ESTELI, NICARAGUA — Sixteen Americans--all physicians and health professionals--paused here recently during a visit to Nicaragua with Operation California, a nonprofit Los Angeles organization that collects medical and other supplies from private companies and distributes them to crisis areas worldwide.
Their political beliefs ranged from liberal to conservative. Some were in private practice; others worked for health-maintenance organizations, county health departments or the University of California. The group had come to Nicaragua to see the faces and judge the feelings of people engaged in a war against the U. S.-backed contras, people living under a Sandinista government the Reagan Administration portrays as a communist threat to North America.
And as health professionals, they wanted to learn how the war was affecting Nicaragua's evolving health system, which even U. S. officials have praised for its accomplishments following the 1979 revolution that deposed dictator Anastasio Somoza.
At Aldo Chamarro Rehabilitation Hospital in Managua, patients included 20 war-injured civilians--12 of them paraplegics and all victims of bombs, mines or bullets. A legless young boy in a wheelchair smiled at the camera while nearby, another youngster stared blankly through one remaining eye, his artificial arm hanging stiffly at his side.
In four years of war the population of Managua has grown from 500,000 to more than 1 million. The impact of the war-related migration to Managua on its water and food supplies, sewage system, medical facilities, schools and social services is a near disaster.
Later this month, overburdened drainage ditches and sewers will be overflowing, producing conditions that will be ideal for contaminating the drinking water and breeding insects and disease-causing parasites. The authorities fear there will be another epidemic of dengue fever, a mosquito-borne malaria-like disease that struck 300,000 Nicaraguans in 1985, 60% of them children. Because of the U. S. embargo, special arrangements had to be made by the United Nations to import pesticides to kill the mosquitoes.
In all of Nicaragua, only 48% of people have drinking water in their homes, and only 3% of the homes have unpolluted water, according to a professor at the School of Public Health. Chiefly for this reason diarrhea is the leading cause of death among children under 5 years of age.
Partly to help prevent these needless deaths, Benjamin Linder, the young U. S. civil engineer ambushed by contras in April, was helping to build a water system in the village where he was killed. During the last few months of Linders' life, Tim Takaro and Susan Cookson, an American husband-and-wife team of medical doctors, worked with Linder conducting a study of diarrhea among children in the village.
On a wall in the couple's home hangs a clown suit Linder often wore while riding his unicycle around town to amuse the children. The house in Jinotega is only a few miles south of the site of much recent fighting.
"We spend a lot of time being scared," Takaro said. "Whenever we go into an area where contras are known to be operating, we speak very loudly and always in English."
In Esteli, due west of Takaro's home, most buildings are still pockmarked with bullet holes from the battle waged to free it from Somoza's National Guard in 1979.
Painted on many walls is a favorite Sandinista symbol: an 18-inch silhouette of Augusto Cesar Sandino, the country's national hero who organized an army of peasants and workers in 1927 to fight the U. S. Marines ordered to Nicaragaua to protect U. S. business interests.
Esteli was the first city the Marines bombed, killing 800 persons, according to local historians. One wall of a room in the city hall displays photographs of the weathered faces of 29 men still living who served with Sandino in that war.
Today the hospital there is a dilapidated 50-year-old building lacking, among other essentials, a functioning autoclave to sterilize instruments, an ambulance that runs and a boiler to heat water. Like most of the nation's 31 hospitals, this one also has no equipment to measure blood oxygen levels, a critical necessity for the care of ill newborns.
"We don't want to do space medicine," said Mario Lacayo, the 27-year-old physician in charge. "Right now we just want to cure diarrhea."
To be a hospital administrator, Lacayo said, "you must know that health is a right and that it is a duty of the state to reach a maximum of people by modifying programs to meet the needs of the people."
Isabel Danel, a young U. S. physician working there, said she came to Nicaragua because she wanted to be part of a process where "people are trying to improve themselves." In Chicago, where she trained, Danel said she felt that she was treating the symptoms of underlying social problems, not the problems themselves.