Piaxlia Village-Organized Healthcare By Danielle Janes In Mexico’s rugged Sierra Madre mountains, over one hundred remote, poor communities provide for their own basic healthcare. Their village health workers, and the training clinic at the base of the mountain, form a unique cooperative network known as Project Piaxtla. Villages formerly plagued by preventable diseases now treat at least 90% of their health problems with a basic set of medicines. Project Piaxtla began in 1963, as a result of California biologist David Werner’s concern over the lack of healthcare in the area. He gathered together foreign health specialists to teach village health workers and provide care. Together they built a small training clinic in the city of Ajoya. He organized the Hesperian Foundation to provide financial assistance. However, to prevent dependence upon outside help, the clinic was turned over to the students, local Ajoya villagers, in just a few years. Most health workers supported themselves by farming. The main clinic experimented with various self-reliant projects of their own, including growing a garden, chicken/pig raising and bee-keeping. None of these generate quite enough to support the clinic’s training program, so the Hesperian Foundation continues to provide financial help. The clinic’s curriculum differed greatly from the typical medical school’s program. The emphasis was on low-cost preventative healthcare, treatment of common serious diseases, use of local resources and community organizing, as opposed to expensive, specialized, high-tech curative care. Students learned through hands-on practice, interactive discussion and entertaining role playing. Instead of weeding out the slower students, the Ajoya instructors made sure everyone kept up. The students passed on valuable health information to their neighbors in the same involving and effective way when they returned to their villages. The student selection process was also distinctive. The Ajoya students were chosen by their village to become health workers. They were not selected for their education (most have only a few years of schooling), as much as for their personal qualities, such as empathy, honesty and leadership. About a third of those chosen were traditional healers and midwives, who with the added training, David Werner said, “have turned out to be some of the best health workers.” Werner wrote the training program’s text. Where There Is No Doctor because there was no available medical reference book that simply and adequately met the needs of basic village healthcare. Its companion guide. Helping Health Workers Learn, draws from the low-cost, effective teaching methods used at Ajoya, and has much in common with Paulo Freire’s works on education. In the training program, the village health workers mastered minor surgery, the delivery of babies, and the treatment of common ailments and even serious diseases (e.g. typhoid, tuberculosis, leprosy and tetanus). Their preventative health education included the development of veterinary skills. They learned to recognize their limits, referring the most complicated problems to certain hospitals in the city that charged less than regular rates. Healthcare Begins With Social Justice According to Martin Lamarque, one of the program’s long-time volunteers, “It became evident that a lot of the problems were rooted in the social condition in which people lived. You cannot have very healthy children if there is not enough food, and there is not going to be enough food if the land isn’t shared equally. And you’re not going to have clean water if the government administering the water system is corrupt. ...So some of the classes had to do with organizing the people to improve their lives.” The health workers’ activist efforts range from putting together plays on the benefits of breast feeding to organizing poor farmers around their constitutional rights to land, grazing areas and public water supplies. One community play, put on by village women and health workers, linked RAIN Spring 1993 Volume XIV, Number 3 Page 14
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