I would really appreciate any feedback. I'm going this alone, no lawyer. The * indicate where there will be an exhibit reference. Sorry for any formatting issues. It didn't keep the spacing when I pasted.
Summary of Letter of support of the I-601, Application for Waiver on the Grounds of Excludability
Case Number: SNSXXXXXXXX
Petitioner's Name: X, USC X
Principal Applicant's Name: HUSBAND X
Preference Category: CR1
Priority Date: 12Jun2013
Foreign State Chargeability: EL SALVADOR
Invoice ID Number: XXXXXXX
MEDICAL/PSYCHOLOGICAL ISSUES
Post-partum psychosis - I am at high risk of developing post-partum psychosis in the next year. The stress of not having my husband here has increased the risk. Having him here would lower it. I would also be able to receive care, which I cannot afford now.
Child’s illness/SIDS risk - Our son, Child, has GERD which leads to a higher risk of SIDS. The medicine to treat it is not easily available here, much less in the United States. The medicine also puts him at risk for adverse events and the medical care in El Salvador would not be sufficient. If our son should die, given my mental health problems, it is likely that I would commit suicide.
Bipolar Disorder and ADHD I have both of these disorders. Bipolar disorder, in particular, can lead to serious consequences. Without my husband’s income, I have not been able to continue treatment. Also, his presence helps me manage my symptoms. I would not be able to get care for the disorders in El Salvador.
Breast Abscess I had a large breast abscess. It is very likely that this will reoccur. I can, at worst, lead to toxic shock. I would not be able to get adequate care in El Salvador.
Endometrioma I had a large endometrioma surgically removed. They are likely to reoccur. If I have surgery again, I will need my husband’s help to care for our child. Also, I would not be able to get adequate care in El Salvador.
Miscarriages & Maternal Age I am already almost 40, have had a chemical pregnancy and have a blocked fallopian tube. At my age, fertility drops and the risk of miscarriage increases. Not only will I likely need specialized care to get pregnant again, miscarriages will negatively affect my mental health.
Bee Sting Allergy If stung by a bee, I may go into anaphylactic shock. I would not be able to get adequate care in El Salvador. Also, there are more Africanized bees in El Salvador, making it more likely I will be stung.
Gluten Intolerance I am unable to eat gluten without severe gastro-intestinal distress. Foods in El Salvador are not labeled clearly like they are in the United States, increasing my chances for an adverse reaction.
Family History of Severe Allergies Along with my bee allergy, several members of my family have life-threatening allergies. These have a genetic component. It is likely that our son will also have an allergy. He would not be able to get adequate care in El Salvador and the possibility and worry would be very stressful to me. He could die.
FINANCIAL ISSUES
I net $2550 a month. My expenses are $3241 a month. I need my husband’s income to pay my bills.
ISSUES IN EL SALVADOR AND SAN PABLO TACACHICO
Crime in San Pablo Tacachico Crime has increased in Husband’s hometown, especially gang violence, and even more worrying teachers, like me, were targeted and killed.
Doctors and Facilities in San Pablo Tacachico All of the doctors in Tacachico are general practitioners and much of the health care is provided at free clinics staffed by volunteers. There are no obstetrician/gynecologists or other specialists. There are also no psychiatrists or psychologists. One of the pharmacies was raided for selling expired medications.
Epidemics in San Pablo Tacachico The city has had recent epidemics of cholera, dengue fever, pneumonia, rotavirus and chikungunya. All of these could be fatal to an infant or young child and cause complications in a pregnant woman.
Sewage/Waste in San Pablo Tacachico The sewage treatment plant is under the control of the state and malfunctions, polluting the area and creating infections and chronic health problems. It would not be a safe place for my child and I to live long-term.
Water in San Pablo Tacachico According to the U.S. Department of State, in general, the water in El Salvador is undrinkable. In San Pablo Tacachico, the water treatment plant has not been maintained over the last eighteen years and barely runs at half-capacity. It would be dangerous to both myself and my child to drink the water there.
Roads and Bridges in and around San Pablo Tacachico According to the State Department, “Poorly maintained roads and vehicles are common and pose a significant danger to travelers. During both daylight and nighttime hours, it is not uncommon to encounter pedestrians, feral dogs, livestock, or abandoned vehicles on the roadways.
