The War Disabled –Wounds Still to Heal
Chepe Concepción is thin as a pencil. He pushes his stiff right leg along ahead of him with the help of a pair of crutches. He lost part of his knee, and with it all movement in that leg. His face, serious, but edged with irony, knows how to break into a smile that makes those around him smile back.
"Why am I like this? Because of Reagan's goddam war; I got it defending our country! The doctors told me I'm always going to be lame, that there's no way to make my knee move again.
"And what do I think? What could I think? At first I was really upset, because now I wouldn't be able to work at anything that involved walking, couldn't run or play baseball. And I still feel shy around girls.
"Who helped me? I did it with my own thinking. That and realizing that I'm not alone in this, that there are a lot of us—with a useless hand, or both hands, lame in one leg, both legs, blind, in wheelchairs... The other guys help too, because we get talking about what happened to us and that helps us adapt and even makes us happy. 'Cause if we're sad we're dead, and for my part, a leg that’s dead is enough."
Chepe Concepción, 20 years old, is from a rural area along the road from Masaya to Tipitapa. He’s one of more than 3,500 soldiers defending the revolution that the contra war in Nicaragua has left with permanent disabilities.
envío interviewed 350 of these people in different parts of the country to learn more about who they are and what they feel; their problems, their aspirations, their limitations and their strengths. In the process we saw the personal and institutional support structures that have emerged to help them readjust; we saw what the revolution has already done, and what it has yet to do. By the end, we came to know something about these wounds which, even when peace comes, will remain open and will only be healed with the help of everyone.
The "cachorros": On the front lines
Data from the interviews indicate that 75% of those with permanent war injuries are between 18 and 25 years old—youth who were doing their military service when they were irreparably wounded. Of those, 85% were wounded in combat.
At the end of 1983, when a draft law was implemented for the first time in Nicaraguan history, Irregular Fighting Battalions (BLI) began to be formed. The BLI units have been decisive in the successful confrontation with the contras, who had precisely been carrying out an irregular war.
The majority of the war-wounded were from these BLIs. Some drafted, some volunteers, they had left their high schools, their universities, their plows, the warmth of their homes, their girlfriends and their mothers to go to war.
Their youth and good training made them able to withstand the long walking, the rain and mud, the hunger and lack of sleep and the diseases of the mountains. "Sandino’s cachorros [cubs]," as the young draftees of the BLIs are called, changed the course of the war by the end of 1985.
In the last four years, thousands of youth have passed through the ranks of the Patriotic Military Service, or SMP, as the draft is commonly known. After two years of service, they are given an ID card as "demobilized."
Extrapolating from our figures above, we can calculate that perhaps 2,500 cachorros have been partially handicapped as a result of being in the front lines of combat in the war the United States unleashed against the Nicaraguan people eight years ago.
Roughly 16 young people with some medical training accompany each BLI, to treat the wounded right away. If the wound is serious, saving the soldier's life depends in large measure on the speed with which he can be evacuated to a hospital.
The Soviet helicopters the Nicaraguan army has had since 1984 have been essential to accomplishing this. But many times the road or path out of the mountainous war zone to a strip where a helicopter can land is long and tortuous, and the wounded are taken out on mule-back.
"Any time that's lost is precious," a medic from the "Santos López" BLI told us. "Because of these long trips down the mountain, many buddies many not lose their life, but they do lose their leg, if it's a wound they sustained stepping on a mine. By the time they get to the hospital, their leg's a mess, full of gangrene, and there's no choice but to amputate."
According to the national census of those with irreparable war injuries, a fifth of them have had one of their limbs amputated. Of these, 95% have lost a leg, and sometimes both.
The majority of such cases were victims of mine explosions. The contras plant mines of all kinds on the mountain roads and on the paths leading to BLI camps. The objective of the small anti-personnel mines, the size of a sardine tin, is precisely that: to amputate.
"To amputate, not to kill; that's what they’re after," said the medic of the Santo López. "It’s painful to say, but it’s easier to take a dead person out of the mountains than one who's wounded. You need four men taking turns carrying him, taking care of him. A wounded person is a burden at the time and after being amputated there's a whole series of new problems."
Chepe Concepción, so serious, yet with his sparkling smile, knows those problems well and has found his own way to come to terms with them. The irony and the smile are both part of it.
"In 86 and 87 I was in a BLI in Region V. The BLIs were never based in a town, never; we were always in the mountains. We're the ones who have made the contras turn tail. The BLIs are the ones who kicked their ass, and some of us ended up disabled. And some—like me—lost our girlfriends. She didn't wait for me and cut me off. If I didn't have this bum leg and could walk okay, I'd go back into the service. I don't know why, but I liked it. I went voluntarily, and even though I ended up lame I don't regret it. What good is regret? At times I dream at night that I'm playing baseball. Or I dream that I'm going through the mountains, that I'm running, fighting, that I'm slogging through the deep mud with the other compas [slang for buddies}, walking with my pack. Then I wake up, and my leg...nothing...it doesn't move."
Speaking with the handicapped cachorros leaves no doubt that Nicaragua won the war with the United States because of a major dose of that enthusiasm and audacity that one only has in youth.
In Apanás: A hospital in the mountainsWhen the Spanish-Brazilian bishop, Dom Pedro Casaldaliga, visited Nicaragua for the first time in 1985, he went as far as the military hospital in Apanás, Jinotega. He described it afterward as "the most joyous hospital I’ve seen in my life, although, by definition, any hospital anywhere is a little sad."
The hospital is really pretty, its wings built of wood, set among the green mountains of the rainy season, near an artificial lake fed by the waters of the Río Tuma. The climate in the north is always fresh.
The hospital bears of the name of Germán Pomares, a peasant founder of the FSLN killed in May 1979, in Jinotega, where he was leading an insurrectionary column. It was built as a field hospital in June 1984 to give the most complete primary care to wounded soldiers.
If the mid-eighties were the hardest times of the war, that was one of the hardest war zones. In the four years the hospital has been operating, 8,000 wounded have been treated and 5,000 operations performed. Apanás' medical capacity and treatment of combatants is only topped by the "Dávila Bolaños" military hospital in Managua, the best equipped in Nicaragua.
