34, a former Russian linguist for the Navy, have never been on a field mission.
“This is a completely different universe,” said LaClaire, a patient administration sergeant. “I was not aware of just how much I was taking for granted. Until you live the experience and see people face to face, you don’t know how much luxury you have had in your life.”
Base camp basics
For nearly two weeks, the team slept co-ed style in canvas tents on an old runway in the Morazon province, in the northwest corner of El Salvador.
They rose before dawn to hearty egg-and-meat breakfasts shipped in boxes from the United States, served cafeteria-style in a trailer and eaten in the open air. For lunch, they picked up Meals Ready to Eat or Salvadoran pupusas, fried cornmeal tortillas filled with beans, cheese or pork. They drank plenty of water.
Surrounded by razor wire and filled with heavy equipment, the base camp was shipped from the United States in pieces for the Army’s New Horizons exercise.
There were Humvees, trailers for a mess hall, showers, generators, tents and a gargantuan washer and dryer system, all to support humanitarian objectives, which included building schools, wells and clinics and running medical readiness exercises.
The Army’s work was focused near former rebel territory, pieces of which were once held by a former guerrilla group, the Farabundo Marti National Liberation Front. The area is also home to the city of El Mozote, where, in 1981, Salvadoran soldiers killed an estimated 900 civilians in an anti-guerrilla campaign, one of the worst massacres in Latin American history.
The country’s civil war has passed, and today, El Salvador, roughly the size of Massachusetts, is home to more than 6 million people.
Agriculture is an important industry, but recently there has been a decline in the export of coffee and a rise in clothing manufacturing. According to embassy personnel, about 17 percent of the country’s gross domestic product comes from money that people working in the United States send back to their families.
Rashes, dizziness, foot pain
The Chilanga medical mission was set up in an elementary school, an open-air cement block building brightly painted in blue and white, the national colors.
Piro sat at an intake table; next to him was a Salvadoran Army interpreter translating medical complaints. Piro held a cheat sheet of ailments listed in Spanish – rash, dizziness, foot pain, low appetite, fever, fungus, sweating, stomach ache, vomiting, chicken pox. By Day 8, he knew most of them by heart.
First Lt. Lezli Clark, a nurse from Rochester, worked next to Piro, shuttling people through the line. Last year, Clark won the Army Nurse Corps excellence award for her work with soldiers returning from war.
She and Piro have both been part of a team of New Hampshire soldiers in charge of case management for troops returning from Iraq and Afghanistan. They tracked injuries and managed care for nearly 400 people. When soldiers came home, Clark gave them her cell phone number.
“I’m a nurse,” she said. “That’s what nurses do.”
Inside the medical area, Capt. Jen Moranti, 30, a nurse from Manchester, gave out hundreds of bags of pills, took temperatures and blood pressure and saw people with aches and pains, lice and dehydration.
“You want to do so much for them,” Moranti said, “but you can really only do so much without follow-up care.”
Lt. Col. Robin DeLeon, 41, a doctor from Boise, Idaho, called a group over to listen to a young girl’s heart. Instead of the normal glub, glub, her heart whooshed – a sign of trouble.
DeLeon told the family she needed to go to the hospital. Her condition would require a more serious operation than the mission could handle.
Situations like that were not easy for the team. The short duration of the trip, the extent of the need and the level of care they were able to provide could be frustrating.
“Not being able to do the things that I can do back home is hard,” said Lt. Col. Susan Caprio, 59, a nurse practitioner from Goffstown.
Chronic disease was the most difficult problem she wrestled with.
“I’m worried about the women (having a stroke),” she said. “We tell them to go to the clinic, but if they could do that, they wouldn’t have come here.”
While the team treated and bandaged and shared smiles with people again and again, it was the people they couldn’t help that some remembered most.
“It’s heartbreaking,” said LaClaire.
The team had been up since around 5:30 a.m. At the end of the day, as members waited to get on the buses in the stifling heat, the soldiers’ sleeves were rolled down to show solidarity with the troops in Iraq.
“I’m tired. It’s hot. It would be nice to sleep in a bed again,” said Caprio.
