1. Designing Wheelchairs in the Wild Wild West

   by David McMullin

A Brief Update on The Politics of Health in Mexico’s Sierra Madre: Increasing Poverty, Crime, and Violence in Rural and Urban Mexico

The Ajoya Massacre

For the last 37 years the village of Ajoya in the foothills of Mexico’s Sierra Madre Occidental, has been the nucleus of the groundbreaking community-based health and rehabilitation innitiatives, projects Piaxtla and PROJIMO. These programs have been the source of the widely used handbooks Where There Is No Doctor, Helping Health Workers Learn, Disabled Village Children, and Nothing About Us Without Us. But over the last several years the combination of drugs, violence, robberies, and kidnappings have plagued the village. At a festival and dance for Mothers’ Day last May (2002), a massacre resulted in the death of 12 person including 2 “Protection Police,” a 7 year old boy, and a grandmother in her 60s.

Community Ownership: the Key to Sustainability

David Werner, 2002

Author’s Misgivings in Writing this Chapter

Although I gladly contributed to the previous two volumes in this series—Practicing Health for All and Reaching Health for All—it was with certain misgivings that I have agreed to write a chapter for the present volume, Sustaining Health for All.

My first misgiving centers on the non sequitur of trying to “sustain” something that remains so far from being realized. The goal of “Health for All” lies on the same slippery uphill path as “Equal Opportunities for All” and “Equal Representation for All.” Yet in the last decade we have in many ways been backsliding rather than advancing toward all these goals. As humanity ventures into the 21st century, the gap between the over-fed and under-fed, the strong and the weak, the rich and the poor continues to widen, both between countries and within them. Effective representation by vulnerable groups has been eroded as wealth and decision-making power have concentrated in hands of a globalized ruling class. The ability of giant corporations and powerful interest groups to swing public elections and to buy politicians has led to a plethora of non-democratic “democracies” that place the economic growth of the elite before the well-being of the many.

Ensuring the Necessary Resources for the Human Right to Health: National and International Measures

Address by David Werner

In the 1940s, the United Nations declared Health a Basic Human Right. The World Health Organization was created to help make that Right a reality. But during the next several decades, the Right to Health remained a distant dream for most of the world’s people.

Toward a Healthier World: Methods and Action for Change

To give some impetus to this last day of the People’s Health Assembly, the Planning Committee asked me to give a so-called “inspirational address.” I guess they want me to say something hopeful, something optimistic, that motivates all of us to keep slogging away in the up-hill struggle for the healthier, more compassionate world we all dream of.

NEED TO WORK ON HEADERS

Communication as if PEOPLE Mattered: Adapting Health Promotion and Social Action to the Global Imbalances of the 21st Century

 

DEMOCRACY as a prerequisite for a HEALTHY SOCIETY: Why Participation is Essential – and How it is Undermined

by David Werner

The well-being of an individual or community depends on many factors, local to global. Above all, it depends on the opportunity of all people to participate as equals in the decisions that determine their well-being . Unfortunately, history shows us that equality in collective decision making—that is to say participatory democracy— is hard to achieve and sustain. Despite the spawning of so-called ‘democratic governments’ in recent decades, most people still have little voice in the policies and decisions that shape their lives. Increasingly, the rules governing the fate of the Earth and its inhabitants are made by a powerful minority who dictates the Global Economy. Thus economic growth (for the wealthy) has become the yardstick of social progress, or ‘development,’ regardless of the human and environmental costs.

Breaking the Grip of Globalization on Poverty-Related Ill-Health: A Perspective from the North

I should begin with an apology. I may not be the right person to speak on poverty and health in the North. First, my community health experience has mostly been in the South, mainly rural Mexico. Second, when in the North, I live in Palo Alto, California, heart of the Silicon Valley, the richest industrial complex on earth. Computers, weapons industry, NASA and BIG money!

Seats That Enable: a Special Seating Seminar-Workshop in Culiacan, Mexico

On 1-5 March 1999, Jean Anne Zollars, a physiotherapist and seating expert from New Mexico, facilitated a mini-course in “Special Seating” at Mas Validos, a Community-Based Rehabilitation programme, run largely by the parents of disabled children in Culiacan, the capital of Sinaloa state, Mexico. The course was followed by a two-day workshop held at PROJIMO, in the village of Ajoya about 160 kilometres away. David Werner was the co-facilitator of the course and workshop.

Health and Equity: Need for a People’s Perspective in the Quest for World Health

David Werner

Too often, in planning strategies to improve health, the people whose lives are most vulnerable have not been consulted. However, the Alma Ata Conference of 1978 was something of an exception. Among its participants were pioneers of community-based health care initiatives from several countries. They emphasized the need, in the pursuit of Health for All, to confront the underlying social, economic and political causes of poverty and poor health. The result was the potentially revolutionary Alma Ata Declaration, which promoted a comprehensive, multi sectoral approach named Primary Health Care. This called for a New Economic Order based on equity and “social justice”, to be achieved through strong community participation.[^1]

Giving Control Back to the People

By David Werner, February 1999

The health workers were eager. They demonstrated their baby-weighing scheme, complete with animated health talks. Then, sitting down under a giant fig tree with the mothers and children of the village, they boasted of the dramatic fall in child deaths and reduction in malnutrition over the past two years.

