Sandro Yovera is one of Nuevo Paraíso's original inhabitants. But he isn't a wizened octogenarian, and his roots don't go back that far at all. He is a man in his late 20s, and he arrived in the town just last February, along with 300 other families, after a river swelled up and swallowed half of his town, leaving him and many of his neighbors homeless.

With a cow and a horse, the only animals he could save, Yovera and his wife are beginning life again in a new place where he has a small plot of land to work, a house, and access to health services a helping hand from the government to get him back up on his feet.

On February 23, 1998, El Niño, the notorious climate system that causes flowers to sprout in the world's driest deserts and wreaks havoc with the agricultural, fishing, and tourism industries and economics in general struck Peru's northwestern department of Piura, where Nuevo Paraíso is located. Yovera's old hometown, now referred to as Antiguo Chato Chico, was destroyed and two-thirds of the population was airlifted by rescue helicopter to dry haven in Nuevo Paraíso. To the dismay of authorities, the other one-third stayed behind in Antiguo Chato Chico which has since become an island to battle the odds.

A Force of Nature

El Niño is a reversal of nature's normal course of events, in which trade winds along the equator deposit nutrient-laden cold water along the western coast of South America, thereby providing abundant food for a thriving marine environment and the fishing industry. Roughly every two to seven years, however, the cool coastal Humboldt Current (or Peru Current), which is rich in silicates, phosphates, and nitrates, is replaced by warm, nutrient-poor ocean water from the equatorial Pacific. This anomaly, which has occurred regularly since weather records first began to be kept in 1877, causes heavy rainfall and flooding in arid areas of South America and droughts in southeast Asia and parts of Africa. These changes in sea surface temperature in the Pacific Ocean and in sea level atmospheric pressure conditions across the Pacific basin also cause increased tropical hurricane weather and cyclones, and facilitate the transmission of infectious diseases, such as malaria, and diarrheal diseases, such as cholera. In the Region of the Americas, Peru, Ecuador, and northern Chile are El Niño's principal targets.

A Helping Hand

This time, when the 1997-1998 El Niño produced its strongest effects in Peru from January through March 1998 it caused torrential rains in the north, especially in the departments of Piura and Tumbes along the Ecuadorian border, and unexpectedly in the south as well. Roads, bridges, crops, and homes disappeared. Of Peru's 25 million people, 215,000 were left damnificados a Spanish word for victims of disaster and many of these were poor farmers. Thousands were placed in temporary shelters, such as schools and churches, while others, such as Sandro Yovera, were transferred to new towns created in El Niño's wake.

When the townpeople from Chato Chico touched down in Nuevo Paraíso, they were met by specially trained health professionals. Dr. Luis Beingolea, health director for the Piura 1 Region, says doctors were standing by ready to vaccinate and provide immediate medical attention. "There were children and adults coming from an area infected with malaria and we had to stop it from spreading," says Beingolea. They had colds and skin diseases, common illnesses during the most intense period of El Niño, which also were treated. The next step was helping the community organize itself. "It may seem like a simple concept," says Beingolea, "but it's difficult to carry out when people have lost everything and experience shock."

In many of the affected towns, people lost their grip and thus the capacity for immediate and long-term planning, says Dr. Enrique Macher, director of the Honorio Delgado-Hideyo Noguchi National Mental Health Institute, which works under the Ministry of Health. The institute provided critical technical support to health personnel during the 1997-1998 El Niño as well as after the 1996 Nazca earthquake. "People typically experience helplessness, frustration, fear, violence, guilt, and sadness once they realize that everything they have worked so hard for is gone," he says. But under the direction of well-coordinated teams of government and nongovernment health personnel, new communities like Nuevo Paraíso were put in order and are now on their way to self-sufficiency.

Every family at Nuevo Paraíso was assigned a small lot of land by the regional government. CARE International, along with the Campesino Research and Promotion Center, a local nongovernmental organization (NGO), helped families build emergency housing units that were donated by the United States Agency for International Development, while COSUDE, a Swiss development organization, donated potable water reservoirs to Nuevo Paraíso and other towns affected by El Niño.

