To Die of Hospitals in El Salvador

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“When a sadness without limits is bound up inside you, to die is no longer so grave.”
—Oblivion, Héctor Abad Faciolince

“The manager tells me they don't know if your father can withstand bone surgery, that he has to be anesthetized, and that because he is diabetic and has blood pressure problems, he may not make it. (...) They will discharge him.”

“They will discharge him? Did they prescribe any treatment?”

“They gave him some pills, but we have to collect money so he can see a private doctor.”

“Do you think they didn’t treat him well?”

“You know how public hospitals work. The person in charge says we can wait without operating, that he’ll recover, although your father will never be able to stretch his arm out to yawn again. She says his bone will remain slightly fused.”

This is a summary of my conversation with the person who took my father to the public hospital. It was his first of a dozen visits to that same place.

That night, I thought my father had only broken a bone, one that would not take away his essential mobility. I thought what was to come would be painful. I miscalculated badly. The worst days of his life were coming, and some of the worst of mine as well. Days accompanied by high doses of pain and anguish. A type of death that no-one wants would come, after prolonged agony.

And all, I think with time, because of a damn leak.

Padre —Father, as I affectionately called my dad— slipped in a small puddle of water in his own room in his house in Lourdes, a town to the west of San Salvador, at around 9 p.m. on August 21, 2023. It had been raining for more than two hours and water had seeped through the roof. He got up to urinate as he almost always did, but he did not notice the leak. As he stood up, he slipped in the puddle and fell. The floor was so slippery that it propelled him at a speed that dragged him a couple of meters across the floor until he crashed into a wall. He broke two important bones, but we did not realize that until much later. His wife, the woman who loved him most, had died months earlier. That night, Padre was alone.

I didn’t find out about the fall until the early hours of the 22nd, several hours later. Padre screamed for help and couldn’t call me because he couldn’t move to the nightstand where his phone was. The neighbors heard his cries and a friend of his took him to San Rafael National Hospital. They treated him quickly, just an hour after he arrived. They examined him and took X-rays, and told him they did not recommend surgery, although what was really happening was that they couldn’t, didn’t want to, or didn’t really know what they should operate on. They discharged him, as if they wanted to get rid of a problem.

I was able to speak with Padre on August 23. His first comment was urgent.

“Hijo, I can’t stand this pain. It’s in my hip, not my shoulder.”

“We’re going to take you to another hospital, Padre.”

I was still in Guatemala, but I was determined to return to El Salvador. In that brief call, I noticed that Padre had already lost his serious tone of voice and was beginning to talk to me as if he were my son.

Padre had also fractured a bone in his hip, but at San Rafael Hospital they misread the X-ray. He fell on the 21st. On August 22, they sent him home with a diagnosis that didn’t sound so serious: he had broken his humerus (the long bone in the arm that connects to the shoulder) and could do without surgery or complex treatment. Seen in this light, and in context, the inability to yawn with his arms stretched out like a cartoon character was the sweetest of punishments for Padre.

In Guatemala, Bernardo Arévalo had confirmed his presidential victory in the second round. I had left the country with an election observation group and had to stay longer —a preventive departure— because President Nayib Bukele named me in bad faith on his Facebook and X accounts. My family and an expert risk analysis told me it was for the best. The president had implicated me in a plot involving spies and leaks alongside his security advisor, Alejandro Muyshondt, whom he accused of being a double agent and who had told me some time ago that he feared for his life. This is irrelevant, but it explains my absence from the country. Muyshondt would die six months later in state custody, showing signs of torture and without trial. I would return to the country to try to ease my father’s suffering, despite multiple recommendations from colleagues and risk advisors not to do so.

My father would die a year, seven months, and 15 days later. 591 days of agony.

The Motorcycle Ambulance

On the night of August 23, the person caring for Padre urged me to take him back to the hospital. The pain in his hip made him cry. Not sure which doctor to go to, public or private, I called the Medical Emergency System, 132.