Crime in El Salvador According to the US Department of State Bureau of Diplomatic Security, “El Salvador is considered one of the most violent countries in the world”. The Department of State has continued to warn U.S. citizens that crime and violence levels in El Salvador remain “critically high”. The State Department has stated that in El Salvador, “U.S. citizens who are visiting El Salvador for extended periods may be at higher risk for extortion demands.”
Medical Care in El Salvador According to the State Department, “medical care is limited. Emergency services, even in the capital city, are rudimentary at best.”
Risks to Teachers in El Salvador Teachers have become prey to extortion, muggings, and murder. In one year, “more than 1,000 teachers had to apply to the Ministry of Education to transfer because they have been threatened.”
Environmental Hazards in El Salvador According to the State Department, El Salvador is also a dangerous place to live because of natural disasters like hurricanes, earthquakes and volcanoes.
LEGAL PROBLEM
Husband was arrested and served 30 days in jail for a misdemeanor DUI in March of 2013. What he did was stupid and dangerous, and he feels horrible about it. He is now a married man with a son. He would never make the same grave error again. He was evaluated by a panel physician who did not feel that he was a risk to himself or others.
EXHIBITS
TBA
Letter of support of the I-601, Application for Waiver on the Grounds of Excludability
To Whom It May Concern:
I, USC, a United States citizen, am writing the following letter to support the I-601 Application for Waiver of Grounds of Inadmissibility for my husband, Husband X X, who is subject to a 10-year bar due his presence in the United States for more than one year after entering without inspection. As explained below, I would face extreme hardships if I were to be without my husband for ten years and it is unsafe for me to move to El Salvador to be with him. We have a son, Child X X, born 03/13/2015.
MEDICAL/PSYCHOLOGICAL ISSUES
Post-partum psychosis
In 2010, I was diagnosed with Bipolar Disorder NOS and Attention Deficit Hyperactivity Disorder (1). Patients with these two disorders together are at risk for manic or depressive episodes, as well as other disorders. Up until December 2014, I was able to receive care from Dr. X for these problems. I discontinued my medication, but was getting behavioral therapy. However, since December, I have not been able to continue with my accustomed second job since I was pregnant. On top of losing the income from my husband, the loss of this income left me unable to pay for my necessary on-going care.
This is especially a problem because women with bipolar disorder have a 100-fold higher risk of developing post-partum psychosis (*). I could develop psychosis, cognitive impairment, and grossly disorganized behavior that represent a complete change from previous functioning and cause my safety and well-being and Child’s to be jeopardized (*).
“Among patients who develop PP after childbirth, 72%–88% have bipolar illness or schizoaffective disorder. Patients who stop their mood stabilizer treatment (as I have) are much more likely to experience a recurrence of bipolar disorder" (*).
“Puerperal hormone shifts, obstetrical complications, sleep deprivation, and increased environmental stress are possible contributing factors to the onset of illness” (3). Not having my husband with me at our child's birth and during his early months is a major source of stress. Even prior to the birth of our child, I was in the highest-risk range on the Holmes-Rahe SRRS of developing mental illness or injury in the two years following my husband’s move (*).
I need my husband as a stabilizing influence and caretaker for both herself and my child for more than just the immediate time period of childbirth. “In the first year after childbirth, suicide risk increases 70-fold, and suicide is the leading cause of maternal death up to 1 year after delivery,” according to the NIH (*).
“PP is considered an emergency that necessitates an urgent evaluation, psychiatric referral, and possible hospitalization. The primary psychiatric diagnosis to consider with the case of early-onset PP is bipolar disorder. Women with a past or family history of bipolar illness are more likely to have bipolar disorder that precipitates an episode of PP” (3).
The lack of my husband’s presence here for the birth of our child, and for the critical year afterwards, is a severe stressor in my life. It increases my already significant risk for post-partum psychosis, a possibly life-threatening disease, as well as for other negative health outcomes.
Child’s illness/SIDS risk
Our son has been diagnosed with gastroesophageal reflux disease (GERD). “The symptoms are worrying for parents. It also has a serious impact on family life, affecting the parent’s -usually the mother’s- interaction with the baby.” For me, GERD has meant that I barely sleep at night. With GERD, “the acidic contents of the stomach may damage the esophagus, leading to complications such as esophageal irritation, inflammation and stricture, while microaspiration of stomach contents may cause respiratory symptoms such as hoarseness, wheezing and sometimes pneumonia” ( ).