In January, when we visited Apanás, more of its beds were occupied than they would be two months later after the cease-fire initiated with the Sapoá accords. The major distraction for the wounded was the Brazilian soap opera, "Niña Moza," then on TV. Medical chores, conversations and even pains and complaints were set aside as Brazil's "golden age" of colonial plantations and slavery wound to its inevitable end each evening.
We spoke with Orlando, a young cleric who had already spent some months as a health worker in the hospital:
"I’ve seen the process that ends in amputation lots of times. The kid comes from the mountains with a leg wound, but still it’s maybe yes, maybe no, without really knowing. But if they got him out of the mountains very late, or if the immediate steps weren't done well due to inexperience on the part of the BLI’s medical workers, chances are good he’s already got gangrene by the time he gets here. Within a few days, even with a lot of antibiotics, the leg is swollen and is turning dark, dark. No matter how much you clean the ward it creates an intolerable stench.
"Now the kid knows: ‘It’s me, I’m rotting; they’re gonna amputate." They know other cases, they've heard. The medic still doesn't tell them anything, but they already know. The first thing they think about is their mother. ‘How am I going to break it to her?’ The medic tells them, ‘We’re going to operate to see if we can save the leg.’ It’s so they’ll have a positive attitude, right? Sometimes the mother comes, because they notify her that her kid is wounded and she knows right away that they’re going to amputate. It’s terrible to see the two hugging each other, crying, before the kid goes into the operating room.
"When they come out, they almost always talk under the anesthesia. Many talk about when they were wounded. It's heavy, because you relive with them the moment they got messed up. It's engraved in their memory; they repeat it. It's an anesthesia that can last sometimes for a whole day, and they talk all the way through it. When they wake up, they feel an emptiness in their body. That's how they describe it. At the moment of feeling for their leg and realizing it's not there, they break down and cry. It's heartrending."
In Apanás boys from the city and the rural areas come together. Some have never seen a television, much less a TV soap opera. For those who are handicapped, the initial questions are different for the two groups. For those from the city, it's questions like: What am I going to tell my mom? Is my girlfriend going to leave me? For the peasants the concerns are: How am I going to be able to plant? How am I going to be able to get on my horse? How can I just stay sitting on a bench?
These questions aren't always resolved positively. There are mothers who become desperate faced with their boy’s unexpected incapacities or who so overprotect him that he ends up feeling really disabled. There are indeed girlfriends who leave someone who has been blinded or paralyzed or crippled. And there are peasants for whom their disability really represents the end of the world—their world.
Faustino was an evangelical pastor. A mine destroyed his leg at the groin. There wasn’t even anything left to attach a prosthetic to. When he went back home, the first and only thing he did was convert to Catholicism so he could drink without remorse. Now he spends the whole day in a hammock, drunk, trying to forget the horrible moment when he lost his leg and his will to live.
Alvaro ended up with one side of his body paralyzed and missing an eye and a leg. The rehabilitation treatment didn’t improve his situation much. Now his mother treats him as if he were a small child, even though he can walk a bit. But, says his mother, "What's he going to do now, the poor little thing?"
"Who do they curse for their misfortune, Orlando?" we asked the hospital worker.
"Those who are the most embittered, who heap blame or show resentment toward the revolution, are the ones who shot themselves in a foot or a hand to get out of the war. There are some cases of this; they do it so they'll be taken to the hospital, cured and then let go. But most are real honest kids, who knocked themselves out for a cause and, let me tell you, they make me feel like a coward. For them, for this majority, clearly they have to curse the war, which is the US imperialist war. They have to curse the contras, who took their leg, a piece of their life, from them. It doesn't occur to anyone to say, "This is how God wanted it." It's got nothing to do with God, no one gives Him any responsibility for his misfortune."
Bayardo: "The last thing I saw"Some 7% of the handicapped lost an eye in the war. Another 1% was completely blinded. Among that 1% is 23-year-old Bayardo González.
We found him in Granada's central park, accompanied by a young woman and a little kid who was trying to take away his walking stick to use for a hobbyhorse.
Bayardo wears mirrored glasses like the rock musicians, to conceal his lightless eyes. He walks surely and various girls stop to greet him. He knows them all by voice and returns the hello. He says he has many girlfriends. He doesn't mind telling his story although he can't hide—or control—his emotion recalling what happened.
"In January 1984 the draft got around to me. And I went when they called me. Deep down inside I was afraid, and I couldn't kick the feeling. I had worked a door-sanding machine in a wood shop, and studied at night. What I wanted was to return quickly so I could continue studying. I lost a little of that fear when I got to the military school, lived with the rest of the guys, and got the training and the talks.
"After two and a half months of military training we went straight to the mountains. Within 15 days we had our first combat. It was over near Wiwilí. The battle began about five in the morning, when it was already light. It was my first combat, and of course I was afraid. Ay, mama mía! But I controlled myself okay. About two hours later I was covering an advance of our guys and came smack up against a group of contras covering the retreat of their own men. They were protected behind a big boulder. We couldn't have been more than 30 yards from each other.
But there I was in the open, with nothing to cover me. There wasn't even a tree nearby, just weeds. A contra got me in the sight of his AK, and he shot just seconds before I did. The bullet went in right between my eyes and came out the side of my neck.
"I felt the impact, a sharp vibration in my ears and everything looked black. I partially passed out. As far as I was concerned I was dead; 'It's all over,' I said to myself. 'Can this darkness be the other world?' When I came to I called to the other compañeros to get me out of there. I didn't feel any fear any more; I just thought I was wounded. At that moment I didn't dream that I was going to end up blind. I remember the contra that shot me with perfect clarity. He was about 25, light skinned, with loose curly black hair, like mine; a little shorter than I am, but stockier. Who knows who he was? He was the last thing I saw in this world."
Bayardo, losing and recovering consciousness, went first to the hospital in Wiwilí, which didn't have the conditions to operate on him. From there to La Trinidad, where they didn't either. In the military hospital in Managua, he was operated on by a Cuban doctor. He spent 25 days there.
"The doctors didn't tell me I was going to be blind. I asked them why I couldn't see and they said, 'That's how it is, don't worry.' But I knew the systems doctors use so one doesn't get agitated. In reality they didn't fool me. I was preparing myself. 'Wow,' I thought, 'I'm going to have to do better.' I thank God my family helped me, and my community too. One day they came from Granada to see me. Fifteen people to see me! Although they spoke softly, I recognized the voices of the people from my neighborhood. And I was pleased that they would come just to see me. That support was very valuable.
