By Margot Newburger, UMMS 2008

Grand Prize Winner 2007 Gerald F. Berlin Creative Writing Award

As we entered the mountains approaching Libertad, clouds drifted between peaks. It was rainy season, and vegetation covered the landscape in brilliant shades of green. I was riding in the back of the pickup truck “El Anciano” chatting with Luis, a small-framed, bright-eyed twenty-year-old from Libertad who, like me, had just completed his third year of medical school. “This,” I told him, “is the most beautiful place I have ever been.” He agreed on the beauty of his home, but pointed out that the terrain had served well as a base for the revolutionary guerilla fighters during the civil war. As we turned from pavement to a rock-and-mud road, and it began to rain, we stood up and held tight to the truck’s side rails, bouncing as we descended into the valley. We had arrived in Libertad, where I would spend the next eight months.

Libertad is a cantón of about 3,000 people located in the mountains of El Salvador. In the 1980’s, this region was a stronghold of the revolutionary forces that fought during the civil war. Now the bombs and bullets have stopped, but poverty continues to bring early death, and the community is mobilizing against the threat of a dam that would drown out most of its best land. Equipped with three years of American medical school, I came here to work with a community-based organization. In a place where most cannot afford the two bus rides to the nearest hospital, people looked to me as “la doctora” despite my assertion that I was a medical student.

Around Christmas, I stopped by the home of Luis’s mother Rosa, a health promoter, to discuss a young woman named Ana whom we had just brought to the nearest hospital extremely ill. Without our transportation, she would not have sought medical treatment. She had signed out against medical advice – with an agreement to return to the hospital after the holidays – after receiving her diagnosis of tuberculosis. Upon return to the hospital, she was refused care because she had “run away.” The social worker arranged an appointment, but the doctor would not touch her. Though it was the weekend and vacation, Rosa decided to accompany me in visiting her at home.

From Rosa’s house low in the valley, we walked uphill. Her four-year-old daughter, Delmi, hair neatly braided for the journey, marched between us hand-in-hand. We began to speak of Luis, now back at school. Having won a scholarship at a Venezuelan medical school, he will be the first doctor from this community, where very few are able to complete high school. “I know that Luis was born during the war,” I said. “Was he born here in Libertad?” Yes, she told me, her voice calm but expression distant: during her labor, planes flew over the valley dropping bombs. No midwife was able to get to the house; she was sure that they would both die. She had just turned seventeen years old, and Luis’s father had already been killed fighting.

I looked down at Delmi, who was happily swinging between us. Rosa and Luis initially lived with her brother’s family. Having left Luis at home one day to carry a letter for the revolutionary army, Rosa was on a bus in the local capital when soldiers captured her. Upon arrival in the military complex, she recognized various other captives, but they all knew better than to let on that they knew each other. Soldiers threw her into a room with piles of body parts. “There was a pile of breasts,” she told me, her voice quickening, “and there were women’s heads. They told me they were going to kill me.” Torture followed. Her cruelest tormenter was a large American with cruel eyes and a poor command of Spanish. “They were going to kill me,” she explained, “but then the Red Cross arrived and liberated us.”

Now we were high up above the valley. We could see the river snaking through the mountains, and the red roof of the tiny clinic where I work. As we began the ascent of another steep part of the path, Delmi pulled back on our hands and complained that she could not stand walking further. “Ya no. Ya no me aguanta ya.” Fortunately we were near Marleny’s house, where Delmi could stay while we visited the patient. A rare household without any young children, Marleny and her mother were thrilled with the visit.

We continued our ascent, picking up sticks as we neared the house. The dogs came towards us barking, and an elderly woman reprimanded them. Ana lay in a hammock on the front porch. A resonant cough rattled her cachectic frame, and she made half-hearted gestures to cover her mouth. Her young son clung to her and warily fixed his large brown eyes on me – I had taken his mother away when she had gone to the hospital. Ana was grateful for the visit, but told us how the medicines made her feel even worse. Her mother brought us coffee and quesadillas while we discussed her treatment. “The pills will make you feel worse at first,” Rosa explained to her, “but you should start to feel better in a few weeks.” Rosa would monitor Ana’s children for clinical signs of tuberculosis, but they would receive no testing or prophylaxis. We talked about the recent upsurge of tuberculosis in the community.

We promised to visit again soon and headed back towards Marleny’s house. After gathering Delmi and a huge bag of plantains, we headed back down the path and ended up on the same descent I had made that first day on the back of the truck. Rosa gave plantains to three skinny sisters playing on the side of the road. It was now dry season, and instead of sinking in mud, I intermittently slipped on dust. At the entrance of the rock-and-dirt road, a new sign proclaimed that the people of Libertad are “decided to fight to the death” against the flooding of their valley. Everything was drying up, green turning to brown in patches of deforestation. The beauty of the mountains had come to feel bittersweet, and I realized how many stick huts were camouflaged into their surroundings.

The noun for hill, cuesta, is the same as the verb for difficult. Here in Libertad, flat ground is scarce. Going up, sweat pours down my face, my heartbeat pounds in my ears, and my mouth quickly dries up as my thirst intensifies. Going down, my feet skid, and my toes stub against rocks. It occurred to me that I was beginning to understand Luis’s view of his home. In this community, as in the landscape, beauty resides amid great hardship – and in the people´s continuing uphill struggle for health, dignity, and self-preservation.

* Names and identifying details of subjects of this essay have been changed.