I have not had more than two hours in a row of sleep since Child was born since I am constantly listening to make sure he is still breathing. He has episodes while sleeping where he chokes from the reflux in his throat. These are called apparent life-threatening events and are extremely traumatizing for me. Since he has started medication, these have been reduced from almost every night to once a week at most. Due to this disease, he has dropped from the 6% percentile to 1% of infants his age, which puts him at risk for “failure to thrive”.* But even more worrying for me, GERD “can be responsible for sudden infant death syndrome.”* If Child were to die, especially if my husband were not with me, I would not want to live.
I am especially concerned about his life because he almost died at birth. He had a triple nuchal cord, which means his umbilical cord was wrapped around his neck three times.* I had a vaginal delivery. This is rare because cutting a nuchal cord can cause the death of a newborn. Also, Child was born at 37 weeks. The cord was wrapped very tightly around his neck. There is a strong possibility that had he gone to 40 weeks, that he would have been stillborn. This possibility exacerbates my worries for my son.
Child is on a daily compounded prescription of omeprazole to control the symptoms.* The medication he needs is hard to find in the United States and would be almost impossible to get in El Salvador. Furthermore, even with the medication, he is at risk. “Pharmacologic treatment for acid suppression and gastric motility have been associated with a wide range of adverse consequences, including late-onset sepsis, necrotizing entercolitis, respiratory infections, dystonia and irritability.”* Were something to happen, I would need the support of my husband. I am having a very difficult time caring for Child now. Any complications would further stress me and have a negative effect on my health, physical and mental.
Bipolar Disorder and ADHD
I had been under the care of X, MD, PA since July 27, 2010 for Bipolar Disorder NOS and Attention Deficit Hyperactivity Disorder (ADHD) Predominantly Hyperactive-Impulsive.
If I remain untreated, as I am right now because I can’t afford to go to therapy, my bipolar disorder could get worse. According to Dr. X, it could lead to mania, depression or psychosis. “Bipolar patients, negative life events, such long-term separation from a spouse, have been found to result in four times the risk of relapse and a three times longer recovery time once remission has been achieved.”* This, on top of my predisposition for post-partum depression or psychosis, worries me. The fact that I also have ADHD makes the bipolar disorder worse. It increases my risk for suicide, which is already high due to the stress of not having my husband to help me and because of the hormones from giving birth.
Patients such as I experience “more episodes of mania and depression, a greater number of irritable days, more suicide attempts, and a more severe disease course.”* I need long-term treatment to maintain control of my symptoms. It is very important for my continuing mental and physical health that I continue my treatment plan under the guidance of a highly qualified psychiatrist. The lack of my husband’s presence has already disrupted my treatment in the United States and getting any treatment would be almost impossible in El Salvador. The U.S. Embassy website lists eight medical health care professionals for the entire country, only three of whom are psychiatrists. Furthermore, all three are in San Salvador, is an hour’s drive away from San Pablo Tacachico.
As mentioned earlier, I have been unable to continue the care I need because of the loss of income caused by my pregnancy and return of my husband to El Salvador. My treatment needs to be resumed as soon as possible. Having my husband present to help my receive my care and to help me pay for it is critical to my well-being.
Prior to my pregnancy, I was on a regimen of 200mg of Lamictal once a day and 10mg of Adderall twice a day for my mental disorders, as well as 2.5 grains of Armour for Hashimoto Thyroiditis. Additionally, I saw my psychiatrist approximately once a month for sessions.*
I also have Ha****moto’s thyroiditis. Although the Armour used to treat my hypothyroidism is not a psychiatric medication, it can affect the efficacy of other medications and the course of my mental disorders. “Mood disorders are intimately associated with suboptimal thyroid function, and hypothyroidism is the most common abnormality found in bipolar disorder. The most common psychiatric symptoms related to untreated hypothyroidism are depression and cognitive dysfunction. Even minor changes in thyroid regulation have the potential to affect the outcome of bipolar disorder.”*
Breast Abscess
Soon after Child’s birth, I developed a breast abscess the size of a kiwi fruit from mastitis caused by breastfeeding*. A breast abscess is a serious complication of mastitis. Mine was caused by use of a nipple shield and lack of rest. “Mothers who are ill or excessively tired have lowered resistance to bacterial infection and are more likely to get mastitis. Fatigue should be avoided if possible.”* Unfortunately, without my husband to help me, and with Child’s GERD, I get little sleep.