"When I left the hospital and came home I still had the same question. They didn't tell me; it was like they didn't dare. But I continued preparing myself. They told me that perhaps with an operation... One day I said to my sister, 'What are the chances that I'll see again?' 'One percent,' she said, and that was when I knew. One percent is zero percent, right? It's absolutely nothing!! But by now I had spent time thinking and preparing myself, and that helped me.
"I often felt desperate. But I got to thinking, 'The past is past; I am what I am and I have to live the present.' That was how I analyzed it, searching for how to get on with my life. A friend who studied with me helped too. He always used to say to me, 'Look, Bayardo, I'm not going to rest until I see myself behind a desk; until I'm a professional.' We worked and studied together before going into the service. We supported each other in everything. Fifteen days after I was blinded, he died in combat. I thought about him and said to myself: I have to do better."
After overcoming the first temptations to isolate himself, a characteristic of all the handicapped we visited, Bayardo went to the "Carlos Fonseca" Center for the Non-Seeing in Managua. There he spent several weeks learning how to use his walking stick so he could walk alone, and how to read and write the Braille method—by machine—and some manual skills. Now he's studying to finish his secondary schooling degree, using a tape recorder because there are no textbooks in Braille. He's in his third year and has been first in his class in the most recent exams.
"When I left the center I felt like my vision had been returned to me, because now I can go where I want. Once a classmate asked me why I was studying. 'And why are you?" I asked her. 'Because the answer you give me is the same one I'm going to give you.' The thing is, I feel equal to them. Perhaps in some important problem, in math for example, I think to myself, 'If I could see, I could have gotten it right.' Because I could see before, I know what it is to see. But I don't spend time longing to see any more; now I don't think about it. Because I feel that I am seeing. Yes, that's exactly how I feel."
In 1980 the Carlos Fonseca Center for the Non-Seeing—FSLN founder Carlos Fonseca was extremely myopic—was created to rehabilitate the blind and partial seers. It’s a free service of the Ministry of Social Welfare, and gets German, Dutch and Uruguayan solidarity assistance. In the center, the blind learn to take care of themselves by learning methods of personal hygiene, cooking and housekeeping. They do sports and learn to use a walking stick (guide dogs are not considered since feeding them is too expensive). They also learn Braille and work skills: ceramics, weaving hammocks and macramé bags, gardening… In 1986, with the help of UNICEF, the Dutch government and Revo, a Dutch non-governmental organization, the first Braille printer in all of Central America—and the fourth in Latin America—was inaugurated in Nicaragua. It was named after the famous Nicaraguan poet, Ruben Dario. Among the books that have been published are children's stories, text books, poems and the writings of Sandino.
The family barrierThe months of convalescence in the hospital help those who will have permanent disadvantages overcome the first psychological shock. The other soldiers who are there help a lot, as does group life in general. The convalescent room at Apanás is cheerful and messy. Cards, chess, a guitar and singer, a television with its soap operas and a radio all compete to take one's mind off the trauma. So does meeting friends one would otherwise never have met. Those from León get to know those from Rivas; those from Masaya meet those from Jinotega; those from the city learn about those from the country. All amputees are told that they can have the leg or the arm they lost back again, and knowing it gives them security. They will return to high school, they will dance again. They even try out moving their mutilated stubs to the salsa rhythm that blares stridently from the radio.
Ricardo, 26 years of age, from Masaya, shot in the abdomen, lost nearly all his small intestine and has five sutures in his large intestine. He spent a year and a half in the military hospital in Managua. Irregularities in the care given him by middle-level military officers, in the efficiency of a medical student and in the response of the support structures for combatants all complicated and extended his misfortune, putting him at the edge of death. Nonetheless, he doesn't exhibit an ounce of resentment.
After the operations and with the loss of so much intestinal tract, his life is no longer the same. He can't exert himself too much, or run or do sports. Or eat everything he would like. "They ordered me not to gain too much weight and to eat vegetables mainly, but here with this economic situation, you have to eat what you find."
He remembers the hospital with real longing and has elaborated theories about its advantages: "When they discharged me, I left with a colostomy, that bag to defecate in, because the intestine took a long time to start functioning, they left it practically sealed. I didn't want to leave my house, everything seemed monotonous; I just stayed in bed with that sadness and looked at myself and said: 'I wasn't like this, my body was normal.' My family really coddled me. They did everything for me. But that doesn't help; what it does is lower your morale. The nice thing about the hospital is that there the family members can't stay and take care of you because they don't want one getting more unequal treatment than the other. You're helped by someone who isn't family.
"I remember one day a nurse came to see me. 'They say that you can't walk, Ricardo.' And I said that, no, I couldn't. So she grabbed the sheet and I don't know how she did it, but all of a sudden I felt that I was on my feet! 'And how is it you say that you can't walk?' And she stuck me in the bath: 'Now I'm not going to bathe you in bed anymore!' The family doesn't do that; they just spoon-feed you. In the hospital you have to do your part. And once you’ve learned this, you teach the other new arrivals.
"In the hospital we’re all really united. When someone goes to the operating room all the rest of us trust him to God. 'Keep up your spirit, don't worry, we're right here behind you.' And we take turns watching, to see how the operation went. When we see the gurney coming we all go out to receive him, to see how it went, to encourage him. Given all this unity, this friendship, I missed the hospital when I left. I missed the guys. Every time I pass the hospital, I yearn for it."
Edgard, missing an eye and an ear and with motor coordination problems throughout his body, is the coordinator of the 18 others handicapped by the war in San Marcos. The most serious problems have not been with the handicapped themselves, with their own resentment or passivity, but with some of their families, who resent the revolution and blame it for their pain.
"In the area around Pius XIII there’s a guy with a lame leg," relates Edgard. "They drafted him into the service and there he had his mishap. They took him wounded to his house. I wanted to give him a pension, so he’d get some small economic help, but his father wouldn't let anyone past the front door. He even raises his machete and curses you out. 'You all grabbed my good and healthy boy and messed him up! Now I don't want anything from you! I'll give it to you with my machete if any of you sons o' bitches comes here again!' He's got his kid all closed up inside as if he were some weird creature. He hasn't even let them fit the kid for a prosthetic, or let him chat with anyone. The boy will never develop himself that way."
