Researchers Study Perceived Health Consequences of Gold Mining in Postwar El Salvador

A group of researchers from the Miller School of Medicine, collaborating with researchers in El Salvador and Canada, have studied the perceived health consequences of gold mining in postwar El Salvador. Their work, a qualitative study that extends beyond the boundaries of science and medicine to link health to a broad range of socioeconomic factors, was recently published in the American Journal of Public Health.

What is unusual about the study is that some of the researchers are trauma surgeons, a group that generally remains within the confines of the operating room when writing about their work.

“Trauma surgeons are beginning to take a look at the upstream causes of injury and disease – the ‘causes of the causes’ – on community, national and global levels,” said Tanya L. Zakrison, M.D., M.H.Sc., M.P.H., assistant professor in the DeWitt Daughtry Family Department of Surgery’s Division of Trauma and Surgical Critical Care, and the lead author of the study. “El Salvador is just one country where foreign corporate interests are trumping public health. It affects literally millions of people around the world in low- and middle-income countries, and that’s why trauma surgeons are asking these types of questions.”

The authors consider El Salvador to be unique for historical and demographic reasons that have an impact on public health. During the U.S.-funded civil war that ravaged the country from 1980 to 1992, as many as 75,000 Salvadorans were killed, and one-third of the population of 5.2 million was either internally displaced or fled the country. The mental health impact of that war is only now being understood. In addition, El Salvador has among the highest population densities in the Western Hemisphere, causing the traumatic impacts of disasters such as war, earthquakes or environmental degradation to have a significant impact on large sectors of the population.

El Salvador has significant gold reserves, and mining activity, specifically of Canadian corporations, has picked up considerably since the end of the civil war, with public health concerns increasing in parallel.

“The direct connection to our work is the link between mining endeavors and trauma — often in the form of torture and physical violence,” said Zakrison. “Research has shown that 70 percent of Salvadorans oppose the initiation of a mining project in their community, but the laws in El Salvador favor foreign corporate interests. Some opponents of mining – both women and men – have even been tortured, disappeared or assassinated in similar patterns that occurred during the civil war. It’s all about the path upstream — the structural violence — that allows these mining companies to come into El Salvador, dictate to the country what will happen, and cause harm to those opposing them.”

Case reports from other countries undergoing metal mining reveal significant health effects, ranging from hearing loss and mercury poisoning to elevated arsenic levels in the blood of local inhabitants. Although these toxicological studies have delineated direct threats from metal mining, little if any research in Latin America has explored the other detriments to public health, according to the authors.

In addition, they write, the effects of mining in the historical context of civil war and foreign intervention in Latin America have not yet been explored. As a result, they undertook a qualitative inquiry of a representative Latin American country to capture attitudes about the public health ramifications of metal mining in a postwar context.

Over a one-month period in 2013, the researchers conducted focus groups and individual semi-structured interviews with community leaders throughout the country. Four major themes emerged:

1. The fallacy of economic development. Virtually all participants considered the promise of national economic growth through mining by foreign companies to be false. Any jobs created for Salvadorans were considered dangerous, temporary and low paying; the cost of public infrastructure to support mining (i.e. the construction of new roads) would be a drain on the economy, as would be the cost of post-mining environmental cleanup. Any true economic incentives, such as tax breaks, went only to the mining companies, which already evade the 2 percent corporate tax rate.

2. A critique of mining activities. Mining was viewed as a major threat to the country’s aquifer system; reduced levels of clean water were seen as a threat to people and animals, and any negative health impacts would be worsened by high population density.

3. The creation of mining-related violence. Criticism of the health, environmental and economic impact of mining in El Salvador was viewed as dangerous, placing community leaders at risk for violence. They described direct threats of violence, including torture and assassinations. Some of the mining company tactics included pitting foreign-backed pro-mining and local, Salvadoran anti-mining groups against each other. This brought back memories of the civil war and its emotional impacts for some participants.

4. Solutions and alternatives to mining activity. Participants described the creation of cooperative microenterprises for sustainable economic growth, political empowerment within communities and development of local participatory democracies.

“Our legacy comes from healing those affected by war,” said Zakrison. “Because of the effects of poverty in inner-city America, we deal with effects similar to those of war here in the United States, and much of that is about exclusion and alienation. Look at issues like firearm-related violence, precarious workplace injuries, intimate partner violence or even substance-related trauma like drinking and driving. Why is it that some segments of the population are more affected? They are typically poor people of color who are marginalized – people rarely heard from, not just in the medical literature, but also in the mainstream.

“You can look the other way and just operate on the cuts and wounds, or you can ask yourself what the answer is to such structural violence. The solutions can’t come from ivory towers, however. We need to be informed by those who are the most affected. They are the ones with the true solutions.”

As their next step, Zakrison and her colleagues are interested in interviewing Salvadoran survivors of the “Rio Sumpul” massacre of 1980 – the first of a number of large-scale killings of civilians (more than 600 men, women and children) by the Salvadoran National Guard.

“The violence that was experienced and witnessed at that time was horrifying,” said Zakrison. “This trauma appears to have been transmitted to subsequent generations and may play a role in the ongoing violence that is happening in El Salvador today.”

Zakrison is particularly interested in the concept of “transgenerational transmission of trauma” – something previously studied in Holocaust survivors and their descendants – and believes that lessons learned from Latin America are applicable to the United States.

“We live in a country that has a legacy of genocide of our indigenous populations and human beings brought over as slaves, which affected millions,” she said. “This history is being forgotten and with it, an understanding of how this history of trauma has affected subsequent generations. The healing that we see in Latin America, with empowered populations fighting against ‘historic forgetting,’ is a model for North America. When a 14-year-old is brought into Ryder Trauma Center after being shot in a country that is not at war, the reasons behind the shooting are often more complex than we might expect.”

Zakrison states that the driving force behind these questions has been her students, at the University of El Salvador, the University of Miami and elsewhere.

“The students are the brave ones who are asking the difficult and uncomfortable questions about structural violence – locally and globally,” she said. “I have students who are investigating everything from the psychological effects of firearm-related violence to inmate deaths while incarcerated in Miami-Dade County. It is always so inspiring to learn from them and to keep pushing the envelope. They are the example we have for true surgical and medical activism, and they remain our hope for the future.”

Zakrison’s Miller School of Medicine co-authors were Evan Valle, M.D., a surgical resident, and Julie Kornfeld, Ph.D., M.P.H., assistant professor of public health sciences and Assistant Dean for Public Health. The article detailing the research findings can be found here.

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