‘Dentists can be fun’
Inside the dental room, a four member team prepared for an extraction – with a little levity.
“Dentists can be fun,” said Col. Ralph Ergas, 46, a pediatric specialist from Manchester.
Maj. Patrick Racz, 38, a dentist from Bristol, added, “Yesterday, we were joking about how we don’t have repeat customers, and then we had a woman come back for more.”
A line outside the door attested to the popularity of their services. Roborto Porg, 55, asked Ergas to remove eight teeth so he could be fitted for partials. After anesthetic, Porg sat stoically, calloused hands folded on his lap, as his teeth were pulled one by one.
“Let’s say he goes to the clinic,” said Ergas. “He pays his bus fare and he misses work, which costs him money.” Local dentists charge $5 a tooth to be pulled, Ergas said; having eight pulled could cost nearly a month’s salary.
“That’s a big deal to him,” said Ergas.
As the last tooth for the day was removed, Porg stood, shook Ergas’s hand and said, “Gracias.”
“They have so much disease here that they have a higher pain tolerance and don’t take as much anesthetic,” Ergas said.
Ergas learned how to say, “no crying” in Spanish – “no llores” – and when he said it to children, the crying stopped.
“They don’t need as much coddling,” Ergas said. “The Salvadoran children are a little more independent (than their American counterparts). They are tougher, and they listen to their parents.”
They also had more tooth decay.
The dental team saw case after case of baby bottle tooth decay, a condition that destroys a child’s upper front teeth because of prolonged contact with sugary liquids.
A fine line
Members of a military medical team walk a fine line between soldiering and healing. In fact, the Geneva Convention gives them their own category in the rules of war. Medical and religious personnel are considered noncombatants even though they wear uniforms and can carry small arms.
That doesn’t mean they haven’t tasted danger.
While riding the buses home to the Salvadoran base camp one night, fireworks exploded in the roadway ahead of the team.
“My heart stopped,” said Staff Sgt. Roy Lowes, 44, a medic from Wolfeboro who spent time in Afghanistan advising a medical company.
Loud noises surprise him and take him back to his tour.
“In Afghanistan, I had to straddle both positions,” he said. “I’m a pretty compassionate person, but at the same time, you have to watch your ass.”
What the Americans learned in El Salvador about teamwork and sacrifice will quickly be put to the test halfway around the world. The youngest member of the group, Pfc. Ashley Philibert, 19, of Weare will leave for Iraq this summer. Philibert, who joined the Army at 17, describes her time in El Salvador as “awesome.” She knows Iraq, where she will be working in security rather than dentistry, will be tougher.
“Normally I’m very cautious, but lately, I’ve been like this is my only opportunity to do this,” she said.
“When else am I going to have a chance to come help people?”
Philibert volunteered for the tour in Iraq. She’s excited, but when she watches the news, she’s scared too.
“I have no idea what to expect.”
Making life better
Inside the eye exam room, Rebecca Calles, 25, the first female pilot in the Salvadoran Air Force, worked alongside Senior Airman Lindsay Lassonde, 21, of Rochester, helping fit residents with eyeglasses.
Petronilo Lopez, 81, had such poor vision he couldn’t read any letters on the chart in front of him.
“Can you see this?” Calles asked in Spanish.
“No,” he answered.
“How about this?” she asked again.
Lassonde sighed. Hundreds of people needed glasses. There was only one Lassonde.
The team told about a young boy who came in. He couldn’t read. He couldn’t see. He couldn’t read because he couldn’t see.
Groups had donated glasses for the trip, but there were not enough exact prescriptions to go around.
Lassonde did the best she could. When she was through, amid hugs and handshakes, her Salvadoran patients smiled and said, “Gracias, gracias, gracias.”
“I can’t get them to see 100 percent, and I can’t fix all their problems, but I can help them,” she said. “And to see their gratitude makes it all worthwhile.”
LaClaire said later: “It’s the most personally satisfying thing that I’ve ever done – because you know what you are doing is making a difference.“It’s not a symbol. You are really making their quality of life better.”