There were maybe thirty of us boarding the plane for Nicaragua, our suitcases packed with sterile gloves, painkillers and antibiotics, bandages and syringes.  The plane would stop briefly in San Salvador, where we would not disembark, and continue on to Managua for a conference organized by the Committee for Health Rights in Central America.

It was barely 5 years since the dictator Somoza had been overthrown by a coalition  of Sandinistas. The country was poor and trying to institute changes including a literacy campaign, agrarian reform and broader health services.  Early tenuous support from the US had been replaced by the Reagan administration’s covert backing of the Contras and the country had become a site for a proxy Cold War conflict.

Our group was rooting for the Sandinistas and especially supported their efforts to get more health care to the population. We were welcomed and toured around Managua, their national university, and a hospital in León.  They told us about their hopes and plans as well as their limitations—which were starkly evident in the poorly equipped wards which often lacked beds and bedding let alone other supplies.  We also saw some sophisticated ICU equipment that went unused for lack of replacement parts.  They needed simpler tools that could be repaired and basic hygiene materials. Similarly, they didn’t need health professionals who required translators and other supports swooping in for brief visits, but could use Spanish-speaking teachers longer term; a midwife friend of mine did just that for a couple of years.

We were especially happy to be able to visit Berkeley’s sister city of Esteli, several hours away in the countryside.  They were very proud of their community health center and excellent childhood immunization program, with over 90% measles coverage. We were impressed to learn that they considered tracking public health data to be a political act (something that would be more evident to everyone years later when COVID stopped the world).  In fact, despite Geneva conventions and declarations of human rights, health care has always reflected social inequities and conflict.  Working to improve health conditions can make you a target.

We asked what they needed most and they requested a transportation vehicle.  Not an ambulance—that would be too much of a target.  They could use a four-wheel drive pickup truck for access over dirt roads, which they could fill with supplies and people—and also jump out or unload if attacked en route by the Contras.

In fact, the busses we took to visit Esteli had to negotiate some unpaved roads through small villages and dense green foliage on the way.  It was beautiful but dangerous.  We saw men in fatigues with guns as we passed through a town and were told that Contras had recently been sighted in the area.  One of our busses broke down so we had to cram into the remaining one, while the driver and a guard stayed with the malfunctioning vehicle to protect it until it could be fixed.  It wasn’t until we had returned safely to Managua that we realized that our trip had been more perilous than anyone had planned.  Of course we were fine but the people of Esteli and in the countryside were not secure.  Their resolve to carry on tending to the health of their community in the face of the war was inspiring.

We were told repeatedly that the best support we could give was to tell their story when we got home.  Our sister city support group, working under the motto of “Salud  y Paz “ (health and peace) put together a slide show and presented it around town wherever we could, once we returned.  And we raised enough money to buy that truck too.

We asked what they needed most and they requested a transportation vehicle. Not an ambulance—that would be too much of a target.