“Hello, my father has broken a bone and is in severe pain in his hip. He went to the hospital, but I would like to transfer him again: Could you send an ambulance?”

“We don’t have an ambulance at the moment, you would have to call the police.”

“But why?”

“They have patrol cars and stretchers, they could take care of him.”

At that moment, I didn’t have any private ambulance numbers, and neither did the person who was taking care of my father. I called the Medical Emergency System again. A woman with a friendly voice answered, but she couldn’t help either. She mentioned that there was a Fosalud, a clinic of the Solidarity Fund for Health, in the area.

El Salvador's healthcare system —including the Salvadoran Social Security Institute (ISSS)— has more than 600 facilities and 30 general hospitals. There are more than 46,000 beds, 1,700 clinics, and 174 laboratories. It sounds like a lot, but it’s not: we have an average of one doctor for every 1,000 inhabitants. These are 2011 data from experts at the Institute for Social Studies in Population at the University of Costa Rica and the World Health Organization, which are difficult to verify because El Salvador has closed all access to public information since it began its path toward dictatorship, to such an extent that, until 2025, it was possible to obtain some general information about the budget of the Chivo Pets public pet hospital (opened in 2022). As for the public health system for humans, much of the information remains confidential until 2027 or until Bukele wishes to extend that secrecy.

The Salvadoran national health system is mixed, as there is also Social Security (ISSS) for workers. My father stopped paying contributions for three months and lost that right.

I got a number for the Fosalud clinic. A man answered who was eager to help but didn’t have the resources to do so.

“We have an ambulance, but only during the day.”

Emergencies also happen at night, I thought. But I didn’t tell him that. I called him at night.

“What if I pay for gas?” I said to convince him.

“It’s not that easy. You can bring your father here, but you have to call another number for transportation.”

They gave me another number. I called the Cruz Verde emergency services. They were too far away and gave me another number, for the police. I thought: They’ll arrive in a big pickup truck and they’ll be able to lay him down in the back seat. I was very wrong.

Two willing police officers arrived, but on motorcycles and with a board that served as a stretcher.

“Sergio, we can’t move your dad like this,” the person who received them told me on the phone.

The police officers did not explain to the person who was with my father how they intended to transport him. There were three people, a board, and a motorcycle. The police did not receive complete information about the case.

The Medical Emergency System was linked to the 911 Police Emergency System a few years before 2019, the beginning of the Bukele era. I accessed the protocols of the Medical Emergency System and the 911 Police Emergency System to try to find something about call handling and the use of motorcycles with stretchers. I found nothing. But I understood that the Medical Emergency System and 911 are connected and that on that day there were employees answering calls, most of which were requests for ambulances, but there were no ambulances available. It seems obvious, but it is serious: You cannot put out fires without water, even if you have firefighters.

That day, I was monitoring two phones: The person who was caring for my father and the calls to the 132 Medical Emergency System. The operator who answered the 132 phone did not have the resources to deal with the situation. There was only one option left: the private sector. For $100, I managed to get an ambulance to arrive in an hour.

If you search Google’s artificial intelligence tool for “ambulance system in El Salvador,” the search engine returns the following: “El Salvador is one of the few countries in the region that has a Medical Emergency System with air, sea, and land transportation. It went from having only nine ambulances in the entire Medical Emergency System to having 140.” I found that same quote (verbatim) on a page of the Ministry of Security’s website, which mentions that the SEM’s operational base has 157 doctors, more than 186 teleoperators, and more than 146 medical assistants.

According to data from the PNC, only known thanks to Guacamaya Leaks, as of 2021, the police had 29 ambulances, of which nine were inactive and one was in fair condition. Social Security had less than 100 ambulances, and the public system, if we take into account what the propaganda claims, had 140, with three boats and a helicopter. But as I said, there is no information available at this time.