The reintegration into society of those handicapped by the war begins in the family. It's not always easy. The family sometimes goes from an excess of initial paternalism to feeling the person as a burden, particularly when they have to deal with the various immobilities that partial or multiple paralysis produces (suffered by 17% of the handicapped). Both abandonment and overprotection can worsen the handicapped person's physical or psychological situation. For example, we saw a young peasant who goes all over his rural area in a wheelchair, but when he goes to the city, he feels like a sick little invalid if he doesn't have a family member beside him.
In Region IV they’ve tried to organize workshops for the families to learn about elementary health care and help their relative with a disability. They also get psychological training to learn how to contribute to the person's development. But there still aren't enough economic and human resources to undertake this task nor is there awareness of the need for it among the families. It's a problem throughout society and now, with the possibility of an end to the war, Nicaragua is beginning to wake up to it. "We share the challenge of your integration into social life" is the slogan—perhaps a little too cold and abstract—that has began to be broadcast in the first TV spots on the subject.
The rejection or incomprehension by relatives, workmates and society in general is a breeding ground for resentments. Often the camaraderie and hope that the group helped nurture in the hospital gets turned into disillusionment once the person is back on the street, where it isn't easy to work or continue studying and there isn't enough economic support, and where moral support is in equally short supply. It is when the opportunities don't appear that one hears the powerfully defiant question that we heard more than once: "I gave a piece of my body to this revolution; what’s it going to give me now?"
One answer: Legs of royal cedarWhen we visited the "Erasmo Paredes Herrera" ortho-prosthesis factory, next door to the "Aldo Chavarría" Rehabilitation Hospital, Esteban, the technical director, was just back from India. He had gone there to learn about the technology used in that country to make prosthetic feet out of rubber. That material permits the artificial feet to get wet or muddy without damage. In Nicaragua, feet are being made with wood and plastic resin, but the Indian technology could be appropriate to our country’s climactic characteristics.
In the Somoza period, whoever lost a leg or an arm was left without or, if they had money, they could travel abroad and solve their own problem. In 1980, with support from Oxfam-Quebec, a small workshop for making prostheses—legs, basically—was created to help those who had been mutilated in the insurrectional war against Somoza. That workshop made 220 prostheses in two years. In 1982 the shop, which had completed its goals, stopped functioning.
With the upsurge in the war in 1984, the Nicaraguan Ministry of Health and the International Red Cross (ICRC), based on this positive experience, decided to create an ortho-prosthesis factory. "Speaking crudely, this is a factory for human spare parts," said Grace Lola, its director. The ICRC financed the installation of the factory and took responsibility, through a team of five of its technicians, for training 13 Nicaraguans. The ICRC also financed the importation of the materials not produced in the country. The budget from the Ministry of Health is used to purchase local materials, especially wood. The artificial legs are made with royal cedar, a precious wood that, given its tremendous hardness, does not eat away or scratch or rot. Upper limbs are made with imported plastic. Ninety-five percent of the prostheses produced—and needed—are lower limbs.
The production has grown and improved. In 1986, when the factory began to function, 86 prostheses were manufactured. In 1987 it was up to 311, and in 1988 it will be between 400 and 500. In 1989 it may reach 600, which is the limit for the factory’s installed capacity.
"The birth of this factory," said Grace, "was related to the war and its growth. The development of the enterprise is now related to the possibilities of reaching a permanent cease-fire. If the war continues, there will be more amputees and we’ll have to expand the plant and prepare more technicians. But if the war ends, why make that investment? So we're waiting, and with the hope of not having to grow."
Up to 1984 the great majority of amputees went abroad. With the solidarity of the German Democratic Republic, Bulgaria, Hungary, Czechoslovakia and Cuba, they returned to Nicaragua walking with their prosthesis. But the technology used in the European countries, adapted to their climate and natural and industrial resources, was not the most useful one back in Nicaragua. Since all prostheses have a useful life of three to four years, problems arose when the user had to go from the technology with which he or she began to walk to the one already successfully used in the Nicaraguan factory. Now, the only ones who are leaving the country are those who specifically need bones lengthened, grafts or other very specialized operations.
The most valued solidarity assistance in Nicaragua is the donation or financing of specific raw materials that are not produced in the country and are used in the making of prostheses and other corrective devices such as orthopedic shoes. (The factory makes 120 pairs of orthopedic shoes a month, but the demand is ten times greater owing to the malnutrition of pregnant women, which causes a large number of children with flat feet).
"It would be much easier to just say, 'please donate a thousand knees,' and have them assured for two years," says Grace. "But that's really no favor, because here we already know to make knees, knee joints and feet. It's better that they donate the materials we need to make them ourselves."
In a room of the factory we see some very moving relics. They are handmade protheses that people with amputated limbs fashioned for themselves out of household materials—plastic mugs, tin cans, wood, pieces of iron. Motivated by the enormous desire to walk again, they used them before they could go to the factory.
Although all amputees (victims of traffic or industrial accidents, sickness—many diabetes cases provoke gangrene—or the 1972 earthquake, etc.) can go to the production center, the combatants have priority there, as they do in health institutions all over the country. For them the service is totally free, covered by the Social Welfare Ministry. Up to 80% of the production is dedicated to covering the demand of the combatants. Other clients are asked to provide some small economic contribution, and people give what they can. Children are also given priority. Now, the only people on the waiting list are non-combatant adults.
The saddest case Grace remembers is that of Kenia, an 8-year-old girl from Siuna, who lost both feet in the contra attack on the mines on December 20, 1987. She would have lost her life had her grandmother not covered her with her body while the contras punished the civilian population with indiscriminate mortaring. When it was all over her grandmother's body was dead weight. Kenia was taken to Puerto Cabezas and then flown to Managua, but by then it was necessary to amputate her legs at the knee.
"While Kenia was here with us, she never stopped crying. It was a terrifying moan. The child also had emotional problems and did not accept that she had lost her two little legs. Afterward the government sent her abroad for further treatment, since she's a child and is growing, she will have to change her prostheses more often. Here we have the two little legs we made her; we're waiting for her to come back."
The factory doesn't only work with physiotherapists. It also depends on psychologists and social workers. As Grace says:
"We wouldn't accomplish anything if the patient left with a technologically good, esthetically attractive prosthesis, as we now make, yet was marginalized on returning to social life. At times they have a great fear of going out because they're afraid of being rejected. And they're not without justification. It's a problem not only in the families, but also in the productive businesses, which don’t accept them.