It is very likely that I will have problems again, either with Child or with any future children. “In up to 20% of women, the mastitis recurs. Recurrence is associated with…surgical treatment, and increased age,” both of which apply to me.*
Here in the United States, treating a breast abscess is a relatively routine, though painful, procedure. “Once an abscess has formed, the only effective treatment is incision and drainage.”* This requires an ultrasound of the abscess and an in-clinic procedure. However, in El Salvador, especially in the area where I would live, there are not adequate facilities.
If mastitis is not treated promptly and properly, “there have been reports of mastitis and toxic shock syndrome (TSS) in both the immediate puerperium and the later postpartum period.” If this happens, it can lead to “staphylococcal breast abscess…fever, hypotension, and multiple organ system dysfunction (myalgia, hypocalcemia, and renal insufficiency)”.*
Endometrioma
In March of 2012, I had a laparoscopic cystectomy because I had an 8cm endometrioma.* An endometrioma is blood-filled ovarian cyst that develops as a result of endometriosis. “Regardless of its symptoms, surgery is most frequently chosen for its treatment because medical treatment alone is inadequate. In addition, a likelihood of malignant change in this disease is not negligible.”* Any ovarian cyst of this size is prone to rupture. A cyst that ruptures could lead to internal bleeding. Unfortunately, it is very common to have a reoccurrence of this type of cyst, with an overall rate of reoccurrence of 30%, and post-operative medical treatment doesn’t significantly change the rate of reoccurence.* The possible timing of the reoccurrence ranges from six months to five years. In September, 2013, I was diagnosed with a smaller 3cm x 4cm cyst, which was monitored by my gynecologist, Dr. Malathi Ellis. According to the Mayo Clinic, “Although there’s no definite way to prevent the growth of ovarian cysts, regular pelvic examinations are a way to help ensure that changes…are diagnosed as soon as possible”.*
Miscarriages & Maternal Age
My husband and I wish to expand our family. This may be difficult given my prior history and my age. Women over the age of thirty-five have more difficulty getting and staying pregnant, their children are at greater risk for birth defects, and they are at greater risk for potentially life-threatening complications. These risks are further compounded by my Hashimoto’s Thyroiditis, blocked fallopian tube, my history of endometriomas, and bipolar disorder. The care that I need will be best provided by my current gynecologist, Dr. Ellis.
Given the specialized care that I will likely need to get pregnant again and sustain a pregnancy, if I move to El Salvador, specifically San Pablo Tacachico, I am likely to face pregnancy loss and possible infertility. Spontaneous miscarriage is the most common pregnancy complication with the reported incidence of 10%-20%. This already happened once to me. In September of 2012, I experienced a very early miscarriage, also known as a chemical pregnancy. This pregnancy was not planned and the father was Husband X. I had blood work and an ultrasound done at the time, but no specific cause was found.* The experience of miscarriage can result in anxiety, depression and grief, and exacerbate previously existing disorders. “Both clinicians and physicians should be aware that in addition to grief and depression, miscarrying women may display significant increases in anxiety after the loss and during the subsequent pregnancy, including the onset of anxiety disorders. Two studies found that anxiety symptoms did not abate with the passage of time following a miscarriage”.* Bipolar disorder is a further complication that increases this risk. When I was pregnant with Child, I bought a fetal heartbeat monitor so that I could check on him every day. Now that he is here, I bought a breathing monitor that he wears whenever he sleeps. Both of these monitors are not medically necessary, and indeed I know that they are not even recommended, but I could not sleep normally or function without them.
“The availability of clinical intervention for women with a loss history who display increased levels of anxiety about [subsequent] pregnancy may be beneficial and may prevent the anxiety from advancing to a significant degree. Severe impairments in interpersonal and social functioning in a woman who has miscarried are likely not to not only affect the woman but also her relationships with her partner and other children.” Unfortunately, the type of regular care that I need would be nearly impossible in San Pablo Tacachico because there are no gynecologists and any care I could receive in the rest of El Salvador would be difficult to get to and of inferior quality to that I have in the United States. There are only three gynecologists who speak English listed on the U.S. Embassy website and all of them are in San Salvador.*
Given my age and the fact that I should not move to El Salvador, if Husband X could not return to the United States for ten years, I would not have the chance to even try to have a family. Women who want children but cannot have them experience greater distress, health complaints, and grief, as well as higher rates of major depressive disorder, dysthymia, and a lower quality of life and health-related quality of life.
