Sanando Heridas (Healing Wounds)

Your bio:

Celina de Sola is Co-Founder and Vice President of Programs at Glasswing International. Her work focuses on designing and implementing innovative, community, and evidence-based initiatives that bring together institutions and people for joint action. Celina has over 20 years of experience in international development and social change, having worked as an international development consultant; a resource specialist for Latino immigrants in the United States; and leading responses to complex humanitarian crises and natural disasters in over 20 countries worldwide. Celina is an alumnus of Harvard University’s School of Public Health (MPH) as well as the University of Pennsylvania (BA) and its Graduate School of Social Policy and Practice (MSW). She is an Obama Foundation Fellow, Skoll Awardee for social entrepreneurship, a member of the Inter-American Foundation’s Advisory Council, a Tällberg Foundation Global Leader, an Ashoka Fellow, a LEGO ReImagine Learning Fellow, and a Penn Social Impact Fellow.  

Project name:

Sanando Heridas (Healing Wounds)

One-line project summary:

Build trauma-informed eco-systems to mitigate the impact of violence and trauma in Central American countries with pervasive violence.

Present your project.

Violence instills terror, takes lives and livelihoods, exacerbates poverty, desperation, community and family disintegration. Victims are 5.5 times more likely to perpetrate violence or be re-victimized (WHO), fueling the cycle of violence and trauma, and overwhelming people and public systems created to provide care. In El Salvador, many violently injured persons are treated at hospitals with limited capacity to address their psychological trauma. It’s critical to reduce the burden of trauma by expanding access to mental health.   

We propose replicating Sanando Heridas, the first hospital-based trauma intervention in Central America. Staff and patients learn about the symptoms of trauma, explore and practice coping strategies and self care activities, creating a system that is informed and skill in addressing trauma.  

A hospital trauma-informed ecosystem will expand access to mental health intervention, build workforce and individuals’ capacity to reduce harm from violence and trauma, and strengthen resilience for systems and individuals. 

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What specific problem are you solving?

Latin America is home to only 8% of the world's population, but 37% of its homicides (World Bank, 2018). Homicide rates in El Salvador, Guatemala, and Honduras are among the highest globally. Studies have found that patients with an initial penetrating trauma injury are likely to return to the emergency room. According to the World Bank,  more than 40% of violently injured young people return to the emergency service in the future with violence-related injuries, and up to 20% are victims of homicide during the five years after the first injury,  highlighting the need for intervention in hospitals.

Despite extreme rates of violence, and evidence that untreated trauma can perpetuate violence and victimization, most Central American communities are still mental health deserts (less than 2% of the health care budget in the region is allocated to mental health (WHO, 2015)).  Citizens are not provided with the care and support to manage the chronic or acute crises of violence and trauma. Also, many health-care providers remain uncertain about the benefits of mental health services, especially for those patients believed to be gang members. These represent enormous challenges and opportunities to improve the mental health ecosystem throughout the region. 

What is your project?

Sanando Heridas has several layers. The first is the program interventionists who are recruited and trained  to assess patients for trauma symptoms, provide immediate psychological first aid and care, and train them to recognize, manage, and cope with their trauma in the long-term. Together they develop a safety plan to meet the patients’ needs, including a discharge plan. Based on the needs, and security risks, the program uses a network of institutions and providers as a referral system to provide specialized services and additional benefits to patients. This referral system is now a part of the national healthcare system.

The Interventionist also trains hospital staff on the physical, emotional, and behavioral manifestation of trauma. Staff use their own experience with work-trauma to tune into their trauma reactions. These exercises build awareness and empathy for patients and for each other. During the training they practice deep breathing and other grounding techniques. These trainings enhance social cohesion at work as it fosters more open communication and peer support. It also increases compassion for patients resulting in improved patient-interaction, and greater interest in referring trauma patients to follow-up care, and also identifying and referring patients to Sanando Heridas. 

Who does your project serve, and in what ways is the project impacting their lives?

Program engages patients treated for interpersonal injuries,   those whose emotional and mental state have been affected by witnessing a violent act, as well as hospital staff. Patients have been exposed to violent events, mainly related to four types of injuries: (i) beating, (ii) gunshot wounds, (iii) stab wounds and (iv) others that may include explosive weapons, threats, and others. Additionally, the program also treats people whose emotional and mental state have been affected by witnessing a violent act.  

The program trains existing service providers as interventionists, who after performing an assessment on patients, then provide immediate psychological first aid and care to help individuals recognize, manage, and cope with their trauma in the long-term. Jointly, patients and interventionists develop a safety plan that emcompases the needs of the beneficiary, and includes action items to follow up and provide additional support. The training also includes self-care for service providers, simultaneously contributing to individual and institutional resilience. Based on the patient's needs, and security risks, the program uses a network of institutions and providers as a referral system (‘trauma-informed ecosystem’) to provide specialized services and additional benefits to patients.

Which dimension of The Elevate Prize does your project most closely address?

Explain how your project relates to The Elevate Prize and your selected dimension.

Sanando Heridas is a program that elevates mental health and puts victims of violence at the center (all victims of violence, including victimizers) by providing them with holistic services and developing positive coping skills. As an evidence-based approach for violence prevention, it elevates the importance of trauma-informed practices and seeks to create a sustainable trauma-informed-care ecosystem. Moreover, Sanando Heridas raises awareness of the deeper and lasting effects of trauma in the short and long term in a person’s life, and how trauma-informed care contributes in breaking the cycle of violence by reducing relapse and retaliation against others or themselves. 

