Steve Babb

In light of the significance of the election in Nicaragua for popular health care, both in Nicaragua and throughout the Third World, we thought it worthwhile to include the following brief analysis of the causes and meaning of the election’s outcome. Steve Babb is a member of the Hesperian staff who spent a year working in Nicaragua.

The lesson of the Nicaraguan election is simple: the US government can bully and buy its proxy into power in a small, desperately poor Third World country. The US engineered the victory of the United Nicaraguan Opposition (UNO) in three ways:

  1. It held a gun to the head of the Nicaraguan people, making it clear that they could choose between electing UN0 and suffering six more years of war and devastating economic sanctions.

  2. It bribed and arm-twisted fourteen disparate parties united only by their opportunism into forming a single opposition coalition, changing a multi-party race in which the Sandinistas would have held a commanding plurality into a two-party contest.

  3. Using a variety of overt and covert channels, it poured up to 26 million dollars into the coffers of UNO and its supporters. (A clear double standard was at work here, since foreign campaign contributions are strictly prohibited under US law.)

Any incumbent government in the world would have trouble winning an election when saddled with a prolonged, bloody war (which in turn prompted the Sandinista gov rnment to introduce a highly unpopular draft) and—even more decisive—a catastrophic economic situation summed up in an annual inflation rate measured in the thousands. Sticking with the FSLN under such circumstances would have required a very advanced level of consciousness—one much higher than most of us North Americans can claim to possess. In fact, it is an impressive tribute to the resilience and sophistication of the Nicaraguan people that over 40 percent of them still cast their ballots for the Frente.

Why is the Nicaraguan economy in such shambles? The most immediate factor is the Contra war. Sandinista mismanagement also contributed to the debacle, although to a much lesser degree; while the revolutionary government’s policies were in many cases sound, it often simply lacked the trained personnel required to implement them effectively. But the more basic culprit is the economic crisis affecting so many Third World countries, marked by declining terms of trade and heavy foreign debt, which meant that the government was in effect dealt a losing hand, no matter what economic policies it adopted. The sharply divided opposition has no coherent program for resolving this fundamental problem, and all the US aid in the world is not going to make it disappear.

In fact, the imposition of the US-favored free market economic strategy—which Washington is certain to make a prerequisite for any meaningful aid—will most likely only worsen the plight of the poor, as has been the case in most other Third World countries. How can anyone aware of the grievous human toll this approach is taking in such countries as Mexico and Brazil, where real wages and nutrition standards have been rolled back to 1960s levels, seriously hold it up as a model?

Moreover, the Bush Administration is unlikely to pump in enough aid to make a lasting difference, especially given its new commitments in Eastern Europe: the proposed $300 million package will barely put a dent in the economic damage and lost production caused by the US destabilization campaign. And US funds are likely to be overwhelmingly targeted at the private sector and wealthy business interests at the expense of the poor majority and equitable development. Those who assume that the US can be counted on to bail out the Chamorro Administration should take a look at the precedents of Grenada and Jamaica, where Washington also played a key role in toppling progressive regimes; after promising the sky, the US failed to deliver sufficient or appropriate aid to its newly installed clients, and both countries are now economic basket cases.

Do the Nicaraguan election results mean that Washington finally won, that after a decade of destabilization and low intensity conflict it at last succeeded in making the Nicaraguan people say “uncle”? Yes and no. The US lacked the power to achieve its optimal scenario: the military over-throw of the Sandinista government (either by the Contras or, if necessary, by an outright US invasion), which would have been followed by a brutally thorough dismantling of the FSLN, its mass organizations, and all the country’s other popular forces, entailing massive repression and loss of life. The US solidarity movement can be proud that its efforts to mobilize public opinion played a key role in averting this outcome.

Health Care in Nicaragua: Gains of the Revolution in Jeopardy

From the start, Nicaragua’s revolutionary government placed great emphasis on popular health care. The Sandinistas inherited from the Somoza dictatorship an under funded, inefficient hospital- and physician-centered health care model which catered to the tiny urban elite while completely neglecting the needs of the country’s poor majority. They quickly replaced this system with a network of health centers and posts that brought almost entirely free services to the most remote rural areas and the poorest Nicaraguans. Moreover, thanks to the revolutionary government’s capacity to mobilize massive popular participation, it was able to conduct a series of extremely successful nationwide vaccination health education campaigns.

The result of all this was that Nicaragua made remarkable progress in improving its people’s health, particularly in the early years of the Revolution. From 1978 to 1983 infant immortality decreased from 121 to 80.2 per 1,000 live births, life expectancy rose from 52 to 59 years, diarrhea fell from first to fourth place as a cause of hospital mortality. * The Sandinistas' health achievements won praise from the World Health Organization and the Pan American Health Organization.