"And it's also a problem in society as a whole. I have to be frank: we tend to see a handicapped person as one incapable of developing his or her abilities, full of limitations. Here one learns that you have to be patient with handicapped people. Some are very demanding, others aggressive; still others are understanding and grateful. But all have a trauma and it requires time and a process for them to accept themselves and us to accept them. It's been a process for me too. I'm not a doctor, and I'd never even worked in any health field. I'm an industrial engineer and they put me here because this is a production enterprise. But it's foolish to think that this factory can be looked at only as an enterprise. These are human problems. But it's not with pity that those who arrive are helped. That happened to me at the beginning. With each case I went home crying, I was anguished, each one filled me with pity. Now no: I'm delighted to work with them, to see them enthusiastic, to give them encouragement, to treat them as I treat any normal person. Pity doesn't help."
By the time amputees get to the production center, they’ve already been rehabilitated in other hospitals. They are healthy people who are lacking a limb. With that the case, it takes about four to six weeks to be able to walk with their prosthesis. They spend that time living at the center, which has guest rooms for some 40 people. We learned about one person who broke records for rehabilitation and use of a prosthesis: the almost-doctor Francisco Ortega, who lost a leg in "Operation Danto."
“I lost my leg but not my country"Operation Danto (March 1988), in the border area with Honduras, was the most conclusive military and moral blow that the Sandinista Popular Army has dealt the counterrevolution in all the years of war. In the 15 days that the action lasted, the contras suffered a thousand dead and wounded. Five BLIs, two regular army units and some small special forces and backup units participated in the operation. The government forces lost 34 men and 68 were wounded, of which 22 lost limbs when mines set by the contras went off as the army moved in to dismantle the contras' strategic camps.
Nicaraguans learned about the operation and its successful results at a moment of national emergency, when 4,000 US Marines were sent to the Honduran border to "impose order." During those days, Nicaraguan television offered the image of Francisco Ortega, a 24-year-old medic, who, with his leg amputated, said calmly and with a smile, "I lost my leg, but my country was not lost." The sentence was only seconds long, but within hours it had become famous and during those tense days sustained the morale of almost everyone.
Three months later, Francisco was walking through the streets of Managua with a leg made of royal cedar and a cane of metal. "They say I go around like this to look like an elegant cripple."
Rehabilitation of all the amputees from Danto was given super priority. Some were dramatic cases: Salome, a cachorro who lost both eyes and a leg; two other young men with both legs mutilated. With the help of the physiotherapists from Aldo Chavarría and their own strength, they broke records for their recovery, often reducing to a few weeks a process that can last eight months overall, from the time of amputation until the prosthesis is managed well. They were interested in testing how short a period of time it could take an amputee to walk again. It was a test and, moreover, an important moral accolade to those who had made such a decisive victory possible for Nicaragua. Five weeks after being operated on, Francisco Ortega was walking again.
In other operations and combats, Francisco had treated many cachorros who had been wounded or lost a limb to the mines.
"I got mine on March 12. We had already had various skirmishes with the Guardia [soldiers typically refer to all contras as remnants of Somoza's hated National Guard]. We were on a hill heating something to eat when we heard an explosion about eight or nine football fields away. We knew the sound well: it was a mine. Then the shouts: 'Get a medic here!' I raced up the hill with Ahmed, the BLI's political officer. Then we saw the soldier: he had lost his leg, so we treated him and ordered his evacuation. Shortly afterwards, Ahmed and I went down. We were the last to go, and were joking about whether we, too, were going to fall on a mine. Suddenly, I felt the explosion, the flash, and then a moment later I went down like a slow-motion film, like when you cut down thick brush. I realized what had happened when I saw Ahmed crying: "What happened to you, little brother?' Below the knee I had no leg. They tied the tourniquet on and put the first bandage on me right there, a red and black bandanna one of the guys was wearing."
Francisco himself serenely took charge of telling them how to wind the bandage, how to apply the tourniquet, how and where to inject the antibiotics.
"At that moment I didn't feel any pain. Immediately I thought, 'I may not have a leg but I'm going to have my life. I remembered the four guys I had cared for in those days of the operation. It had pained me so to see them mutilated, but I tried to be strong to give them strength. 'Ah,1 I thought, 'if I did that, I'm not going to do some other fool thing now.' Ahmed said to me, 'Don't lose it, little brother.' 'Don't worry,' I assured him, 'there's enough man here for anything.' That was a line from the novel La Vorágine, which we had read together and recalled when we climbed the hill. Then I saw that the other guys were gathering around and some were crying. 'Hey man, what are you all doing crying over me if I'm not dead?' So they took me down and I began to check myself over to see if I was whole. The leg that flew off never appeared anywhere. The mines pulverize them sometimes."
Francisco will finish med school in 1989. The experience of the amputation has born in him the vocation of specializing in physiotherapy. He will be the second Nicaraguan doctor to follow that specialization since the triumph. There are only three other such specialists from before the revolution. "Before this I thought of studying psychiatry or epidemiology. But I see that physiotherapy integrates the mental part that I liked about psychiatry."
"What emotional reactions have you observed among other crippled buddies?"
"At the moment of the explosion and the amputation, it's logical, normal, that some are really afflicted. But after their morale comes back, the desire to overcome that also comes. We all give each other strength. In our case, once we were in the plane that brought us to Managua we were telling jokes. If we saw someone real quiet, being silent, we made a pact to raise his spirits. Afterward, in the rehabilitation and at the prosthesis center, I got to know many more guys with amputations. There's tremendous spirit. Everybody was impatient because they were all being measured at the same time so they could fit their prostheses all at once. Everybody wanted his leg so he could go out and return to life. I think that's what predominates among us, a tremendous desire to overcome, to face the thing with guts."
"And how do you feel now with the prosthesis?"
"Good. When they fit you, the first time you put it on, they dress you in shorts in front of a mirror so you can see yourself. I felt happy. I had never stopped to think how important it is to stand up on your own feet, to take a step, to walk. It was a happy moment. Now, after a month with the prosthesis, I have to recognize my limitations: I can't run, I can't play basketball, which I always loved, I can't walk too long because after five blocks it pinches and bothers me. And I can't take buses. Because if here healthy people have to be athletes to run and jump on a bus, we can forget it! I think the most difficult thing isn't the amputation or the rehabilitation process. The hardest part is going out into normal life, those first months when one goes out into the street."
