Medical Brigades

Medical's a complicated and messy topic whether you are in El Salvador or the United States or probably just about any place in the world.  The disparity between what is available between one country and the next seems unfair.  The disparity between what is available to people with resources or insurance and people without resources or insurance seems unfair.  The sense of unfairness and awareness of disparities along with genuine desires to do good in the world drive people from the United States to organize mission groups to care for people in El Salvador.

The topic of this story:  Medical Brigades.

If you are a regular reader of my random stories, you know that healthcare in El Salvador is a topic about which I frequently write.  Search "medical" or any other healthcare type words, and dozens of stories will pop up.  I am not a professional in a medical field, but I have a 17-year history of walking with the Salvadoran people in the areas of health and education.

Why this topic at this moment?  In one word:  stories.

This is the time of year during which the folks in my synod of the Lutheran Church (ELCA) in the US are working with their Companion Synod, the Salvadoran Lutheran Church, to define the plans for the annual Missions of Healing Family Wellness Fairs which take place each February.  As I am engaged in conversations in El Salvador with the on-the-ground planning team, I keep hearing stories.  A common theme:  Medical Brigades.

I am going to state right here that I do believe Medical Brigades have their place.  What we currently plan with our companions has evolved over the years and it was rooted in what might be described as a Medical Brigade (although we have never used that terminology).  When Salvadoran Lutheran Church folk or US Lutheran folk refer to what we do together as a Medical Brigade, someone is always ready with the correction:  Mission of Healing.  Still, the term Medical Brigade is used all the time and medical brigades are working all over the country.

In the early years, the communities we connect with did not have access to medical care.  There was no medicine available.  There was one pharmaceutical laboratory in El Salvador with a monopoly on the market and only a few products.  Generic medicines from the US were not available locally.  We started our work in communication with the clinic nearest to our focus community and brought what the doctor there recommended.  We assembled a team of medical professionals to help diagnose illnesses and care for the people.

The situation now in El Salvador is that there are multiple pharmaceutical laboratories and competitive prices.  Front-line US medications are not available in El Salvador, but older forms and generics are.  People do struggle to pay for medications if their free clinic or insurance-based clinic does not have the correct medications in stock.  In the cities, there are multiple pharmacies on every corner.  The supermarkets in the city and small towns carry everything from anti-parasite medication to pain-reliever to cough medicine. And in just about every town, there is a story about a recent Medical Brigade.

Here is an example of how this played out yesterday when a few of us were hanging out before a meeting...
Pastor #1:  I am so thankful for the Mission of Healing that we did 2 years ago at the park in our community.  The director of the clinic continues to thank me for the excellent education which you gave the people.  She is building on that and is giving out less than half of the medicine she did before.  The people are healthier because they are not taking this pill and this pill for every small thing.  They are using the natural recipes and managing chronic illnesses with better control of their medications.  She is so happy to get started on the plans for the coming year.
Pastor #2:  The fair we did at the school last year was so beautiful.  The people learned so much as families.  The teachers at the school still talk about it. Did you know after that we had a medical brigade?

There it is:  Medical Brigade.
Pastor #2 continues:  I think it was in March or April.  No, I don't know where they were from, somewhere in the US.  It was very stressful for me.  The people were lined up at the school, and they were standing there for more than 2 hours.  They kept saying, "Pastor, when are they coming?" I was worried they would not show up.  Then they did.  They were more than 2 hours late because they had to buy all the medicine at Walmart.  Some of the people had to leave so they just got their medicine.  In the end it was OK, but I was so worried.

I have questions.  Why would someone schedule a Medical Brigade to come to a town where a Mission of Healing had happened 2 months prior?  Why would a Medical Brigade come to a town which has a clinic and a mobile medical unit (ECO)?  Were the people so unhappy that we did not dish out medicine like candy at the Mission of Healing that they clamored for a Medical Brigade?  (We do give every family a basic kit with some basic medications for the home.)  I am pretty sure there are places out in the far and wide in El Salvador or even in the central city that could really benefit from a Medical Brigade.

Also yesterday, as a little group of us sat in my church office...
Evangelist:  The Unidad de Salud (local health clinic) is doing Medical Brigades next month in the schools.  They are bringing doctors and nurses and medicines and all the students will have check-ups.  When you come next year for the Mission of Healing, we will work with them.  Is it OK if they bring more medicines and a bigger team than last time?  If they provide exams, such as PAP tests, for sure we will want medicine on hand for sexually transmitted illnesses.
Yes, I say.  This is exactly the kind of collaboration we are growing:  the local clinic bringing its local health professionals, working side by side with us and using the medications which are appropriate and locally available.

The Evangelist continues:  So at the "Medical Advice" table people can bring their medicines and ask questions about how to use them, right?  Sometimes at the Unidad they do not give good instructions because there isn't time.  You can help with that, right?  And if the Unidad does not have the medicines they need for the exams they are doing, do you think you can collaborate with the government to help purchase some?
I make no promises, but this sounds like a reasonable idea to me.

In this community, the local goal is to have a Mission of Healing Wellness Fair annually.  We help every other year.

I learned this morning that one week after next year's Mission of Healing, a team of US professionals working with a non-governmental organization will have a Medical Brigade in the same location where the school brigades and the Lutheran-based Mission of Healing are taking place.  I know no details, but I wonder why we cannot do a better job of communicating with one another, in El Salvador and outside of El Salvador, so that we are not saturating certain areas with gobs of resources while other areas never receive a bit of help.  Disparity.  In a society which is crazy about medications (and I recognize the US is not a model example on this point), and a society in which medical professionals and teachers are working to change the "pop a pill for everything" mindset, the Medical Brigade culture in El Salvador, in my opinion, is not always helpful.  It could be argued that is some forms, it is harmful.

Yesterday, my husband stopped by a home to pick up what he thought were photographs to take to a family in the US.  When he arrived, he was presented with a variety of items including a group of syringes containing red liquid.  The idea was for us to take these back to the US because it is a good medicine for fever and the family member in the US needs it.  We think the red liquid was actually vitamins, but there was no clear packaging.  This kind of confusion with medicine happens ALL the time in El Salvador.  It is bad enough with their local products given in their local clinics, but even worse, in my experience, when people receive medications from the US during a Medical Brigade.  So often, bags are not labeled, patients cannot read the labels, patients cannot read at all, the pills are different colors than those used in El Salvador so patients mix them up, and once the medication is gone, people have no idea how to explain the medication's use to their local clinic personnel.

Over the years we have surely made some bad decisions with the Mission of Healing, but we hold tight to two core values:  accompaniment and adaptation.  I don't think the Medical Brigade culture in El Salvador will change very soon.  My hope is that the healthcare system, churches and charitable organizations can better coordinate so the the people of El Salvador who need care can get it and so that those who come to El Salvador to do good, do not do harm


  1. A clarification: "laboratories" in El Salvador are pharmaceutical companies.
    As a member of the Mission of Healing since its inception, I agree with the sentiments expressed in this blog. By collaborating with local health professionals, we have learned that health education is more important than pills in areas where there is access to clinics or mobile health teams. Where a clinic or mobile team is available, a "medical brigade" can do harm by dispensing medications not available in a developing nation and by seeming to compete with the local health system. Cooperation, collaboration and coordination will hopefully prevent US teams from doing more harm than good in developing nations.

  2. This is an excellent post. Thank you, Linda!


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