As the years went by, however, the US government’s relentless destabilization campaign began to erode the Revolution’s health accomplishments. Washington’s trade embargo and credit boycott drastically reduced the amount of foreign exchange for purchasing medicines and medical equipment abroad, while the US-sponsored Contra war forced the Sandinistas to divert precious economic and human resources from the health care sector to defense. Most directly, the Contras singled out health care facilities and personnel as special targets of their attacks, seeking to undermine the popular support they generated for the Revolution. Through 1984, the Contras had destroyed or forced the closing of 50 clinics, and had killed 72 health workers. * * Many more health workers were wounded, kidnapped, or tortured. Even in the face of this systematic onslaught, the Sandinista government managed to preserve most of the major health gains that had been won; only in the late ’80s, for instance, did child mortality again begin to rise slightly.

It is too early to know how the change of government in Nicaragua will affect its people’s health. The Bush Administration’s $300 million aid package earmarks only 14 million for the health care sector—less than half the amount it allocates to repatriating the Contras. The newly elected UNO government and the US are likely to push for the privatization of the health sector and for policies that make the practice of medicine highly profitable for private doctors, hospitals, and drug companies. As a result, health care will probably became more expensive, more skewed toward urban areas, and less accessible to the poor majority. In fact, if the Chamorro Administration pursues the kinds of policies its Washington patron desires, Nicaragua’s health status may well descend to the abysmal levels that prevail in such US client states as Honduras, El Salvador, and Grenada.

* Richard Garfield and E. Taboada, “Health Serviced Reforms in Revolutionary Nicaragua,” American Journal of Public Health, Vol. 74,No. 10 (October 1994), p. 1138.

* * Ibid.

After decades of almost uninterrupted suffering and sacrifice, the Nicaraguan people have opted to take a well - Deserved breather.

But, tragically, Washington still wielded sufficient clout to be able to prevent the Nicaraguan Revolution from realizing its potential and blossoming into a “good example” for other Third World nations to follow—and to punish the Nicaraguan people savagely for their refusal to bow to its dictates (over 30,000 killed in the Contra war, tens of thousands more maimed or killed indirectly due to the effects of the war and US economic sanctions). However, how severe and permanent a setback it has been able to inflict remains to be seen.

After decades of almost uninterrupted suffering and sacrifice, the Nicaraguan people have opted to take a well-de-served breather. But UNO, which has never issued a coherent platform spelling out what it stands for, and its US patron should be careful not to misinterpret the election’s message. If the Chamorro Administration tries to roll back the Sandinistas' legacy of accomplishments and ideals—agrarian reform, improved literacy and health care, self-determination, and a firm commitment to defending the rights and interests of the country’s poor majority—it will encounter a spirited and organized popular resistance.

The Nicaraguan Revolution is a historical fact that cannot be erased, much as those in Washington would like to do so.

The FSLN remains by far the most popular and best-organized political party in Nicaragua. It draws strength from a formidable network of grassroots activists and mass organizations, lending credence to Daniel Ortega’s claim that the Frente will be able to “govern from below.” What is more, the FSLN can count on an army, police, and local militias firmly grounded in nationalist, Sandinista ideals, which will make it very difficult for the US to reestablish a force like the Somoza dynasty’s National Guard which could be used to enforce unpopular policies and repress the Nicaraguan poor. (It is ironic, but predictable, that Washington, while apparently unconcerned about the threat posed to emerging democratic processes in Chile, Argentina, Brazil, Guatemala, etc. by still-powerful right-wing military establishments, is lobbying strenuously for the disbanding or “depoliticization” of one of the very few armies in Latin America that actually plays a progressive role.) The Nicaraguan Revolution, then, is a historical fact that cannot be erased, much as those in Washington would like to do so.

In fact, given the likelihood that the UNO coalition will fail to live up to the Nicaraguan public’s expectations for a miraculous economic recovery, antagonize the country’s poor, wallow in corruption, or simply come apart at the seams due to internal strains, many Nicaraguans may soon be looking back fondly on the days of Sandinista ascendancy. They may decide that, if US policies—whether hostile or “friendly”—and an unjust international economic order condemn them to suffer in any case, they might as well suffer with dignity, while upholding an ideal and pioneering an alternative, more compassionate development model.

So, while it is clearly much too early to make any predictions, the FSLN would appear to stand a very good chance of winning the 1996 elections. Something similar happened recently in Jamaica, where the progressive, nationalist leader Michael Manley was voted back into power after losing the previous election in the wake of an intense US-or-chestrated destabilization campaign (though, fortunately, it is hard to imagine the FSLN compromising its principles as drastically as Manley’s People’s National Party has done). If the Sandinistas manage to duplicate Manley’s feat, they will gain an unprecedented double legitimacy, becoming the first revolutionary movement ever to win power twice, first through a popular insurrection and then, following a stint out of office, through a free election.

In the meantime, concerned citizens in the US have a more important role than ever to play. We must pressure Congress to allocate aid in forms and through channels that promote genuine, equitable development and that help, rather than hurt, the Nicaraguan poor. We must monitor and curtail US meddling in Nicaragua’s internal affairs, which will assume a more insidious form now that a client regime is in power there. And we must prevent the Bush Administration from exploiting the sharp conflicts that will inevitably occur as supporters of the Revolution struggle to defend its gains as a pretext for refusing to disband the Contras or launching a direct military intervention.