Of course, they don’t advertise motorcycle ambulances with wooden boards, even if there was a protocol within the system for that type of resource.

Stretcher + Patient + Police Officer 1 + Police Officer 2 + a motorcycle. I find it hard to imagine the plan the police had to take Padre, who had a broken hip, on a motorcycle through the traffic on the Los Chorros highway, whose dirt slopes tend to fracture with the same violence as Padre’s hip.

The new ambulances are real. I don’t know if there are 140 of them, but I did see a couple outside a hotel that was hosting a delegation of high-performance surfers, and I also saw them in a convoy of trucks that are used to ease the presidential family’s journey through traffic. I also saw them outside El Salvador Hospital. They exist, but they don’t arrive, or I didn’t know how to get them to arrive in the more than ten times I had medical emergencies with my father. But I saw them. Some are white Mercedes Benz, with fresh stripes and looking quite new, first world. They have new stretchers and even vital sign monitors that you only see in hospitals, and there are different brands: Ford, Peugeot. They all look new.

Padre was one of those middle-class Salvadorans who worked for a salary and was on the payroll for most of his life, who paid into the system, who are supposed to have the right to be helped by the public health system, at least so they don’t die in pain.

In Padre’s case, the public system could only offer a stretcher, a motorcycle, and two police officers to transport an elderly man who had broken his hip.

A Full Life

“Put the books and uniforms in the water tank!” Padre shouted as soon as he entered the house. He arrived somewhat frightened. It was noon on Friday, November 10, 1989. We lived in the San Francisco neighborhood, considered middle class, one of those neighborhoods with small shops and tortilla stores, but without dirt roads.

“What books?!” my brother and I replied in unison. He was lying on the sofa while I was setting up an Atari on an old knob-controlled television. It was vacation time, and Padre always came home for lunch. At that time, Padre was 38 years old and was in his best moment after separating from my mother. He played the role of both father and mother. It made him happy. Padre was an exception to the Salvadoran norm: It was Madre who left for cigarettes and never came back. It fell to Padre to take on the double responsibility of raising us and working, with valuable help from my grandmother.

“There are searches, don’t ask!” he replied as he went to look for some boxes. In that year’s offensive, the searches were carried out by soldiers and guerrillas alike.

The water tank was a more affordable replacement for the cistern, with a capacity to store 10,000 liters of water, enough to withstand three days of shortages caused by the terrible drinking water distribution service. In my house in 1989, there was a tank mounted on the roof, and that is where Padre decided to hide objects that were objectionable to both sides of the war, the army and the guerrillas. I remember packing my grandfather’s kepi with amazement, because only then had it dawned on me that he had been in the military, and that his uniforms had become as subject to censorship as Roque Dalton’s books. Padre didn’t read much, but he also had a couple of books by the subversive poet, who was murdered by other subversives with no poetry of their own. What Padre was most eager to do was hide my grandfather’s National Guard uniforms.

By then, Padre was at the height of his meteoric rise or social mobility. He had a poor childhood, during which he had to work in pig manure. Padre proudly recounted the time he was able to buy his first pair of new shoes, and he seemed to tell it as a feat that saved him from a miserable life. My grandmother, a woman infinite in love and popular wisdom, was a maid and jack-of-all-trades in a village house. My father began his fragile social ascent, as I understand it, when he obtained a position as a civil servant —an office worker— in a military government back in the early 1970s. That desk gave him a network of contacts and specific knowledge of the world of offices and the equipment necessary for bureaucracy. From there, in the 1980s, he became an efficient salesman, although his business cards said Sales Executive. He was a large-scale photocopier salesman at a time when transnational companies offered good benefits.

At the age of 20, he was about to become the owner of a small house in an urban area, a good neighborhood in Santa Tecla. By the age of 30, he even had a second-hand Audi and a social network of friends with more resources. I never lacked a pair of shoes.