Management of Long-Term Disability

When I was first asked to address the topic of “Management of Long-Term Disability,” I had misgivings. As a person with a disability myself, “I am less interested in management” than in the never-ending struggle for acceptance, dignity and opportunity. Most disabled people seek liberation from prejudice, pity, over-protection, domination, cruelty and exclusion by society.

As an advocate of CBR, I have misgivings too. The emphasis on “management” fits like a well-worn glove onto the institutional bio-medical model of rehabilitation—a model in serious need of evolution.

 

Who Killed Primary Health Care? How the Ideal of ‘Health for All’ was Turned into the Reality of Worsening Health for the World’s Poor

by David Werner

 

An instructor of community-health workers in Kenya once told me about a sobering experience she had when she was visiting a rural health post. In the heat of midday an exhausted young mother arrived on foot from an isolated hut several kilometres away in the savannah. In a colourful shawl across her back she carried her baby, Kofi, who—she explained—had severe ‘running stomach’ and was very ill. She begged the health worker for the life-saving medicine in the silver envelope that she had heard about on the radio. She was referring to Oral Rehydration Salts, of which 400 million packets are produced each year as part of the international campaign to reduce deaths from diarrhoea, still the biggest killer of children in many poor countries.

The Hidden Costs of Free Trade: Mexico Bites the Bullet

by David Werner and Jason Weston

The Life and Death of Primary Health Care: Presented to the UN ‘Global Summit’ (1995)

by David Werner

In the Alma Ata Declaration on 1978, the world’s nations affirmed that both health and health care are basic human rights. But in recent years, for growing numbers of destitute people the possibilities of receiving adequate health services has been growing more remote. The reason in large part is financial. Since the early 1980s the income gap between rich and poor has been widening, both between countries and within them. Today over one billion persons, or one in five of the world’s people, survive (or try to survive) on less than one dollar per day. [^1] In many countries, while unemployment rises, minimum wages have fallen so low that they do not cover the family’s basic food needs. Worsening people’s hardships yet further, at the same time that poverty is deepening in most Third World nations, the costs for basic health services are being systematically shifted from the public sector to the individual consumer.

The Politics of Health: An Interview with David Werner

by Kathryn True

The Politics of Health: A Retrospective

Project Piaxtla: A Villager-Run Health Program

When the Piaxtla Project started in 1965, the “diseases of poverty” dominated the health scene. One in three children died before reaching the age of five, primarily of diarrhea and infectious disease combined with chronic undernutrition. Seven in ten women were anemic, and one in ten died during or after childbirth.

A Grassroots Struggle for Health and Rights in Rural Mexico

by David Werner, 1994

Project Piaxtla is a rural health care initiative run by local villagers in western Mexico. Named after the local river, Piaxtla was started 30 years ago to serve a large, rugged, sparsely populated, mountainous region in the state of Sinaloa. The program is based in Ajoya, the largest village (population l,000) in its area of coverage. This grassroots initiative has followed an uncharted course which has led it from a narrow focus on curative and then preventive measures to a comprehensive approach which confronts the underlying social, political, and economic causes of poor health. From the first, a major concern has been the survival, health, and quality of life of children. These have improved over the years, although new, more global obstacles threaten to reverse some of the gains. The author of this account, David Werner, has been involved with the program as an advisor and facilitator since its inception.

A talk given at a seminar organized by:

Author Contact:

International People’s Health Council, Northern Region C/O

Healthwrights

c/o Jason Weston

3897 Hendricks Road

Lakeport CA 95453 USA

 

info@healthwrights.org

The Life and Death of Primary Health Care or The McDonaldization of Alma Ata

A talk by David Werner

1. Appropriate Technology: People with Disabilities in the Struggle for Social Change

   1. David Werner

Pushing Drugs in a Free Market Economy: What the Pharmaceutical, Tobacco, and Narcotics Trade Have in Common

by David Werner

The American Medical Students Association has chosen a daunting theme for this year’s annual convention. The rampant misuse of drugs—both legal and illicit—has become a major and growing threat to health: of individuals, of communities, and of society as a whole. Official campaigns to combat substance abuse have largely failed because professionals and politicians tend to “blame the victims” rather than to confront the systemic root of the problem.

Juan: Drug Smuggler Turned Therapist

I am going to tell you the story of my life. When I was five years old, my mother died. From then on, my father took charge of our family and life went on. But when I was 10 my father died too. That’s when I lost the rudder to my life. I suffered until I was 13. Then everything changed. I became friends with a man who offered to help me. He was the answer to my dreams because I was so tired of living in poverty, so tired of suffering. I thanked God for the opportunity to end my misery.

La Guerra Antidrogas

Por David Werner

Traducción: Delia Juárez G.