Bee Sting Allergy
I have been diagnosed with a bee allergy.* Insect allergies, like mine, are “one of the three most common triggers for anaphylaxis”.* A systemic reaction, like the one I had, is considered a serious medical event. If I were to be stung again, my reaction might be the same, or it might be much worse. “The prediction of future sting reactions is difficult…[but one study found] 11% of patients had more severe reactions to re-sting”.* Furthermore, while I was stung by a domestic bumblebee, which can only sting once, I would be equally allergic to Africanized bumblebees, which are common in El Salvador. However, “rather than the single sting of a domestic honeybee, Africanized honeybees often sting in large numbers, occasionally in the hundreds”.* For example, in 2012, “a woman and her pet died from an Africanized bees attack in a residential area north of the capital of El Salvador.”* This could be deadly to me, especially given the poor medical care available in San Pablo Tacachico, and El Salvador in general.
Gluten Intolerance
I react negatively to wheat gluten, as documented by my primary care physician Dr. Y.* I have severe, days-long intestinal distress, including abdominal cramps, bloated stomach, nausea and vomiting, and mild edema. The easiest way for me to avoid exposure is to eat a gluten-free diet. According to the Asociación de Celíacos y Sensibles al Gluten de El Salvador (ACELYSES), information about celiac disease and gluten sensitivity is little known in El Salvador. Even though most traditional dishes are naturally gluten-free, most Salvadorans do not know or understand the term gluten-free. Packaged food in El Salvador does not follow the same labeling rules as in the United States. There is little regulation of ingredient lists. In restaurants, it can be difficult to ensure that what is ordered is in fact made as specified.*
Family History of Severe Allergies
The incidence of life-threatening food allergies in the population in general “has increased dramatically in recent years. The severity of allergic disease also appears to be increasing as demonstrated by the doubling of hospitalizations for anaphylaxis” from 2005-2010. Our child, Child, and future children have a high probability that they will have some kind of severe allergy, given my family history. Members of my family have allergies so severe they could cause anaphylaxis. The two of my three brothers have a severe allergy to shellfish and my nephew has a tree nut allergy. “Family history is a strong risk factor for the development of food allergy.” Other members have allergies that are severe but would not cause anaphylaxis. My paternal grandmother had a severe wheat allergy, my middle brother Nathan has soy, wheat, and garlic allergies, and my paternal cousin has a milk allergy (not lactose intolerance). Additionally, many of us have allergic rhinitis and eczema. My cousin’s child has eczema so severely, his skin peeled like he was burned. “Certain atopic diseases that include asthma, allergic rhinitis, eczema and food allergy aggregate within families.”* Our son Child has been diagnosed with reflux and has already shown signs of sensitivity to dairy proteins and eggs. Furthermore, the environment in El Salvador in general, and San Pablo Tacachico specifically, increases his risk. “Environmental factors that have commonly been considered in interactions with genetic risk factors include air pollution and microbial exposures.”* As shown in the following sections, both of these factors would be present if Child and I moved to El Salvador.
“There is no cure or preventative treatment for food allergy at present.” Child’s possible food allergies or hypersensitivity would be a major stressor for me. “The impact of food allergy on aspects of daily living and quality of life, as well as emotional states such as anxiety and depression, has been shown to impact adversely on the child and family.”*
FINANCIAL ISSUES
Up until January 2015, I had two jobs. I teach at Creekview High School in Carrollton Farmers Branch ISD and I was an adjunct professor at El Centro College. Between the two jobs, I had just enough to pay all my bills, even without my husband’s income of approximately $1,000 per month. However, since I was due in late March or early April, I was not allowed to teach this last semester at El Centro. This left me with approximately $1,200 less per month. I will be unable to resume this job because I cannot find someone to care for my son from 7am-9pm. Additionally, I will now have the added expense of daycare and insurance for Child. Without the added income my husband could provide, I am not able to meet my financial obligations. In fact, I am already delinquent on my mortgage. The following is my budget:
Monthly Income: $2550 TOTAL INCOME
Monthly Expenses: $755 Daycare through my work (+$115 in August)
$128 Phone
$150 Electricity
$1073 Mortgage
$150 Internet/cable
$200 Credit card
$335 Car loan
$50 Water
$100 Gasoline
$300 Food, diapers, etc.