One day, after hiding my grandfather's military uniforms in a water tank, the “hasta el tope” (“to the end of the road”) offensive began in El Salvador, the most important military offensive carried out by the guerrillas in the 11 years of civil war. It was a failure in terms of its main objective, which was to seize power, but it did succeed in bringing about a peace agreement in 1992. Hasta el tope meant, among other things, that the war had reached the capital and that there was no social bubble in which to hide. I was 11 years old at the time, and my relationship with my father was strong.

When I say close, I mean that, despite the trauma, my mother’s absence was beginning to heal. At least for me. My brother and I studied at a middle-class Marist school, full of the children of officers and military personnel, a kind of lineage overflowing with privileges —or opportunities for abuse— during the civil war.

Padre was proud to have two sons at that school, and perhaps today I understand that better. Vega, the character in El Asco by Horacio Castellanos Moya, explains it in his description of Salvadorans: “Everyone wants to be in the military, everyone would be happy if they were in the military, everyone would love to be in the military.” The war aroused more curiosity than fear in me.

Padre studied economics at the National University, but he didn’t finish his studies; he married my mother very early. He dedicated his life to trying to give us the best, but he had a major distraction at the height of his social mobility.

From the age of 38 to 60, Padre devoted himself to trying to save my brother. He couldn't. My brother was caught in the crossfire of postwar violence.

My brother was intelligent; he could fight, shoot, and would most likely have been a good soldier. He died for getting involved where he shouldn't have: he got into a fight with a poorly paid man who worked 24-hour shifts and had war trauma, who also had a shotgun. He had gotten into a fight with a pharmacy security guard.

Those years were the murkiest part of my father's life. They began right after the Offensive. When I was 11, my brother was 16. I thought about books and soccer, and my brother thought about parties and car races. Because he was popular, my brother managed to sneak into the homes of the children of the most powerful military men. Years later, I realized the significance of those surnames, now universal for their war crimes. More than one of those military men whose homes my brother visited appears in the famous Iran-Contra affair. But, again, that's not what this story is about.

The children of those military men were friends with my brother, a dangerous social network for the son of a photocopier salesman. The children of generals and colonels could afford a life of abuse and excess that my brother was not going to navigate well. That's when he sank into the trappings of parties, appearances, and the trivialities of showing off in cars and nights where he didn't belong. He was the eldest brother and an exemplary child, but he was seduced by the competition for popularity among Salvadoran teenagers. He made many bad decisions.

Private versus Public

August 25, 2023. Four days after his fall. Despite warnings from my security advisors, and despite the fact that Bukele's security advisor had already been in prison for 16 days for, among other things, talking to me, I arrived in El Salvador to see Padre. With more information and the phone numbers of private doctors specializing in bones, he began the journey through hospitals that do not make you wait for emergencies. I met doctors who spoke more frankly.

“Look, he needs a hip replacement, it's like a screw,” said Dr. Private, who confirmed the fracture in less than a minute after looking at the X-rays of my father's hip.

“And why didn't they notice it at San Rafael, doctor?” I asked, puzzled.

“I couldn't say, maybe they took the test wrong,” he replied as if it were perfectly normal. Then he explained that, more important than the shoulder, was relieving my father's hip pain.

At the private hospital, I also realized that they have a very accurate system and record-keeping, that they can charge for even the simplest cotton swab used by each patient. Per day, between $350 and $500. There is a bed for visitors, they clean, and they provide routine care every hour. I realized that there are different types of antibiotics and that there is one that is very special and very difficult to find in the public system, and that the tiny bottle of each dose costs $100, and the treatment lasted ten days. It worked.

At that moment, I believed that the sacrifice would be worth it to see my father standing again. Months later, I learned from a friend who had suffered an accident while traveling that in France he had paid only 45 euros for half a dozen visits from a nurse to treat a broken arm.

But this is Padre’s story. In that private hospital with those private doctors, he began the path of relative hope and also of my financial distress.

