El Mercado (or, sometimes you can´t see the forest)
On a public health mission I went to the town market with two municipality officials and one of the centro de salud staff to see what recommendations we could make. Santiago´s market appeared to me fairly typical for a market in Central America. Crowded, full of people sitting on the floor selling fruits, nuts, crabs, fish, fish heads, and pretty much anything else that you could need. 
But on this trip, we focused on the stands that sell food. Picture a booth at a carnival or farmer´s market where you can buy a plate of tortillas, beans and rice. Or soup and a soda.
The town of Santiago is starting a new program in improve the sanitation of the market so our task was to go from stand to stand and make suggestions to them about how they could prepare food more safely. At every stand we asked to see their official permit allowing them to sell food, and the ‘Tarjetas de Salud’ (health cards) which every employee is supposed to carry stating that they have tested negative for TB. And at almost every stand people told us ‘Oh yes, we have those, but we keep them at home.’ I was actually surprised at how many store owners told us honestly ‘No, we don’t have those.’
The other recommendations were pretty basic. My major contribution was to point out that no one had any real way to wash their hands (definitely needed my master’s to notice that one) and that maybe the best place to store the vegetables wasn’t on the ground.
But here is the really funny thing: When I got back home I realized that the stands we visited probably weren’t the main threat to public health in the market. A much greater nidus for infection and vermin is probably the unrefrigerated fish, fruits and vegetables sitting on the ground. And those are the poorest vendors, who don’t pay license fees and who couldn’t afford to if they were charged. So I wrote my notes up for the centro de salud and in it I explained this, but it is a hard line to walk because on the one hand I don’t want suggest taking away the livelihood of the poorest people in the market, but reforming the rules for who can sit on the floor and sell without doing so would require money from somewhere.
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