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A couple watches as workers bury the bodies of people who died from COVID-19 in El Salvador.
Six years ago, as U.S. members of the El Salvador Mental Health Project and the Association for the Development of El Salvador convened a meeting of people who had been health promoters during their country’s twelve-year civil war (1980-1992), it immediately became clear that asking them to talk about their experiences as lay health care providers was going to be emotionally difficult.
“We realized that these horrific experiences were not just felt by individuals, but were community concerns that impacted everyone.”
Marc Rosenthal, a retired emergency room nurse and the project’s Madison, Wisconsin-based cofounder, recalls that people began to cry and shake as they recounted having to flee into mountains, caves, and refugee camps near or at the border between El Salvador and Honduras.
“As they began talking about things that had happened—stories of death squads, rape, and absolute terror—one woman told the group that years earlier, when she’d been hiding from the militia in a cave, her baby had started to cry and, in desperation, she’d smothered him,” Rosenthal says. “That was a transformative moment, a devastating moment, of understanding the trauma that people had been through and had been living with since the war ended.”
In addition, he says, “we realized that these horrific experiences were not just felt by individuals, but were community concerns that impacted everyone.”
Marc’s brother, David Rosenthal, a professor in the Department of Rehabilitation Psychology and Special Education at the University of Wisconsin-Madison, was also at that meeting. As soon as he returned to the United States, he applied for, and secured, a university challenge grant to begin offering mental health services to residents of Arcatao, a small, largely agricultural community in the department of Chalatenango in the country’s northernmost region.
The El Salvador Mental Health Project officially launched in 2018 and continues to be supported by individual donors as well as the university.
Several groups of Arcatao residents now participate in biweekly project-run workshops—called talleres—conducted by Rosy Manzano, a highly trained psychotherapist who travels to Arcatao for in-person meetings with war veterans, people interested in preserving the country’s historical memory, and groups of women whose lives have been touched by the armed conflict.
“The groups are a delicate balance,” David Rosenthal says. “Having people talk about the heavy stuff that happened during the war can be cathartic, but it can also be retraumatizing, so we have to make sure that people include stories of resilience and remember to talk about all the things they did that saved their lives and the lives of their loved ones.”
“Women still have the major responsibility for caring for kids, working in the fields, and maintaining the home, so it’s often hard for them to participate in a three-hour workshop.”
It’s a huge and challenging mission, and couples traditional group work with individual therapy sessions—in-person during scheduled workshops in Arcatao and over Zoom at other times—and combines talk therapy with movement, art, and writing exercises. Trauma-informed yoga is also offered.
The latter was developed by The Center for Trauma and Embodiment at the Justice Resource Institute in Brookline, Massachusetts, specifically for people with Post Traumatic Stress Disorder (PTSD)—whether from exposure to war, interpersonal violence, or other life-threatening situations; it utilizes slow movement and breathing to help relieve the stress and anguish that are stored in the body.
Besides the classes that Manzano offers, bilingual yoga teacher Clare Norelle of Greenroot Yoga has created a series of fifteen-minute YouTube videos that workshop participants can access on their own.
These electronic and in-person resources are essential in El Salvador’s rural communities, the Rosenthals say, because 92 percent of the country’s mental health budget is allocated to the National Psychiatric Hospital in San Salvador. This, they add, can mean a four-hour round-trip journey for many of the country’s 6.3 million residents, making accessing psychiatric care nearly impossible for rural residents and those who lack the financial means to travel to the capital city.
Nonetheless, there is widespread need.
“PTSD is a community-based mental health issue,” Marc Rosenthal tells The Progressive. “Although the war ended in 1992, and for the most part succeeded in demilitarizing the country, many people still live in extreme poverty and have to contend with environmental damage from earthquakes and hurricanes.”—issues that are best addressed by a physically and emotionally healthy body politic.
This, of course, puts mental health into sharp focus.
Beginning in 2015, when the idea for the project was first being floated, discussions between U.S. volunteers, the Association for the Development of El Salvador, and the Association of Communities for the Development of Chalatenango involved a great deal of listening.
“We, as U.S. volunteers, did not want to impose our ideas on the people of Arcatao,” Marc Rosenthal explains. “But from what we heard from people who were working on the ground with youth, with women, and with elders, there was a huge need for a program to deal with mental health. This was true not only for those who had been alive during the war, or during moments of extreme violence, but for their children and grandchildren. There was a universal sense that El Salvadorans wanted us to help them.”
So they have.
While the El Salvador Mental Health Project is a wholly independent entity, Zulma Tobar, co-coordinator of US-El Salvador Sister Cities—a thirty-five-year-old network that came together in 1986 to oppose the more than $1 million a day that the United States provided to El Salvador’s rightwing militias to suppress the popularly supported Faribundo Marti National Liberation Front (FMLN) during the war—reports that people throughout El Salvador continue to need help processing their wartime dislocation and exposure to military violence.
“Many people have been carrying the trauma on their own,” Tobar says. “Rosy’s work in Arcatao has shown us that even when people are reluctant to talk about what they went through, by using theater, writing, drawing, painting and movement people can share what they experienced and get some relief. Right now, one of the biggest issues is time, especially for women. Women still have the major responsibility for caring for kids, working in the fields, and maintaining the home, so it’s often hard for them to participate in a three-hour workshop.”
Nonetheless, she knows how essential it is for them to do so. “My mom suffered in the war, like most of the older people in my community,” Tobar says. “Any time she hears an airplane or helicopter, she gets scared. The challenge for us, as community activists, is that many people are tired of hearing political arguments. They’re afraid to do community organizing. They don’t want to commemorate massacres or go to anti-government rallies because they continue to be fearful of being disappeared or hurt.”
Promoting mental health is a big piece of this work, she adds. And while the pandemic has made outreach and in-person work more difficult, it has also kept North American supporters of the Mental Health Project away from Arcatao since their last visit in February 2020.
Still, David Rosenthal is confident that project supporters will be able to maintain their commitment to “toggling together the resources” to keep it going. Whether this means raising funds for more Wi-Fi hotspots, or working to train more laypeople in therapeutic treatment modalities, the El Salvador Mental Health Project is committed to ensuring that psychological support services are available and accessible to all Arcatao residents who want them.
“Since we began, we’ve worked to make sure we’re not parachuting gringos who come in, then leave,” he says. “We see the project as an exercise in culturally sensitive solidarity. We’re in this together with the people of Arcatao.”