Padre spent his retirement remodeling an Evangelical church he had founded just before my brother's death in 2006, leaving him without benefits or property.

Six months before his fall, he had lost the woman who loved him most, and whom he loved with devotion. Almost his entire world had died: my grandmother, my brother, his wife. All he had left was his church. And me.

[rel2]

Dr. Privado gave me several options and was direct on one point: Padre needed surgery on his hip and shoulder. He offered me a menu of options, but before getting to them, his fragile body had to be strengthened: high blood pressure and diabetes. The negligence of San Rafael Hospital and the state itself also had to be corrected.

In an ideal world and a prosperous El Salvador, the doctors at San Rafael Hospital would have operated on Padre's hip the same day he arrived. So much pain and so many days without surgery were unnecessary and only worsened his condition. He lost sodium, and it was highly likely, according to Dr. Privado's theory, that this prolonged pain led to what is commonly called a stroke.

A public hospital does not have the power to allocate resources or budgets to itself. It is only incompetent because of responsibilities from above.

At the beginning of April 2024, on one of the more than ten occasions we were at San Rafael Hospital, I was able to understand something else.

“I'm bringing my dad, we're here for an emergency,” I told a security guard at the entrance.

“Do you have a wheelchair? We don't have any,” she replied, without knowing whether my father could stand or not.

That day, he had to be admitted because he was having chest pains and had vomited. We arrived at 9 p.m. and left at 5 a.m., and he was not admitted due to a lack of beds. People were sleeping in the hallway outside, as if it were a campsite. They put Padre on an IV and sent him home.

San Rafael is one of 30 hospitals that receive hundreds of emergencies every day and treat them with pure willpower, but without the most basic necessities: medicines and resources that cost money. The Pharmaceutical Poverty Survey, conducted by Francisco Gavidia University (UFG) and the Solidarity Pharmacy Association, reveals that more than 53 percent of users of the public system (including the ISSS) have been denied medication for their ailments. Data from 2024. And it is even more serious when you consider that four out of five Salvadorans are condemned to use the public system, according to this same study.

With the private hospital, everything is very different. The private doctor, for example, told me that he would charge $10,000, not including hospital and medicine costs. He also told me that I should prepare myself for another significant expense, about $5,000 more for follow-up with private doctors who kept him afloat and would try to alleviate ailments such as diabetes and high blood pressure.

I didn't have that money, although I did have the possibility of getting some of it. I thought, ironically, that I hoped what the government and its supporters were saying was true, so I could ask George Soros for an advance. I laughed and rambled on about possibilities, thinking about the silly idea of going to the United States to wash dishes.

I was able to pay for the initial expenses with a credit card, then I formalized a debt. Doing the math, I will have spent $30,000 that I didn't have and am paying back little by little. A person earning minimum wage would have to spend six years of their life paying their entire income to pay off that debt in gross terms, without the bloodthirsty interest that a bank can charge.

My father was in a decent room and underwent two operations in a private hospital. He was treated by experts in cutting and healing bones. But if he had been able to go to El Salvador Hospital, perhaps everything would have been different. It's a hypothetical situation that's pointless to discuss. That's why it angers me to read the propaganda of good government. “The healthcare system was strengthened and modernized in terms of care services with the delivery of ICU ambulances. The first delivery was in 2021 with an initial batch of 12 ambulances, in January 2022 another 22 units were delivered, and in May 2022, the third delivery of 20 ambulances was made, with an investment amounting to more than $2.8 million.”

I am telling this from a position of privilege. I am aware of that. Around that time, I learned the story of Jorge, who travels 224 kilometers every week to get to the nearest hospital for dialysis, a treatment he could receive closer to home. 224 kilometers is a cruel sentence.

I am writing for several reasons: I want to put what has happened in my life in recent years in order, to find out if it is true that writing brings calm to the torments of the soul (as Violeta Parra sang), and to bear witness to my father's transition from public precariousness to the private tranquility we achieved through my indebtedness.

