A cancer diagnosis flips your world and your life upside down. It distorts the way you view reality and compresses time. It forces you to weigh alternatives and make choices that normal people don’t have to make and conventional circumstances don’t dictate. Deciding to treat it, and specifically how to treat it, involves not merely what is available, but what a patient can tolerate. Cancer patients are frequently weak and wounded, and the tools that physicians have at their disposal, recent remarkable advances notwithstanding, are dangerous and can be lethal.

Most of the alternatives like radiation and chemotherapy aren’t picnics. The general principle behind both approaches is that killing the cancer means killing a lot of other good cells and tissue along the way. Unless either treatment is applied very carefully by well-trained professionals who know what they are doing, have compassion, and understand the limits and tolerance levels of their patients the medicine can, possibly, be just as bad as the disease.

El Salvador has had a very bad case of social cancer for a while now—namely, it has had a chronic violence and crime problem. Long ranked as the most dangerous country in the Western hemisphere, daily life in El Salvador was dominated by crime gangs. Now the reflexive tendency in Latin America, not without reason, is to assume this involves drugs. And without question, El Salvador has narco trafficking.

But criminals also specialize, much like doctors, and El Salvador’s government and civil society had failed to address a rising tide of criminal gangs who pursued their profits and power the old-fashioned way through extortion, kidnapping, robbery, and violence. It made living in El Salvador very difficult, particularly for working people, so-called “clase trabajador” or the blue-collar working class. Paying off the thug on the corner of your block to simply go to work without being beaten or killed wears on people much like cancer. It forces them to accept harsh medicine that normally they would not consider. But such treatments can sometimes be as bad as the disease.

Misunderstanding Bukele

Nayib Bukele was elected president of El Salvador and began serving in 2019. His background is interesting. His family was in the advertising industry, and they produced election ads for the dominant left-wing party coalition. He was first elected mayor of the nation’s capital, San Salvador, prior to winning the presidency. As mayor, he initiated a series of policies to try to mitigate crime, which was far and away the most salient issue for voters. Some of his opponents and certain members of the US State Department accused him of negotiating with gangs to lower the violence levels to maintain the peace. Whether or not this is true, he pursued policies of placing security cameras and lights throughout the capital. But neither of these developments made much of a dent in the crime situation.

Bukele was a popular mayor and identified as a rising national political star, much to the chagrin of the ruling members of the left-wing coalition to which he belonged. When he expressed some ambition for the presidency, his party responded by attacking him and passing him over for national office. He was eventually ousted from the coalition after a rather public and open conflict with some of his fellow party leaders. Bukele is an opportunist and sensing an opening he created a new political group: “Nuevas Ideas.” The party’s platform was focused on decreasing gang influence, but most of the proposals were relatively tame and conventional. He proposed public works projects for youths to reduce gang participation, increasing government spending on education, and redistributive efforts to reduce inequality. These are the sort of normal prescriptions you’d get from the experts at the international development agencies.

His background in PR and political skills shone in the 2019 presidential campaign. He effectively used his ouster from the party to distance himself from it and the other dominant parties and run an outsider campaign that targeted the corrupt status quo. When he won a majority of the votes, he became the first such “outsider” to win the office since the mid-1980s.

But as president, he pivoted and began more aggressively attacking the gangs. Gangs in El Salvador surprisingly have their roots in the US. Salvadoran immigrants got involved in illegal activities in the US and started to establish criminal enterprises back home. While the US has a fairly robust legal system and law enforcement mechanism, El Salvador and most of Central America do not. Policing is poor, civil society is weak, and rule of law is virtually non-existent. The gangs thrived, like an invasive species.

Bukele began his term by trying to disrupt gang finances and policing well-known areas where the gangs extorted money from locals throughout the country. He also rehashed many of the public works proposals he tried as mayor. None of that solved the problem, so Bukele decided to change to a much more radical and aggressive form of medicine.

He began increasing the armaments of the police and the military and putting the nation’s prisons on lockdown. Prisons are very different in Latin America than they are in the Western world as Brown University economist David Skarbek has very elegantly explained in his book The Puzzle of Prison Order in which he compares the way that different prisons are administered throughout the world. Historically, in countries that lacked the state capacity and resources to have “professional” prisons, incarceration was a sort of co-production good run by the guards but also by the prisoners themselves. Prisoners don’t want to live in chaos, so they actually have an incentive to help organize the institutions. However, that autonomy has natural consequences—prisoners get a lot more space to continue to pursue criminal activities within and outside their cells. Markets emerge within the prisons and revenue streams are created.