The street scene"Breaking Barriers" is the title of a documentary produced a few years ago in Nicaragua to spread awareness about the problems of people with handicaps. With the first hurdles overcome—the first physical and psychological trauma, the hospital with its curing and rehabilitation process, adaptation to auxiliary apparatuses—and with the temptation to close oneself up in the family womb also overcome, there are still many other barriers the physically disadvantaged person has to break.
In this, as in almost everything, there’s strength in unity. Some 3,000 people with physical handicaps —whatever the origin of their problem—are today actively organized in the Ernesto Ché Guevara Organization of Revolutionary Disabled (ORD). The organization was created in 1980 to bring together those with permanent injuries from the liberation war against Somoza. Ché Guevara, who overcame the disability of his asthma to fight for Latin America's liberation, was elected as the organization’s namesake.
ORD, which has now expanded into the country’s most isolated zones, as we were able to attest, has tried since 1986 to strengthen its mechanisms so that those with disabilities can get together periodically, communicate their problems to each other and to all of society. The organization coordinates with the state institutions representing the interests of the physically disadvantaged: for scholarships, trips, treatment, etc. The major objective is that physically disadvantaged people be recognized as just one more individual when looking for work, studying, doing sports, enjoying themselves, taking a bus or going through the streets in their wheelchairs; that they participate as just another person. Fernando López, injured in the insurrection and now in a wheelchair, is the director of ORD. He sums it up this way: "The challenge is to get the handicapped person out of his or her house and into the street."
To begin to achieve this with those who can't walk, ORD maintains the only workshop in the country that makes and repairs wheelchairs. With the help of Shia, a Swiss nongovernmental organization, the shop makes about 30 chairs a month and sells them as cheaply as possible. ORD also provides other materials to the physically handicapped: colostomy bags, hearing aids, catheters, etc., that it imports with solidarity donations.
After getting the person out on the street, it’s up to the person to gain moral authority by showing society that he or she is really capable. "If they don't see it with their own eyes, they aren't going to believe it," says Fernando. One of the activities that can bring prejudices tumbling down fastest is competitive sports. To see them doing sports helps people "believe." ORD has begun to organize these games in different locations in the country. The first games at a national level were successfully held in Managua in November 1987. Wheelchair races, races for the blind, swimming, basketball, shooting, chess...; the physical potential displayed by the handicapped was remarkable.
It was during the first such sports competition organized by ORD in Granada, Region IV, that we met Roberto, a 20-year-old from Masatepe, with a prosthetic device on his left arm. Before his misfortune—as almost everybody calls it—he was a carpenter. He had come to participate in the shooting match, although he didn’t win. He had only had his prosthesis for three months. The fact that his new arm ended in a hook was a huge problem for him. His face, still that of a boy, was touching when he looked down abjectly at his metal hand. All the injustice of this war seemed contained in those eyes:
"At the beginning I threw this thing in a bag so nobody would look at me. Because they not only look, they comment; they start noticing and they make me embarrassed. I still don't take it out much. When I'm most distressed is when I go to a dance and ask a girl to dance and no one wants to dance with me. The only ones who will are my cousins. Perhaps if I had something that seemed like a hand I wouldn't think such things. Those contras have really messed us up a lot. Because of that one feels rancor toward them at times."
But it's easier to prepare a sports competition than ensure work. Those with physical limitations have to be trained in an appropriate skill—not always one they already knew—and the businesses and society have to be prepared to accept them like any other worker.
It is in that aspect that the problems are more complex and harder to resolve. Some 47% of those we interviewed weren’t studying or working at anything. Over 90% received economic assistance from the state, but not enough to cover their maintenance much less help the family. Almost 70% had only primary school education and 95% wanted to learn a trade or study to improve their situation, so they wouldn't be a burden on their family. The most outstanding thing in the answers of the immense majority was the great desire to improve themselves and the decision to go, now and to wherever, to start doing something. An overflowing river in search of a channel.
The only systematic initiative that has existed up to now to train the physically disadvantaged in skills appropriate to their possibilities is the Gaspar García Laviana Center, created in September 1979 in some houses confiscated from the Somocistas in an attractive Managua neighborhood. It provided job training for those injured in the insurrection as well as victims of polio, a disease that the revolution succeeded in eradicating within a few years. In that first stage, the center trained 260 youths.
In April 1986, with support from Terre des Hommes, a Swiss organization, a second stage was begun to train those injured in the counterrevolutionary war and others. The center has room for 100 students, with workshops for spinning, dressmaking, toy making and radio and TV repair. Some graduates of the center formed a sewing cooperative in Managua with about a dozen members, which is quite active. The Instituto Histórico Centroamericano (IHCA) will open a training school for war injured this year with four-month courses in auto mechanics and other classes in history and human development.
But learning a trade is still not the same as having a job. Nicaragua's very difficult economic crisis and the reduction of personnel in the state bureaucracy to try to achieve greater efficiency have caused a lot of unemployment, particularly among the physically disadvantaged, who are a priori judged less efficient than the rest. Some we talked with viewed such decisions as what amounted to a scandal. Others had been offered work as watchmen by the state. A young man with motor disability in one leg cried when he spoke of this offer. "How am I going to do that at my age?" Toribio, a peasant from Malpaisillo, an active cooperative organizer and a militia member, with spinal nephritis problems, was worse; they didn't offer him anything. He also cried when telling us about it: "Before I was useful and now I'm of no use. "And how am I going to feed this passel of kids? The state doesn't want to remember this old dog like it is now."
The main problems faced in the Gaspar García Laviana center have to do with breaking down various barriers, family ones above all. Excessive family dependence provokes avoidance or absenteeism in the classes. "They’ve been so babied that they can't get used to it here," says one psychologist. Family economic problems also influence attendance, as do emotional barriers: they feel inferior, incapable, and invent all kinds of physical excuses to not go to class, arrive late or take extra rests. According to María Auxiliadora Leyva, director of the center, they are specialists in simulating illnesses and weaving complicated traps to avoid accepting responsibility and self-discipline. When the course ended, some applied those skills in reverse; they set up situations to avoid leaving the center and returning to their community, from which they felt disconnected. It's not easy for the majority of these war wounded to leap the psychological hurdles.