Those who had remained behind in Antiguo Chato Chico also received assistance, in the form of construction materials to rebuild their severely damaged dwellings. Aluminum sheeting for the roof and wooden stakes and nails have been donated by a local NGO, and other organizations maintain their presence in the area as well. "At least it's a start," Yovera says with optimism. "At least we have something. Then we'll see what happens."

Government and nongovernment organizations, including the Ministry of Health, Civil Defense, the National Food Assistance Program, CARE International, Plan International, the International Red Cross, Cáritas, the Adventist Development and Relief Agency, and dozens of local Peruvian NGOs, provided widespread support to the damnificados at the height of disaster and continue to do so as El Niño winds down.

An Ounce of Prevention

Peru's health ministry and the Lima office of the Pan American Health Organization (PAHO) wanted to ensure that health efforts would be streamlined to deliver as much help as possible to the people affected by El Niño. In September 1997 they sponsored a strategic seminar that gathered representatives of 120 institutions to draw up and evaluate plans to deal with the looming crisis in three stages: prevention activities for before El Niño hit, relief activities to address the high-impact stage, and reconstruction and recovery activities for the post-El Niño phase.

The seminar's success led the sponsors to host two others, one in the northern region of Grau, where floods were expected, and one in the southern region of Arequipa, where droughts were predicted. Inter-institutional groups made up of health and various other government agencies also were set up in each region. In the department of Piura alone, a consortium of more than 20 local organizations was created to mitigate the potential destruction posed by El Niño.

Today, the group continues to provide support and response during the post-El Niño phase that is expected to last through the end of 1999. "The impact of El Niño has been astounding," says Dr. Elmer Escobar, who until July 1998 headed PAHO's country office in Peru. "Peru was the country that was best prepared for El Niño. On the other hand, it was also the worst hit."

More than 500 miles of roads, some 50 bridges, 247,000 acres of crops, and about 500 schools have been destroyed in the country. "Yet if you compare this with the fact that only five out of 424 health establishments were demolished, the health sector fared well," says Ciro Ugarte, director of the National Institute of Civil Defense, which coordinated relief efforts between the Ministry of Health and national civil defense units. "First, a level of risk was calculated, and then the work was done with the next 25-30 years in mind. That was the difference.

"The health sector was far and beyond better prepared than other sectors," he continues. "But that is because health centers in rural areas need to function at optimum capacity when transportation and communications are cut off, communities become isolated, and people require medical care."

Controlling Disease Outbreaks

With El Niño at peak force, health centers, posts, and hospitals all performed at a feverish pace. Health personnel worked double and triple shifts, and extra staff were recruited and trained to deal with the skyrocketing demand for emergency care.

With the unrelentingly intense rains, new and old diseases emerged. Cholera and malaria, wo that reached high numbers in Piura, were effectively controlled shortly after their outbreak. "We crushed cholera," Beingolea says with pride, "with our Improving Health' campaign," which consisted of a traveling caravan of health professionals who performed light-hearted and humorous skits that educated villagers on sound disease prevention and health practices. At the national level, the Ministry of Health, with PAHO's technical support, designed and distributed easy-to-read pamphlets with similar health messages, urging those who became sick with one or more of the most common illnesses whose numbers increased with the flooding malaria, dengue fever, acute respiratory infections, acute diarrheal diseases, skin ailments, bubonic plague, and rabies to go as soon as possible to the nearest local health facility. Then the Ministry made sure that a steady supply of essential medicines used to treat these diseases was channeled to the health posts in communities most affected by El Niño.

Of course, no plan is foolproof. In April 1998, the local clinic in La Huanquilla, a small town of some 100 families located in Piura's province of Moropón, received two carefully packed boxes of medicine that had been stacked on the floor. The nurse's assistant who was on duty at the clinic says they lost everything when floodwaters unexpectedly barreled through, washing away patients' records, the clinic's stock of health promotion materials, and the medicines.

