In the autumn chill, a far cry from the tropical climate of home, a small group of Central American immigrants gathered last night in Southeast Baltimore to acknowledge the victims of torture who live in their midst.
Joined by some North American friends, they sang, read from Scripture and listened to the testimony of Margarito Esquino, who was kidnapped, tortured and threatened with death in El Salvador.
Last night's vigil in Upper Fells Point was a first step toward providing healing and counseling for members of Baltimore's nascent Latino community, who come from places like El Salvador, where torture the government and government-backed death squads once were widespread.
Baltimore's Advocates for Survivors of Trauma and Torture (ASTT), which includes a small core of health care professionals, has joined with the Centro de la Comunidad, an East Baltimore community services agency, to start the Partnership for Community Mental Health to identify torture victims and provide psychological services to them.
Mr. Esquino, who lives in Washington and remains active in the National Association of Salvadoran Indigenous, told the gathering of the alienation many Central Americans feel, partly because of the persecution they suffered, but also because they were uprooted from their homes and moved to an unfamiliar country where they don't speak the language.
"We're not here because we want to be," he said. "In my case, it embarrasses me to be in this country."
The vigil and the mental health program are aimed at some members of the community -- nobody is certain how many -- who still suffer the effects of torture in the form of mental health problems like depression, anxiety and post-traumatic stress syndrome.
"Right now, there is only anecdotal evidence of mental health problems suffered by torture victims," said Dr. James Sanders, a family physician who is the director of Advocates of Survivors of Trauma and Torture. "One of the first things the Partnership for Community Mental Health will do is to perform a survey to determine the prevalence of such problems."
Dr. Sanders said he expects an incredulous response when people hear that his group wants to treat torture victims.
"Who'd think about Baltimore as a place with this sort of problem?" he said. "If it's in Baltimore, then it's in a lot of places."
To find torture victims, organizers will go to the grass roots. People in "listening professions" -- such as hairdressers or bartenders, who talk to customers all day -- will receive training to become "health promoters," who can identify people suffering from such mental health problems.
"The idea is that they would facilitate discussion of the issues, so it would not be considered a taboo," Dr. Sanders said. "If someone is identified as needing a great deal of help, more than the health promoters can deal with, the ASTT hooks them up with doctors and other health professionals who can do more intensive work."
Use of health promoters, lay people trained in the basics of public health, is common in Latin America, where access to health care is limited.
The same problem exists in the Latino community here, which is why the model will be used.
It may be the first instance in this country of health promoters being used to identify and treat torture and trauma victims, said Douglas Johnson, executive director of the Minneapolis-based Center for the Victims of Torture, the first center in the United States for such torture victims.
"You're dealing with a population that has no access to health care and more trained people, so you more or less settle for people with much less training and the higher risks associated with that, basically because you have no choice," he said.
Dr. Sanders said he has heard criticism that treating torture victims is not the most pressing need in the Hispanic community.
"Well, it might not be the most pressing need, but it permeates every need," he said. Without going to the root of the problem, "you're going to have a bunch of dysfunctional people who will forever be on the dole."