$3241 TOTAL EXPENSES
I am short almost $700 each month. Also, the above expenses do not include any emergencies that might arise such as medical bills or car repairs.
ISSUES IN EL SALVADOR AND SAN PABLO TACACHICO
Husband X has spoken to multiple relatives about my safety were Child and I to move to El Salvador. His cousins have told him that I would be safest in San Pablo Tacachico, where there are many members of his extended family to help keep me safe. They said that should I fly to the airport, I should not try to take a taxi or even leave the airport grounds. They would send someone for me. It is widely known that bandits run taxis, buses and cars off the roads around the airport in order to rob people.
Crime in San Pablo Tacachico
Even though Tacachico is where all of Husband X’s family lives and where he has stated that I would have the most protection, since he has family to help, that may not be enough to be safe. Until 2009, Tacachico was peaceful, but that changed in 2010. “Tacachico, a sweltering town of just one square kilometer, is no longer a city of peaceful streets and countryside. In the village, the assaults on bystanders or business robberies have become frequent, and in rural areas armed assaults are reported at any time and on any day.” In that one year, there was a 175% increase in the murder rate.* Now, according to the Department of State, La Libertad is “experiencing chronic, high levels of reported criminal activity”.*
When I went to visit my husband for Christmas, the uncle of his cousin’s wife was killed by gangsters. His name was Jose Luis Barillas Polanco and he owned the gas station cattycorner from the only hotel in town.* Since my mother-in-law’s house has no air conditioning, and I was pregnant, we thought about staying at the hotel the night Barillas Polanco was strangled in his home above the station, as we had done in a previous visit. It was terrifying and stressful to know how close that murder was.
It is getting more and more dangerous in San Pablo Tacachico. In November, a sixteen-year-old boy was grabbed from his car, kidnapped, and killed by armed gang members.* In December, a gang member attacked the police in San Pablo Tacachico and was killed.* In February of this year, a woman walking on a road in the area and was shot in the face and died.* Also in February, a gang member was shot in broad daylight in the middle of one of the main streets.* Furthermore, five members of the notorious MS13 gang, a Transnational Criminal Organization, were arrested in February for being part of an extortion scheme which operated in San Pablo Tacachico*. My husband, who has no connection with gangs, is afraid to leave his mother’s house and is afraid that gang members will find out he has an American wife and child and target him. The thought that my son will lose his father before he ever meets him is incredibly stressful to me.
Three years ago, three teachers, including one teacher of English, were kidnapped and killed in a town right outside of Tacachico.* Husband knows the sons of one of the victims because they grew up near him and is still in contact. Even more frightening is that throughout El Salvador teachers, like me, specifically, have become targets. “Public school teachers throughout the country have become a main target of extortion and death threats”.*
In 2011, two innocent shopkeepers were gunned down with M-16 in the central market of downtown Tacachico.* Scarily, according to the Department of State, this is not uncommon in El Salvador. “The number of illegal weapons on the streets is estimated at more than 600,000, including AK-47s and M-16 assault rifles, various handguns, and military-grade weaponry… Crimes committed by criminals armed with automatic weapons are considered routine”.*
In part this is because while some of the country enjoyed lower homicide rates due to the recent gang truce, “there are areas of El Salvador where murders increased by over 200 percent between 2011 and 2014,” including “red zones” like “the area where the departments of San Salvador, La Libertad, and Chatelanango meet (such as El Paisnal, San Pablo Tacachico, and Tejutla).”*
Epidemics in San Pablo Tacachico
In 1992 there was a cholera epidemic. More recently, in 2002 there was an outbreak of Dengue fever. In 2003, there was an epidemic of pneumonia and conjunctivitis. In February of 2005, there was a Rotavirus outbreak.* This last summer, many people, including my husband and his grandmother were striken with chikungunya. All of these diseases could be fatal to an infant or young child and can cause problems in pregnant women. We intend to expand our family and were I to be pregnant in El Salvador, my health and that of my unborn child would be at risk. The chikungunya virus “frequently causes serious issues including persistent brain injury to babies born to mothers who get the virus near the time of delivery.”* This happened to one of Husband’s cousins. Her child was born prematurely, was in the NICU and still has problems because she got chikungunya in her third trimester.