Nicaraguan psychologists have offered various analyses of how this kind of war, the slow war of erosion decreed by the Reagan government, has affected the psychology of Nicaraguans. They conclude that, in general, people have remained healthy. Psychologists from the Sandinista army stress a fact they consider fundamental: the support and love that society in general extends to the cachorros, both mobilized and demobilized, gives them a psychological strength that permits them to participate in such a difficult war with a large degree of sanity. The fact that the war is viewed by most as defense of the nation against outside aggression psychologically unites the civilian population and the combatants as well, keeping them morally united and psychologically strong. Daily life in Nicaragua confirms these conclusions constantly and in many ways.
This does not mean that no one suffers psychological damage. Among the war wounded, 4% are those experiencing various kinds of psychological disorders. They dig trenches in the backyard of their house; they feel that the Guardia are following them, even in their own home; they become aggressive if they get hold of a weapon; they go through phases of reconstructing at home the combat that most seriously affected them; they become alcoholic; some attempt suicide; and a few succeed.
Some of those with psychological damage receive treatment in a specialized center in Managua. But in fact the majority of the war injured need conscientious, individualized psychological assistance, which is the responsibility of all of society. In this area much remains to be done, and much more will be able to be done when peace finally comes.
Support to the combatantsWhen the war escalated in 1983, the government decided on the massive incorporation of Nicaragua's young men into military service. By the end of the following year it created the Commission of Support to Combatants, which was charged with resolving as efficiently as possible the new problems that the massive mobilization was engendering. The commission would work in coordination with the army, the neighborhood committees, the women’s and youth organizations, and the ministries of health, education, labor and social welfare.
Since the tasks were new, new structures, channels and personnel had to be created. The requirements included family visits to the mobilized youth; providing information to family members about injuries and deaths; economic support to the families, the injured and orphans; transportation for trips to hospitals and burials; pensions to the families of those fallen; and, starting two years later, assistance to the first demobilized draftees to reintegrate them into society. Among the tasks was that of supporting the war wounded in every way possible.
The state provided funding for these complex tasks—50 million córdobas a month in early 1988, according to information given to health and education workers by President Daniel Ortega last June. In that meeting he explained the enormous but nonetheless insufficient social expenses that weigh so heavily on the country’s weakened budget.
The commission also has regional and zonal branches throughout the country. Region IV has the greatest number of war wounded per inhabitant. The four departments that make up that region (Granada, Masaya, Carazo and Rivas) have 605,000 inhabitants, and 22% of all war disabled. Region III, Managua, with a million inhabitants, a third of the national population, has 27%.
Region IV's support center for combatants, or CRAC as everyone calls it (for Casa Regional de Apoyo a los Combatientes), is located in Granada. In 1987 it provided 132,640 services to 40,436 people, running the range mentioned above. But the reality is grimmer behind the statistics, as Fernando Rivas, director of Granada's CRAC, says:
"We can finally say that our activities cover 100% of those in our region affected by the war; nothing gets away from us anymore. But the budget we receive is completely inadequate for everything we have to do. We lack so many things and have nothing to get them with. We need vehicles to help the handicapped get around, clinics specialized in treating war psychosis, special corrective apparatuses, and professionals to come and work with us. So many things so the handicapped can survive, like all of Nicaragua has to survive."
"Is there awareness in the state institutions of the tremendous challenge to society that the war handicapped represents?" we asked him.
"I would say that only now is the revolution beginning to discover that it has to do concrete things to guarantee the future of these heroes. They merit it, because the vast majority of them were disabled in heroic actions to defend all the rest of us. This question of the war handicapped is new for many, just as a few years ago the draft and the war that generated the need for it was new. I think that a national campaign to make people sensitive to the problem will now be necessary. We have to train them and employ them, to build ramps where there are only stairs so they can go up in their wheelchairs; we'll have to invest material and human resources in them. But the truth is that we still can't do it. The war hasn't finished."
"Is it your responsibility to inform the family that a son has been killed or is wounded or crippled?"
"Yes. It's really hard to go give this news. But we give it without hiding anything. The policy of the revolution is to be truthful. One single slip in that would jeopardize all the credibility we’ve been gaining, the confidence we’ve won. When we go give the news, there are all kinds of reactions, often distorted ones; and sometimes there's resentment. It's logical that there would be. But the escalation of the counterrevolutionary aggression has meant that people are getting clearer, they're identifying better who their enemy is. It is not the same thing now to go say that a soldier in the service was killed or is in a hospital wounded or with an amputated leg as it was in 1982, 83, 84 to go say that a reservist or militia member was killed or hurt. The difference between now and before is radical; now people know who's to blame for this war, who’s causing their grief and suffering."
"Are there psychologists working with you?"
"In some CRACS there are social workers, psychologists, sociologists. In this one we don't have any of those professionals. Here we only have concrete experience. We've learned through the practical school of hard knocks, through the families’ disagreeable expressions. This revolution is in need of professionals. And we need them in all the specialties. But what we have most of here in this revolution is willingness and determination, and with that we'll forge ahead."
"So speaking concretely, what have you learned about people with handicaps over these years?"
"That the most important thing is to make the person comprehend that he must accept himself, accept his reality and tear down the walls. We also try to give them the spirit to leave the house, to be on the street. We have to be there visiting them, drawing them out. The job isn’t only with them, but with their families as well. We've also learned that you have to get them out of being idle, so that their mind is occupied and they begin to feel necessary, important again."
"When the war ends, will the CRACs end too?"
"They won't end because there will always have to be a draft and we'll always have cachorros to support. And, above all, because an end to the war doesn't mean that the handicapped will cease to exist or that the mothers of fallen combatants will see their sons reborn. In this country, even though health and education are for everyone, the first place in line will always be for those who at a certain stage of the revolution gave a piece of their body, or gave the life of a son to defend our future."
Enabling the disabledThe reality, which we could experience during our visits to the places where the war wounded are treated, is that much has been done, but there is so much more to do. These people's potential has not yet been tapped. There are those who appreciate a visit more than a pension, but there are also those who are so isolated and dispersed throughout the countryside that they receive neither. There are those who seek work and don't find it, and those who find it but aren't trained to undertake it. And there are psychological wounds, some skin deep and some hidden deeply away, that have still not been sutured. And there is, above all else, the lack of real ways for these people to reenter society through the same door everyone else uses.