"At 2:00 in the morning, the river flooded the entire clinic, ruining the beds, mattresses... everything," she says. Because the whole town was flooded and weather remained humid throughout May, people were getting sick with bronchitis and skin diseases. Realizing the need to respond to a large sick population and keep disease epidemics at bay, the Ministry of Health first ordered all medicines to be reduced to 50 percent of their regular cost, then made them free nationwide for 15 days, says Beingolea. Only the most critically affected areas, such as La Huanquilla, were allowed to continue providing free medicines and services for as long as was necessary. Even before El Niño hit Peru in January, says Beingolea, the government had an extensive epidemiological network of 3,000 notification units up and running so that it could closely monitor disease outbreaks. During the last major El Niño, in 1982-1983, says Lima-based PAHO epidemiologist Dr. José Moya, no surveillance units of this type existed in the country.

The units send Moya weekly reports on 15 illnesses under constant surveillance since El Niño began, including the most common ones. This surveillance continues in the post-El Niño stage, as certain illnesses, such as malaria and plague, are predicted to emerge in larger numbers.

After El Niño

Piura was unusually green in May 1998. The rains have given life to the area's vegetation and the promise of more abundant harvests. After having lost a quarter-million acres of crops nationwide, primarily the staples of rice and sugarcane, this would be good news. But, unfortunately, the well-founded fear exists that, as people begin returning to their crops, this will also encourage disease-carrying rodents which have emerged in some areas as a result of collapsed sewer systems to live and breed near human populations. Campaigns now are underway to eliminate rodents and make sure trash is stored in protected areas, says Ugarte.

As Peru enters the recovery phase, health officials say most of their energy will go toward monitoring and controlling diseases and making minor repairs to health facilities. Little will be spent on major repairs. Most NGOs continue helping people up and out of a situation of even more extreme poverty, now that subsistence farmers have lost what little they had before. Sandro Yovera really can't say what his future will be like, since Nuevo Paraíso is not farmland but a desert-like area. NGOs are already at work in several of the affected communities teaching villagers how to make a living in nonagricultural pursuits.

Damage Control Pays Off

Back in mid-1997, when El Niño was still but a distant threat, the health sector began repairing its hospitals, clinics, and posts. Roofs were fixed or replaced, and drainage systems, water reservoirs, energy generators, and radios were installed. Maybe this is why, says Ugarte, only five public health establishments in the entire country were lost, and these, he notes, were destroyed only because they happened to be located in areas where the possibility of severe rains seemed out of the picture.

Total losses in the health sector for the 1982-1983 El Niño have been estimated at US$ 2 billion, with little evidence that prevention activities were undertaken. In 1998, losses reached US$ 1.45 billion, including the US$ 800 million that was spent on prevention, says Ugarte. Though 90 percent of the health facilities will need minor repairs, he calculates that US$ 7 million will be needed to reconstruct and retrofit them. Ugarte points out, though, that the situation could have been much worse: "Many lives were saved because the health sector prepared the way it did," he says.

"The problem of El Niño is a multisectoral problem affecting health, public works, agriculture, and education," notes Escobar. "It calls for a unified multisectoral response." Peru's President, Alberto Fujimori, has said much the same: El Niño is a recurring phenomenon that all sectors need to take into account when building roads, bridges, hospitals, hotels, offices, housing, and other structures.

The state of readiness of Peru's health sector provided an object lesson in the value of advance planning, as well as in the importance of close cooperation and communication between partner organizations. When El Niño hit, the extensive epidemiological network swung into full action, local health leaders equipped their staff and facilities to deal with the worst, and were unflagging in their efforts to serve a population that was disoriented, in shock, perhaps injured or ill, and understandably apprehensive about its fate. During these critical months, according to health officials, more information and experience were compiled than in any previous El Niño. These tools, along with heightened community awareness of the importance of education and solidarity, will be key to heading off El Niño during its next visit to our Hemisphere.

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Debbie K. Becht is a freelance journalist who frequently covers health, culture, and business issues in the Andean countries.