GLOBAL ILLS AND POPULAR STRUGGLES IN ECUADOR

by David Werner

Disabled People in International Development

by David Werner

A visitor to the capital of Luanda is immediately struck by the many disabled men, women, and children hobbling along with the help of wooden poles or crutches. Most of the disabilities are due to amputation or polio, both the result—directly or indirectly—of the “Low Intensity Conflict” (LIC) to which the Angolan people have been subjected since independence. The incidence of polio is due to the breakdown of health services in a land where access to rural areas has been cut off by random but persistent terrorist attacks along roads.

Project Projimo: A Program For and By Disabled People

by David Werner

My main interest is in innovative community program where disabled persons themselves or members of their families take the lead in management, provision of services and decision making. My interest in program that are run by and help empower disabled persons comes from my own personal bias, for I, myself, have a physical disability.

Short Quotes by David Werner on Community-Based Rehabilitation

In the July 1989 issue of “Independent Living,” David Werner, a disabled community organizer and rehabilitation expert, author of Where There Is No Doctor and Disabled Village Children among others, describes several innovative examples of Third World projects run by disabled people themselves producing rehabilitation services and assistive devices as income generating projects. He writes:

Health For No One by the Year 2000: The High Cost of Placing ‘National Security’ Before Global Justice

Before and Beyond Objectives and Goals: The Vision

by David Werner

In the planning and evaluation of health programs, often a great deal of discussion is devoted to “objectives” and “goals.” Goals tend to be more general, objectives more specific, but both are—or, it is commonly agreed, should be—clearly defined. They become the fixed landmarks toward which the ship sets sail.

Empowerment and Health

Talk by David Werner

Introduction: The Importance of Empowerment

How important is empowerment to achieving ‘health for all’? Extremely important! In reality, health depends more on empowerment of and by the people than it does on health care per se.

Yet, when I was invited to speak on ’empowerment’ I had misgivings.

For when words become jargon they lose their power. The term ’empowerment’, which in its fullest sense is a liberating grassroots concept involving confrontation, has now been so sanitized and depoliticized by the health and development establishment that it has become more pacifying than liberating. We have all but forgotten its political roots in poder popular or power by the people.

Home Remedies

Topics:

1. Asthma

2. Cough and Cold

3. Cuts, Wounds and Stings

Public Health, Poverty and Empowerment—A Challenge

by David Werner

Those of you receiving a degree in public health are faced with an unusual—and in some ways paradoxical—challenge. For as we all know, in today’s world the biggest obstacles to ‘health for all’ are not technical, but rather social and political. Widespread hunger and poor health do not result from total scarcity of resources, or from overpopulation, as was once thought. Rather, they result from unfair distribution; of land, resources, knowledge, and power—too much in the hands of too few. Or, as Mahatma Gandhi put it; There is enough for everyone’s need but not for everyone’s greed.

1. The Village Health Worker—Lackey or Liberator?

   by David Werner

 

Throughout Latin America, the programmed use of health auxiliaries has, in recent years, become an important part of the new international push of ‘community oriented’ health care. But in Latin America village health workers are far from new. Various religious groups and non-government agencies have been training promotores de salud or health promoters for decades. And to a large (but diminishing) extent, villagers still rely, as they always have, on their local curanderos, herb doctors, bone setters, traditional midwives and spiritual healers. More recently, the médico practicante or empirical doctor has assumed in the villages the same role of self-made practitioner and prescriber of drugs that the neighborhood pharmacist has assumed in larger towns and cities.

What We Learned from María

Introduction

Those of us whom solitude entices to peer into the night skies of our own being, and thereby into Being in general, are often dumbfounded by the didactic irony of fate. It is as if “blind” luck and “pure” chance conspired with our human sensibilities to pursue paths as clear yet inexplicable as evolution. Perhaps we are just imagining things, reading into events whatever significance we project upon them, as with inkblots. Be that as it may, the chips do fall at times with awesome significance, stopping us short. The sleepless Fates, which once presided over Greek plays, weaving with the portentious shuttle of strophe and antistrophe the thread of the hero’s Hubris until at last he snarled in the inextricable web of Nemesis—even today ring within us a note of fearful recognition. Events in our daily lives time and again fall into momentous patterns, as if trying to teach us something we have long known, yet ignore; as if Fortune herself were half Poet and half Prankster, and our disquiet existence a tragic-comedy deftly designed to put us in our place.

Primary Health Care and the Temptation of Excellence

For better and for worse, the Ajoya Clinic has come a long way since 1965, when it began as a few boxes of medicines and bandages on the front porch of the casa of blind Ramón, and its staff was no more than an ex-schoolteacher trying hard to play medic, assisted by a handful of over-eager village children. Then, to be sure, we had a strong sense of community—sometimes too strong—for we shared the open porch with dogs, chickens, pigs, cockroaches, a pile of pumpkins, a corn crib, a small table at which we ate in shifts, and five cots which at night were unfolded to sleep eight of the household and myself.