The Sandinista government is attempting to push ahead with ambitious health care programs that suffered severe setbacks because of seven years of civil war. ``We are just beginning to move ahead a bit. But we have a long way to go,'' Dr. Milton Valdez, deputy health minister, said in an interview. The Sandinistas promised improved health care as part of a package of social pledges made after they ousted the rightist Somoza dynasty in July 1979. Shortly after coming to power, the Sandinistas set out to build clinics and install a socialistic medical system. ``Our policies were based on health being a right for the people and an obligation of the state,'' Valdez said. But the promises of the leftist government gave way to the realities of the war started by Contra rebels 1{ years after the Sandinistas took control. The battles destroyed more than 100 rural clinics by the end of last year, helped bring back such diseases as malaria and created combat-related mental problems. The situation was further complicated in 1985 when a U.S. trade embargo cut off many supplies and spare parts for medical equipment. Health officials acknowlege that not all of the problems can be blamed on the war. A lack of hygiene education and basic unsanitary conditions in the capital as well as the isolated rural farmlands are blamed for a current epidemic of dengue, an infectious disease carried by mosquitos. During six days in July, the Health Ministry reported, almost 3,000 children were treated for diarrhea, the No. 1 killer of children in Nicaragua. The government recently called on residents in Managua to clean-up the trash and cut the grass in their neighborhoods. Valdez said health programs suffered serious deterioration by 1983 with the loss of clinics and personnel and doctors who fled the country. ``We had constructed a health system for peace. It clashed with the war,'' Valdez added. ``We had malaria under control along the Pacific Coast. But then we began large troop mobilizations to the mountains, where malaria still existed, and they brought it back to the cities.'' Doctors and medical volunteers couldn't get into remote combat regions or those controlled by the Contras. Barricada International, a Sandinista publication, said in a recent edition that 600 students, health workers and teachers had been killed, wounded or kidnapped while working in war zones. Mental problems stemming from combat surfaced. ``It's difficult to confront. The ones who spend two years fighting have the most problems,'' Valdez said. ``We have seen an increase in violent deaths _ homicides and suicides _ and more aggressiveness in general.'' One woman told a reporter her son returned from almost two years in combat with serious emotional problems. ``He would scream in his sleep that the Contras were coming,'' she said. ``He would become nervous when he was awake.'' Valdez said mental problems also are found among the numerous ex-soldiers who suffered losses of limbs in the war. ``It's not the actual loss of limb that causes the problems but the psychological part,'' he said. ``The combatants are No. 2 on our priority list. No. 1 are the children.'' The Health Ministry this year outlined a three-year plan and designated 1988 the year ``for defense and protection of children's lives.'' Infant mortality, halved since July 1979, stands at 64.5 per 1,000 births. It is the highest in Central America. Health workers have been taking advantage of a fragile truce since March to vaccinate rural children against polio, measles, diptheria and tuberculosis. Valdez said it was too soon to rebuild the lost clinics because fighting continues and the economy still is suffering. Medical care is free but medicine is not, Valdez said. Only about 10 percent of Nicaragua's doctors work with the state system. The others are private practitioners. Medicines are among a long list of basics that are in need. Black marketeers make large profits selling medications at outdoor markets. The largest single cause of death to adults up to age 49 last year was related to the war, Health Ministry statistics indicated. The ministry said it has detected only 26 cases of AIDS in Nicaragua and that only five of those were Nicaraguans.
