“There will be a knock at the door,” says Rene, an El Salvadoran pastor and my close friend, “and they will say, ‘Give us your daughter, or we will kill you and your family.’” He continues: “Gangs control many of the villages. They are in the schools; they are in this school! If the leader sees a girl that he likes, no matter her age, he sends members of his gang to her home and demand the girl be given to them to be used as the leader decides. If the parents refuse, the gang members keep their word and take the girl anyway. When a boy reaches the age of 10, he may be killed if he does not join a gang. This is one reason why many of the children arriving at the U.S. borders are alone, without parents or a significant other. Their parents had to make a decision; a decision of life or death; a last resort, a gut-wrenching decision; yet the decision becomes all too clear. It is safer for their children to make this most perilous journey than to remain in their own home.” I listen in disbelief as I sit on the crumbling concrete steps of the village school where our medical clinic is temporarily located for the week. The village is located on the side of an inactive, waterless volcano where large cisterns dot the mountainside collecting precious rainwater for the people’s everyday needs. This is my 12th year leading medical teams to a country and people I have come to love deeply. It has become my “segunda casa,” my second home, yet, somehow, I have not heard this story that is the reality for many in El Salvador. It is a beautiful country of volcanic mountains and rock-strewn beaches. Its beauty in stark contrast to the ever-present violence and intimidation of the gangs. Even the capital, San Salvador, cannot escape this dark reality. Mara Salvatrucha, MS 13, are names that illicit fear in every El Salvadoran; most of all, the fear of a knock at the door. Often, “coyotes” will take these children and others willing to sacrifice everything for a chance at a life offering a glimmer of hope, on this most hazardous trek where illness, injury, and death are ever-present. They are soulless mercenaries who feed on and live off this agonal reality at a precious cost to these desperate families – of money, fractured families, and even death. To live without hope is not to live; it is simply to exist. So, the decision is made, and the children are sent. Hope of a better life for them and their loved ones left behind a powerful driving force. In the villages, lacking many of the modern luxuries of the larger towns and cities, little is known about the news of the world. For them, life is a daily struggle of survival. They know not of the “immigration problem” that is often front-page news in the U.S. They are oblivious to the polarizing issue, with all its ugly faces, that it has become in our country. They only know what they have always heard, that America stands for freedom, opportunity, and most of all hope. They want that for themselves but especially for their children. So, this heart-wrenching story is repeated over and over again, and the tears fall, hearts break, and families separated. Many in the U.S. ask the question, “Why?” Why would parents send their children on a potential death march? How could they ever do that? How could they be so heartless, unloving, irresponsible? Did they not care for their children, love their children? “I would never do that,” we all easily say without hesitation. But, in those same circumstances, would we? Fortunately, we do not live such a cruel reality. My heart aches, and my eyes glisten. There are children at the school now that we will see in the clinic who live in this Twilight Zone of reality. I feel helpless. As a physician, I seek to comfort, treat, and heal. As a father, I do everything I can to love and protect my children. The people of El Salvador seek to do the same for those they love, no matter the cost, no matter the sacrifice. May we not forget this. I never will. Andy Lamb is an internal medicine physician. He can be reached at Bugle Notes. Source