On this long road that still remains to be traveled we met Moisés Santana in Masaya. He was wounded in the insurrection, tortured in Somoza's jails and wounded again in the counterrevolutionary war. He's missing four fingers on one hand, has wounds in both legs and a bullet is still lodged four centimeters from his spine. What has concerned Moisés most in recent years is the resentment and disillusion he has seen accumulating among those from his area who were left handicapped after the insurrection, and more recently among the cachorros as well. The negative attitudes build up mainly because they can’t find work, or because it’s too difficult to get around and look for it, or because no one encourages them to find it.
Out of this concern a collective initiative was born: the creation of a cattle cooperative in El Ostional, eight kilometers from the Costa Rican border, in which more than 100 war wounded and their families from Region IV will have work. The Ministry of Agrarian Reform provided 1,400 manzanas of land and the first cattle; the bank guaranteed credits and technical assistance. There has also been discussion of creating a sales network to sell the milk, cheese and cream produced by the cooperative.
One of the leaders of the cooperative—himself partially disabled in the war—has also grasped the depths of the material and moral needs of the war wounded, brothers in struggle and in pain:
"The thing is that all those wounded compañeros who've been almost abandoned by the revolution really worries me. The bulk of them were in the insurrection, and they were the youngest ones too. I don't know if the problem is that they haven't gotten involved in the revolution more or that the revolution doesn't look after them. But there they are. They wander through the streets with no work, and for that reason start tossing down the liquor. When we began with the idea of the cooperative, some leaders of the institutions didn't understand us. 'How are you going to work in the countryside if you don't have any experience at it?' they'd say. The way I see it is that there still isn't enough support, not enough mutual understanding. This project is a rescue mission. These brothers have to be given the chance to understand that life isn't something that's given to us ready-made but is rather the opportunity to make something really well ourselves. It has to be explained to them that if the revolution hasn't helped us more it's because we haven't organized ourselves. And we do have to organize ourselves. So we're all going to the cooperative, those of us without eyes, without a leg, with psychoses, with paralyzed arms, legs, the drunks, the delinquents, the fuckups and the ones that don't give a damn. There are no conditions, and no quotas. The only thing is to give work to everyone.
"It's going to be a labor of political and human recovery. We're ready to show the Nicaraguan people and the entire world that we disabled have more strengths than the able-bodied. Because for the able-bodied everything is simple and perhaps for that reason they don't put as much love into their work. On the other hand, for us the simplest thing we do is done with sacrifice. Maybe that makes us love it more. So, we're going to work and to love the cooperative."
Because it's a complex initiative aimed at uniting so many people who are now dispersed, this cooperative isn't going to be an easy thing to pull off. But because it's an initiative that arose from the handicapped themselves, from the ground up, and was born out of compassion, out of feeling "one with" the disadvantaged, it's a good example of what has to be done. It's also an example of how much can be done when there's confidence in the potential that is now dormant in these people, waiting only to be sparked.
This solidarity of the handicapped with their own is an effective and mobilizing solidarity, full of hope, guided by comprehension and patience. Such solidarity is what Nicaragua will need when the nightmare of the war ends and when, victorious but mutilated, the reconstruction of its geography and its economy begins. When, to continue the metaphor, Nicaragua begins to close up its wounds.
US Vietnam veteran Brian Willson, who lost both legs when a train carrying arms for the contras and for the armies of El Salvador and Honduras rolled intentionally over him, came to Nicaragua in April. He walked steadily with his two prostheses and his cane, and maintained a grueling schedule of meetings and visits. He came to receive Nicaragua's highest Order, the one that carries Sandino's name. In his acceptance speech he reiterated his solidarity and his determination to make it effective. It's a very special solidarity, that of the only gringo "disabled" in this war. In his speech the day he was decorated, Brian said:
"In January 1986 I visited Nicaragua, and I saw that many human beings were being killed and mutilated in my name as a US citizen. Returning to the United States I felt the call to sell everything I had, to live poorly and work as hard as I could to end my government’s militarist policy against the people of Nicaragua and El Salvador.... The legs of Nicaraguans have been made one with mine. On the track of the train loaded with weapons I simply did what I believe any honorable person would have done: I tried to save those I love, I wanted to avoid more of you being killed and mutilated. And by doing it I affirmed what I believe: that we’re all equal and all have the same right to life. We North Americans aren't worth more than you. You Nicaraguans aren't worth less than us. The train didn't stop. The madness of militarism ran over and mutilated all people with consciousness in the whole world that day. We ask ourselves and we ask you to pardon us. Forgive us for our country's diabolical policy, which has caused you so much suffering and us so much shame."
On that occasion, Brian Willson paid a visit to ORD, the organization of revolutionary disabled. He chatted at length with members of the organization and at one point removed his prostheses to reveal funny faces painted on the stumps of his legs. The image both stunned and delighted television news viewers that night.
Brian also visited Francisco Ortega in the military hospital. Francisco had just come out of the third operation necessary to conclude the amputation of his leg. Francisco recounted the meeting with warmth:
"He asked me if I felt much pain. And since he now has experience, he gave me advice on how to avoid the cramps that you always get after an amputation. He also recommended that I get some help from an acupuncturist. He calmly showed me his two prostheses. He's a man who looks to be morally, as well as physically, very strong. He says he's learned much from the Nicaraguans."
Looking at Francisco Ortega, so morally strong himself, the thought comes immediately: ...and the Nicaraguans have so much to learn from their own war wounded.
"And you, Francisco, do you still hold to that phrase that made you famous?"
"I said that because it was how I felt; and I still feel it. I lost my leg, but not my country or my revolution. It would be more painful if the Guardia or some gringo came here to rule. We’d prefer to go hungry. There's no question that the government has made errors, but the revolution is the cleanest project that we've ever had in Nicaragua. How do the projects of those fuckers serve us, when the minute $20,000 appears they kill each other for it? Just think how they would destroy the country if they were the ones running it! That would be a permanent death. It would be like a death penalty. The way that Panamanian Indian chief was sentenced to death when the Spanish conquerors came. It would be sadder than anything. My leg is nothing! I lost it, sure I lost it, but we didn't lose our country."