How did you come up with your project?

In 2006, I moved back to El Salvador after years of leading international humanitarian efforts in conflict zones and natural disasters sites, where I found that criminal and gang activities were fueling a rapid rise in violence. I knew about a program in the US that worked to address trauma in a hospital setting. I thought that this might work in El Salvador since hospitals tend to be neutral environments and is the place where everyone comes for treatment, both the injured person and those who sometimes cause injuries. 

One of the US program staff, and a hospital nurse (who later became our first program staff)  came to El Salvador to collaborate with us to design a program that could fit our context. Because of high rates of violence and concern for safety, we could not operate in the community. Instead, we created a brochure that acted as the case manager, which took patients through the process of learning about their trauma symptoms, practicing coping and self care activities, and using supportive people in their lives. This process was replicated with hospital staff so they could too understand the impact of personal and work trauma on their emotions and behavior.

Why are you passionate about your project?

I was born in El Salvador right before our civil war. I lived a sheltered life in this conflict-torn nation until my family was forced to move to the US when I was six years old. I spent every holiday in El Salvador, so constantly had to navigate two worlds - my life in an affluent US suburb, and my other life inside a protected bubble surrounded by an impoverished and dangerous El Salvador. I found it distressing witnessing how children my age suffered and struggled, this motivated me to organize student volunteer activities starting at age 12. Later, in graduate school, I worked with undocumented immigrants who fled violence in Mexico and Central America. This work exposed me to the extreme challenges, trauma, and loneliness that immigrants faced, and the lack of community support to help them cope and navigate their new lives in the US. I always found myself trying to fill gaps in a system designed without knowledge of the population’s needs. I realized my efforts were palliative and unsustainable, and began thinking about how a mental health ecosystem could alleviate acute distress and equip people with hope, a sense of agency, and the skills to thrive.

Why are you well-positioned to deliver this project?

Glasswing’s expertise in trauma intervention is rooted in over a decade of work in developing trauma-informed mental health practices in hospitals, schools, and communities, evaluating program impact and conducting feedback sessions with program beneficiaries. Sanando Heridas has been funded by partners such as USAID, the Inter-American Development Bank, and replicated at both institutional and community levels. In El Salvador alone, Sanando Heridas has strengthened the capacity and skills of almost 4,000 public service providers. Moreover, in 2019, an independent evaluation by the World Bank illustrated that Sanando Heridas reduced the likelihood of recidivism for violent injury by up to 30%, and that by training personnel in trauma, the rate of referral of patients to specialists increased by up to 58%, demonstrating their improved trauma assessment capacity. 

The current political context offers opportunities to influence national policies that favor a new approach to public security, which focuses on violence prevention. Our existing partnerships with government institutions (Ministry of Education, municipalities, public health system, law enforcement, Immigration) place Sanando Heridas in a unique position to continue expanding in the region, as the program has also been adapted for:

• Staff training in government centers for returning migrants (El Salvador-Honduras) to better respond to the mental health needs of migrants.

• Police training in Guatemala and Honduras. Police have shown improvements in self-regulation, impulse-control, and empathy. 

• School-based Well-being Committees that address the ‘mental health deserts’ in communities by facilitating individual and collective grieving, as well as detecting and referring cases of abuse. 

Provide an example of your ability to overcome adversity.

For the first 3 years of the program, obtaining buy-in from the Ministry of Health and government hospital staff was difficult, seeing as – despite the vast number of violent injuries they treated – they didn’t recognize the importance, or their role, in addressing psychological trauma. Our strategy was not only to present scientific evidence (often through peer-based learning), but also provide short, interactive training in self-care and trauma education, to help healthcare workers manage their own vicarious trauma. Once they were able to understand the often-devastating symptoms they faced, it was easier to empathize with patients.

Another challenge was that the US-based intervention models that inspired this program included significant home and community-based case management. This was virtually impossible for us to do because of the extreme risk it posed to our team and our clients, due to gang violence. We had to find alternatives to ensure ongoing support so clients could continue healing once they left the hospital. Aside from conducting remote, telephonic interventions, we also decided to focus on decentralizing access to mental health support. We did this by establishing more ‘trauma-informed communities’ through training, and helping to set up/activate detection and referral systems in communities. 

Describe a past experience that demonstrates your leadership ability.

Working in a region plagued by violence and trauma, polarization, and instability, leveraging empathy, and optimism are critical to bringing together ‘unlikely’ partners with vastly different ideologies and backgrounds. Knowing that to transform our countries, we need to break molds and shift paradigms, I often propose ideas that seem impossible until we see them through.

Believing deeply in collaboration, my role is often to ‘convene and catalyze’ across disparate stakeholders, ensuring communities are at the table. 5 years ago, we decided to overhaul San Salvador’s ‘Central Park’, a neglected and dangerous space right in front of the country’s most important public hospital. We had to overcome significant push-back due to extreme political polarization. It required contagious optimism, aspirational thinking, and perseverance. 

At a time when the US Administration had cut all aid to Central America because of the migration crisis, we also had to build bi-partisan support -for this and many other violence prevention projects- with visiting US Congressional Delegations. I had to garner trust and credibility, and engender a shared vision among people that weren’t necessarily aligned with each other. Against all odds, we succeeded, and the park is now one of the only safe spaces for families.

How long have you been working on your project?

Sanando Heridas started in 2012 in El Salvador.

Where are you headquartered?

What type of organization is your project?