The president that the vast majority wants received half of the hospitals without modernization, more than 30 years after they were built. Seven years after coming to power, there is not a single decent national hospital, except for El Salvador Hospital, which can only be accessed with a referral from another hospital, without clear criteria.

The series of unfortunate and stormy events ended badly. From day one to day 365 —the first year— Padre's brain began to suffer. After undergoing treatment at the private hospital and with the private doctor, he was admitted to a recovery clinic for palliative care.

The Secret Hospital

After exhausting all the money I didn't have in the private system, I was able to get a place at El Salvador Hospital. After the fall in August 2023, my father spent a few months recovering and living a relatively normal life. But he began to suffer chest pains and a feeling of not being able to breathe again. He was able to walk with a walker, but his main means of mobility was a wheelchair. I never spoke to Padre again as I had before, as he had lost his memory and his speech was very slurred. He mumbled very simple words and sentences. He lost his ability to articulate ideas and his eloquence.

At the end of March 2024, eight months later, he returned to San Rafael. And from there he was transferred to El Salvador Hospital. A couple of fellow journalists had mentioned to me that this hospital was not functioning, and I actually came to believe it. On April 15, 2024, I realized that this was not true, that El Salvador Hospital was functioning, and very well, although its number of beds, number of patients, and patient selection criteria are unclear.

According to Carlos Ramos Hinds, vice president of the Medical Association of El Salvador (Colmedes), it operates in “isolation” from the rest of the health system and confirms what happened to me: A patient can only be admitted with a referral that must be approved by “an entity that is not very clear.” He said this to La Prensa Gráfica, quoting a doctor from that hospital, but anonymously. He said that they accepted those who required ICU treatment and hospitalization for internal medicine and surgery, but there are also such patients in other hospitals, so the criteria remained vague. My father underwent a litany of tests and was brought out of a crisis that followed his fall.

Amidst this opacity, there was more light than in the private sector. I knew that admission was by referral from a specialist at a public hospital. And that was the case with my father. Someone from the church managed to get a doctor from San Rafael Hospital to give him a referral and sign the transfer to El Salvador Hospital. The referral was approved on April 15, 2024, and that day my father was admitted to the Secret Hospital.

[rel1]

At the Secret Hospital, he was treated very well. He was seen by a neurologist who performed various very expensive tests in the private system and realized that Padre had suffered delusions as a result of abnormal electrical activity in the brain (like epilepsy) that did not manifest itself with visible seizures, but only with confusion. At El Salvador Hospital, they performed an electroencephalogram and a CT scan, as they had many more questions than answers about Padre's moments of dementia (also called confusion).

Padre spent six days in that hospital, which was created by Bukele on June 21, 2020, during the pandemic, keeping secret how much money was spent on its construction. I communicated with the doctors once a day, and when he started to get much better, I even spoke to him via video call. The staff and doctors explained to me, for example, that Padre was in the early stages of kidney failure. They gave me a damning and devastating document: They confirmed that he had intermittent episodes of delirium. He couldn't distinguish reality, he didn't know where he was, and the pain had turned him into a person with the speech of a seven-year-old child.

Eight months after that leak condemned my father, eight months after a motorcycle with two police officers and a stretcher showed up at his house and my father told me on the phone, as if he were my son, that he was in a lot of pain, the doctors at El Salvador Hospital determined that Padre had hyponatremia, an electrolyte imbalance (sodium and potassium) that severely alters brain and nerve function; cardiomyopathy, a disease of the heart muscle that makes it difficult to pump blood efficiently; and encephalomalacia, a softening or loss of brain tissue due to a lack of blood supply. Padre had suffered a previous stroke that had not been identified in public hospitals.