Doctors and Facilities in San Pablo Tacachico
The medical facilities available in Tacachico and the surrounding area are inadequate to address my medical issues. There is no hospital in Tacachico. All of the doctors in Tacachico are general practitioners and much of the health care is provided at free clinics staffed by volunteers. There are no obstetrician/gynecologists or other specialists. There are also no psychiatrists or psychologists. The only mental health care that is offered is posters and educational materials.
There is one small government clinic that is 27 years old and, according to a 2006 government report, in need of infrastructure change. There is one room for emergencies, one for minor surgeries, which is also the room where vaccinations and ambulatory care are given, and one for Labor & Delivery, as well as a small pharmacy. The nearest hospital is an hour drive by car (longer by bus) in Santa Tecla. The next largest facility is a clinic 45 minutes away in San Juan Opico.
There are also private facilities – the Red Cross, three dental facilities and five doctors with private practices, and two additional pharmacies. However, the pharmacies in Tacachico are not very trustworthy because one of the pharmacies in Tacachico was raided for dispensing expired medicine.*
Sewage/Waste in San Pablo Tacachico
The sewage treatment plant is under the control of the state and malfunctions, polluting the area and creating infections and chronic health problems. People raise pigs within the city limits, there are mounds of garbage, tires are burned, and there are constantly puddles that are breeding grounds for mosquitos and flies. The solid waste landfill does not meet the specifications of the Ministry of Environment.*
Water in San Pablo Tacachico
According to the U.S. Department of State, in general, the water in El Salvador is undrinkable, even more so in Tacachico, where the water treatment plant is having serious issues. According to study done in March of 2013, it has not been maintained over the last eighteen years and barely runs at half-capacity.* Tests in 2008 showed that E. coli count in the “treated” water from the plant was 4000 times higher and the fecal coliform count was 8000 times higher than the maximum safe level. The pollution is so bad that aquatic life cannot exist in the rivers. A report by La Fundación Instituto de Investigación y Promoción Ambiental (The Institute for Environmental Investigation and Promotion Foundation) said, “The contamination could be described as alarming and criminal.”*
Also, the three rivers in the area are very polluted. “The Rio Sucio is one of the most polluted rivers in the country with industrial discharges, the Rio Suquiapa is contaminated by coffee cultivation run-off, and the Rio Copinula is contaminated with sewage.”*
Earthquakes and Hurricanes in San Pablo Tacachico
In 2001, there was an earthquake in Tachachico. Later that year, there were aftershocks from a nearby earthquake. In 1996 and 2005, Hurricanes Mitch and Stan caused damage to the town.*
Roads and Bridges in and around San Pablo Tacachico
Another issue is that the roads in El Salvador are often unusable. This would be a major concern if there were to be a medical problem and Child or I would have to get to San Salvador from Tacachico. According to the State Department, “Poorly maintained roads and vehicles are common and pose a significant danger to travelers. It is not uncommon to encounter pedestrians, feral dogs, livestock, or abandoned vehicles on the roadways. Missing manhole covers or storm drain covers with large objects in the roadway may be regularly encountered. If traffic signals are working, they are often ignored”.*
“During the rainy season (May-October), heavy and persistent storms can cause landslides, topple trees and power lines, and wash away roads and bridges”. For example, “In October 2011, 10 days of heavy rains destroyed crops and towns in Central America, hitting El Salvador particularly hard with mudslides and flooding that killed 34 persons and forced 50,000 to seek temporary shelter”.* In San Pablo Tacachico and the area surrounding it, several bridges were destroyed, including the one over the Río Sucio that links Tacachico with the neighboring municipality of San Pablo Paisnal.*
Crime in El Salvador
According to the US Department of State Bureau of Diplomatic Security, “El Salvador is considered one of the most violent countries in the world”. The “Department of State updated the Travel Warning for El Salvador in November 2014 to notify U.S. citizens about travel safety concerns and challenges. Police statistics show an increase in annual homicides during 2014, attributed primarily to the cessation of a controversial 2012 truce between local gangs”.* If I move to El Salvador, I could become the victim of many different types of crime. “Crime in this country can run the gamut from credit card skimming to homicide and is unpredictable, gang-centric, and characterized by violence directed against known victims as well as targets of opportunity”.* Since I have obviously Anglo characteristics and features - light hair, light skin and green eyes - I have a greater likelihood of becoming a target.
