[Where There Is No Doctor is] arguably the most wide-used public health manual in the world… a text that has meant survival for thousands in the Third World since the early 1970s.
—World Health Organization

Chances are that if you visited a remote district hospital in a developing country you would find a well-thumbed copy of Where There Is No Doctor in its library. The book is intended primarily for village health workers, but generations of docotrs and medical missionaries who have worked in under-resourced communities globally witll vouch for its value in providing concise, reliable information.
—British Medical Journal review

It has been my original intention to remain in the village of Ajoya only long enough to arrange for a burro train to transport the medicines to the high countryt of the Sierra. But Nture has had her surprises waiting for me, and my friends back in Palo Alto have had theirs. The result has been that now, some eight weeks later, I am at last getting my small cavalcade in motion. But perhaps it is better this way. Not only have I come to know and love the Puieblo of Ajoya, but by now each little village and rancho along the way has extended its invitation to me, and has offered to transport my cargo to the next. Already many villagers have come for medicines from as far away as Jocuixtita, Verano, and Caballo de Arriba (up to 40 miles by burro trail into the mountains.) Wherever I go I know I will be welcome.
—Report from the Sierra Madre #1 (1966)

Sometimes, alone at night at my mountainside clinic, as I sit on the stone bench beneath the huge Royal Pine in the patio and look up through its black silhouette at the vast and muted sky, I, like the moon, find the needed distance and stillness to reflect. I consider such thoughts as daylight has little time for. Sometimes I ask . . .
What is the justification of an endeavor like Project Piaxtla? What right have we—intruders from another culture and in some respects from another age—to descend upon an isolated, tradition-oriented, impoverished but relatively stable society such as inhabits this beautiful and wild Sierra Madre Occidental, and attempt to improve the standard of health and medical care? True, the campesinos express appreciation. But are they ready for such “improvements”? And. are such “improvements” really for the best? What will be the long range consequences of our efforts?
—“Taking a Personal Turn” from Newsletter #07 (1971)

There is a great need to simplify and extend the science of rehabilitation, physical therapy, and orthopedic aids so that basic skills are widely available to community health workers and through them to the familities of disabled children.
Project PROJIMO in western Mexico is a modest yet innovative response to this enormous need. It is a rural rehabilitation program run by local villagers, most of them disabled. The main purpose of the program is to give families the understanding and skills they need to help their disabled children develop their full potential. The project is structured to develop self-reliance in all who participate: workers, parents, and children. It is a community-based program in so far as it is directed by local persons from poor farmworking families, and has the participation, in various ways, of much of the community.
—“Project PROJIMO—A Villager-Run Rehabilitation Program for Disabled Children in Western Mexico” from Newsletter #15

She looked down at her legs. They lay there in front of her body, one crossed over the other. But she couldn’t feel them. They didn’t seem to belong to her anymore. Dizzy with pain, she sat there. What had happened? She noticed that there was a pool of liquid coming out between her legs. The puddle grew on the ground until it came about half way down her thighs, then it stopped spreading and soaked into the dirt. She had peed where she sat, but she couldn’t feel it coming out, or wetting her. She couldn’t feel her legs or anything. A bullet had ricocheted off a rock and shattered her spine. Lupe looked up at her brothers and said nothing.
—“Lupe, the Wildcat” from Newsletter #17

In the Sierra Madre of rural Sinaloa, Mexico, the Piaxtla village health team, after analyzing the causes of undernutrition and poor health, has played a key role in organizing poor farmers to fight for their constitutional land rights. Most families agree that—more than any other action—their organized reclamation and redistribution of unconstitutionally large private land holdings has led to improved nutrition of children and decrease in child mortality. However, the gains they have achieved both in land distribution and in health care are now in danger of being reversed because of international trade agreements (NAFTA) and global forces that favor the rich at the expense of the poor. The recent peasant uprising in the distant state of Chiapas has forced the government to respond, at least provisionally, to the peasant demands for land and basic rights. But in the present undemocratic global climate, the future for disadvantaged peoples remains perilous.
—“How the Uprising in Chiapas Revitalized the Struggle for Health in Sinaloa”

Last May (2008) Marcelo Acevedo fell ill and rapidly succumbed to brain cancer. The event was briefly noted in our last newsletter, but because Marcelo touched and changed so many people’s lives, we decided to devote this newsletter to his memory. Marcelo was one of the founders and core members of PROJIMO, the Community based rehabilitation program run by disabled villagers in western Mexico. As a disabled person who reached out with his hands and heart to do his very best to help other people, on equal terms, Marcelo was a personification of the highest ideals of the program.
—“Remembering Marcelo” from Newsletter #63

This article from Newsletter from the Sierra Madre #10, April, 1975, has become one of the classics of health care literature. The story, which tells the events leading up to the tragic death a distressed village woman in Mexico, shows the importance of cultural sensitivity, and of taking the concerns of the ailing person seriously. The tragedy of María helped many of us rethink our approach to health care and become not only better health workers, but more humble and caring human beings.
—What We Learned from Maria

Last year a group of my co-workers and I visited nearly 40 rural health projects, both government and non-government, in nine Latin American countries[.] Our objective has been to encourage a dialogue among the various groups, as well as to try to draw together many respective approaches, methods, insights and problems into a sort of field guide for health planners and educators, so we can all learn from each other’s experience. […] We were inspired by some of the things we saw, and profoundly disturbed by others. While in some of the projects we visited, people were in fact regarded as a resource to control disease, in others we had the sickening impression that disease was being used as a resource to control people. We began to look at different programs, and functions, in terms of where they lay along a continuum between two poles: community supportive and community oppressive.
—The Village Health Worker: Lacky or Liberator?

It is essential that we disabled people demand, help to design, and take the lead in enablement programmes that do not try to normalize us into an unjust society, but rather empower us to become leaders in the struggle for transformation. Together we must work toward a social order that provides all people, rich and poor, weak and strong, disabled and non-disabled, with equal opportunities, equal rights, and equal respect.
—Appropriate Technology: People with Disabilities in the Struggle for Social Change

In our ongoing struggle for the Health and Rights of All, now in the 21st Century, what can we learn from the heyday of the Community Based Primary Health Care in Latin America during the last half of the 20th Century? I would suggest we can learn a lot including things that can help ground us in our current strategies of organized action for change. As an aging activist from those challenging times, I would like to share with you some stories and lessons about the role that village health promoters and their grassroots networks played in the pursuit of health and social justice in those days.
—People’s Struggle for Health and Liberation in Latin America: A Historical Perspective