Salvador’s prisons were no different, so Bukele decided to attack the cancer of gangs by “locking down” the prisons and limiting visitors and outside contacts to cut off the revenue streams. Additional officers and troops were used to accomplish this, and he continued to divert resources to the armed forces and police to grow their capacity preparing for something bolder if needed. He also began to selectively use emergency declarations. He suspended rules and constitutional protections as treatment for this disease of the gangs. A conflict was brewing, but whatever thin respect for rules, norms, and civil rights was shrinking.

Eventually the gangs had an outburst of violence and Bukele seized the opportunity to round up tens of thousands of suspected gang members in a nationwide sweep led by his military and police. He packed these individuals into a newly built prison that was unlike any other in the region. Stacked on top of one another and essentially deprived of most of their civil liberties, the prisoners have been locked away for several years. However the violence and crime rates in the country, unsurprisingly, have cratered. El Salvador is now one of the safest countries in the hemisphere and Bukele is a rock star in his country. How popular is he?

The Salvadoran constitution prohibits presidents from serving consecutive terms in office. But the country had become accustomed to the idea that Bukele was above the constitution, which was widely viewed as having failed at effectively governing the country. Last year a group of the country’s judges ruled he could run again for president, and he won an overwhelming victory, even in the face of the normal political turbulence for sitting politicians in Latin America. Corruption charges, allegations of negotiations with the gangs, the Covid pandemic, and even the adoption of Bitcoin as the nation’s currency did nothing to dissuade voters from re-electing him in a landslide.

Strong-Man History

Just this week his party, which won a supermajority in the Salvadoran legislature, has voted to allow more rapid changes to the constitution, which will in effect give Bukele more autonomy and power to shape the existing rules of the nation’s political system. It’s not outside the realm of possibility he will amend the constitution to run for president again and stay in power indefinitely.

The great American philosopher Alfred E Neuman was famous for his expression that was summarized by the phrase “What, me worry?” He graced the front page of Mad Magazine posed in various crisis situations. Many Salvadorans, and those of the American right who are currently “fanboys” of Bukele, are undoubtedly thinking the same thing now. Faced with a failed state and social crisis, a heroic political leader seems to have emerged to save his nation despite criticism from international organizations and human rights groups—the very groups that the American right and many Latin Americans ridicule. Bukele seems a perfect solution to a serious challenge facing the region.

But here it’s important to remember the dangers of unmonitored chemotherapy treatments. Latin America has a long history of political oncologists who believed that unshackled from the constraints of constitutions and social convention they could uniquely bring their nations to various endpoints of bliss and success. In many ways, it began with Latin America’s most famous founding father Simon Bolivar who cared little for institutions and law and more for fame and military success. The great man has long been valued over the rule of law. Bolivar’s more recent followers include people like Juan Peron and later the Kirchners in Argentina who have destroyed that nation’s economy and political system. Hugo Chavez and his successor Nicolás Maduro in Venezuela promised a magical rebirth once they were rid of the nation’s political rules and constraints and the country now suffers from higher poverty rates, bulging prison populations, and rampant inflation. In Central America, Daniel Ortega has been in power in Nicaragua for decades on and off with little respect for rules and institutions.

Some on the right might point to Augusto Pinochet as a counter example, but Pinochet was a horrible individual who committed high crimes along with political violence and killing. He may have helped encourage a highly successful conversion to a market economy, but only at a very high price. Is such a price worth it, even when compared to a state run by gangs without effective policing or social order?

Not a Solution to Anything

It’s easy to see why so many on the right have become enamored with Bukele. They too lack basic respect for rules and institutions. They, like him, are largely unanchored by any coherent set of ideas or philosophy. Raw power and faith in “great individuals” seem to be their only consistent views. The rise of contempt for elites and policy experts after the financial crisis and Covid lockdowns have dovetailed with a fear of immigration, crime, and disorder. Bukele looks like a prototype for them, and they are swooning.

But those of us in the reasonable center should be very leery of alternatives such as Bukele. In private conversations with individuals who have connections to the Salvadoran business community, I have heard many stories of Bukele playing favorites and prosecuting his enemies when it comes to the Salvadoran economy. He’s not a free-market fan and certainly believes that a managed economy (one managed by him, at least) is preferable to one in which markets and uncontrolled growth exist. And he appears to be more than happy to apply the same approach to social and economic life that he does to law enforcement—la mano dura, or the strong hand.

Nothing I say here is meant to defend the previous status quo in El Salvador. Individuals I have contacted to discuss the situation are emphatic about how much things have improved. But the long-term risks of this new medicine are painfully clear through an even cursory reading of human history. Salvador was dying of a social cancer, and its new treatment plan seems to have put the disease in remission. But that modern prison bursting at the seams won’t magically disappear. Salvador’s new ruling class seems to like power and enjoy exercising it. It seems more than likely that instead of chemotherapy the people of Salvador were sold snake oil by an increasingly power-hungry salesman.