The State Department has stated that in El Salvador, “Extortion attempts can be transnational in nature and can include kidnapping of victims. And that “Extortion is a particularly serious and very common crime in El Salvador.” Furthermore, “U.S. citizens who are visiting El Salvador for extended periods may be at higher risk for extortion demands… For example, in 2011, a two year-old U.S. citizen was kidnapped from the home of his grandparents in El Salvador by eight to 10 armed men. Ransom demands made to family members in both El Salvador and the United States were traced back to a local prison used exclusively to incarcerate gang members”. I am terrified of something like this happening to our son, especially since “recent reports show that there is an increase in the level of violence associated with extortion cases, including media reports of extortion victims and witnesses being killed.”*
“In 2011, El Salvador had one of the highest per capita murder rates in the world: 71 per 100,000 people. Since January 2010, 25 U.S. citizens have been murdered in El Salvador, three of whom were killed in the first half of 2013. A majority of serious crimes are never solved; only six of the 24 murders committed against U.S. citizens since January 2010 have resulted in convictions”. Then “the country’s homicide rate dropped during a 2012-13 gang truce, but rose again after it fell apart,” and this May, it had “the most killings for a single month since the country’s civil war ended in 1992.”*
Medical Care in El Salvador
According to the State Department, “medical care is limited. Emergency services, even in the capital city, are rudimentary at best.”*
Risks to Teachers in El Salvador
“The escalating violence in El Salvador has not spared the country’s schools, where students and teachers have become prey to extortion, muggings, and murder.”* In 2011, “139 school students and six teachers were murdered. Most of the victims were in the vicinity of the schools they attended or worked in, mostly public schools.”* In the same year, “more than 1,000 teachers had to apply to the Ministry of Education to transfer because they have been threatened.” According to reports, “Most of the complaints come from La Libertad,” which is where my husband’s family lives and where I would be looking for a job.*
News reports say that “Teachers are known victims of violence, facing extortion by gang members who threaten to kill them unless they make ‘protection payments’. This has led many teachers to leave their posts.”* For example, a “gang member asked [his teachers] to give him the grades to advance to the next grade level, but at the refusal of the teachers, the student/gangster threatened them with death.”* The national newspaper, “El Diario de Hoy, spoke with several teachers who, for fear of retaliation by gangs, requested not to specify the name of the schools to which they belong, but they say they are paying $300 monthly for extortion.”* This is almost the entire salary of a teacher in El Salvador.
“La Mara offers [students] drugs, extortion money, parties, guns and all that. There are all kinds of firearms from handmade grenades, and teachers, students and locals are afraid to give all this information to police.”* Even if the students aren’t in gangs, there are the pawns of those who are. “‘Who is behind the demands?’ The answer lies in the teachers’ own students: children of gang members, gang-allied parents, neighbors and opportunists. There are parents who are engaged in drug dealing and use their children to send or receive drugs. Some teachers have been forced to keep packages of drugs for students. Other students have forced teachers to keep firearms in their desks to avoid being caught by the authorities”*
Environmental Hazards in El Salvador
According to the State Department, El Salvador is also a dangerous place to live because of natural disasters. “El Salvador suffers a major earthquake approximately every 10 years. In 2001, three earthquakes and their aftershocks resulted in over 1,000 deaths, a million homeless, and the destruction of over 400,000 homes”. There were other strong earthquakes in 2006 and 2007.* It is very likely that if I live in El Salvador I will be affected by an earthquake, quite possibly a very serious one.
Furthermore, there are seven active volcanoes in El Salvador, three of which are less than 20 miles from San Pablo Tacachico. Also, “approximately nine significant tropical storms and hurricanes have affected El Salvador in recent years.”*
HUSBAND’S LEGAL PROBLEM
Finally, it must be mentioned that my husband was arrested and served 30 days in jail for a misdemeanor DUI in March of 2013. What he did was stupid and dangerous, and he feels horrible about it. It was also a wake-up call. He was an irresponsible, single boy. Now he is a married man with a son. He takes that responsibility and the responsibility to the community very seriously. He would never make the same grave error again. In fact, he hasn’t even driven since the incident, nor does he drink to excess. He only has a toast with his family on special occasions. He was evaluated by a panel physician who did not feel that he was a risk to himself or others.
It would not be possible for Child and me to move to El Salvador. We need to stay in the United States, and I require my husband to be with me, for my own health and well-being, as well as that of my child. For all of the reasons above, I am asking that you grant the I-601 Application for Waiver of Grounds of Inadmissibility for my husband, Husband X X. Thank you.
Sincerely,
USC X X