Thanks to the forcefulness (and the little-known but excellent resources of El Salvador Hospital), I realized that Padre was in agony. He had suffered several strokes and at least five diagnosed heart attacks, all closely related to his fall and fracture. As a result of that fall, doctors suspected that the intense pain and fragile condition (diabetes and high blood pressure) made Fa's circulatory system more vulnerable. They suspected that the first cardiac arrest and stroke, only confirmed at El Salvador Hospital, could have been the result of hip pain. A vital pain that no-one, in eight months, was able to detect in Padre's more than ten visits to public hospitals.

Dying Poorly

After reviewing what happened, I learned that the water leak that accumulated in the room of misfortune is also closely related to the death of his wife, La Niña Lilian, as I called her. Padre lost the will to live after the death of La Niña Lilian, an essentially good woman. From the day she died, what came was pain in his soul, and then pain in his bones and in hospitals. That pain made him age quickly, like a wine uncorked.

I always had an excessive fear of my father's death. It is not something extraordinary, especially when you are six years old. I saw him die in a nightmare and cried like a six-year-old cries, without restraint. The nightmare happened 40 years ago, the same night I saw my mother leave home. It was the day my father was condemned to many years of sadness and to raising two boys addicted to maternal affection. That March of 1985, my father's corpse in my nightmare affected me more than my mother's sudden abandonment.

I say Madre and Padre because that's what I've called them for as long as I can remember. I never called them Mommy or Daddy. Out of affection, somewhat blasphemous on my part, I also called Father “Saint”. My father was evangelical and I am an atheist, but he accepted my sarcastic joke. Saint, where do you want to eat? Saint, what's wrong with you? Saint... Padre.

From childhood, I was taught to think of death as a punishment, but today I think of it as a reward. Yes, the death of a loved one can also be a reward. And it should be benign. Father's death was not.

Malmurió. He died poorly: He was taken to two public hospitals in El Salvador, two private hospitals, two Fosalud centers... there was no ambulance, and then two policemen on a motorcycle with a stretcher. I was in ten different places at different times in different hospitals. For three days, Padre lay dying alongside an anonymous gang member at San Rafael Hospital, covered in tattoos, the man who was always unconscious and connected to a machine, guarded by two distracted agents from the El Salvador prison system. Seeing that image, I thought that at least Padre had people who loved and cared for him. That he had me.

Those were times when I spent half my hours trying to solve something that in a civilized country would not be so dramatic. A dignified death should not bankrupt a family or lead them to the point of sacrificing the possibility of raising the hands of a good man. How is it possible that you have to pay $100 a day for an antibiotic that should be provided by the state? In El Salvador, the public sector is no better than the private sector. That promise that Bukele likes to repeat is just that, a promise. In El Salvador's hospitals, the problem is that, in general, the public sector is bad and the private sector is unaffordable.

Padre died at 9:36 a.m. on April 4, and to get there, he suffered four heart attacks in less than ten days. He was discharged twice from the precarious San Rafael Hospital.

Padre died of hospitals, not in hospitals.

They discharged him knowing he would die. 589 days earlier, they had also discharged him without realizing that the most serious problem was in his hip and not his shoulder. If they had operated on him on day 1, under the same conditions as they operated on him in the private hospital, they might have spared my father 591 days of pain. And death.

The first time I did it —thinking of Padre's death as a rest— I felt like a bad son. I said goodbye to my father's body with spontaneous and dramatic crying at 7 p.m. on April 4. I cried, but I also thought: being dead is not pain, it is rest. In El Salvador, the path to eternal rest can include significant doses of torture and suffering that can only be mitigated with money. A lot of it.

I don't like to remember the last five days of Padre's life. He had shrunk and didn't seem happy. But I also had the privilege of saying goodbye.

“Hijo, I love you,” he said to me like a child at 5:45 p.m., the day before he died. Padre rarely told me he loved me. He said it when I scored a goal at age seven, and he repeated it when my mother passed away. He was a man of few words, and he had very few words left when he said it.