How the Uprising in Chiapas Revitalized the Struggle for Health in Sinaloa

David Werner

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.

Determinants of Health in Mexico’s Sierra Madre

It has been said that one of the best indicators of the overall health of a population is the “under-five mortality rate” (U5MR) of its children. In 1965, when the villager run health program called Project Piaxtla began in the mountains of Western Mexico, 34 out of every 100 children died before reaching their fifth birthday. Today between 5 and 7 children per 100 die: more than is acceptable but a big improvement over the earlier rate. Equally important, now there are far fewer malnourished, sickly and stunted children. More youngsters are healthy, growing well, and bursting with life.

A lot of factors contribute to this impressive drop in child death rate. Most families agree that their villager-run health program—named Piaxtla after the local river—has played a key role in reducing child death and improving health. But if you ask “What actions brought the biggest improvements?” few people will say curative or preventive measures. Many will mention organized social and political action.

Most villagers realize that the main reason why so many of their children used to get sick and die is that often they didn’t get enough to eat. And in the Sierra Madre mountains of Sinaloa (as in many other parts of Mexico, of Latin America, and much of the Third World) the problem of undernutrition in children is closely linked to distribution of power, wealth, and land.

Land distribution has been a crucial issue ever since the Spanish Conquest.It was also a key factor in the 1910 Mexican Revolution. In the late 1800’s Mexico’s president-turned-dictator, Porfirio Díaz, gave huge tracts of land to wealthy cronies. This further entrenched the cruel feudal system. Good farmland became concentrated in giant plantations, or latifundia. Dispossessed peasants (indigenous and mestizo) had few options.

Either they worked as serfs or share croppers for the powerful latifundistas, or they retreated into the hills to grow scanty crops on steep slopes through slash-and-burn farming. Either way, survival was difficult. Tortillas and salt, with a few boiled beans if they were lucky, became the standard diet of millions of landless peasants. . . .Small wonder people revolted!

In the Mexican Revolution—with the war cry: “Tierra y Libertad” (Land and Liberty)—landless campesinos throughout the countryside united behind popular leaders such as Pancho Villa and Emiliano Zapata. At last, the Díaz dictatorship was toppled and a new, truly revolutionary Constitution was drawn up: one of the most progressive in the world.

The heart of the Mexican Constitution was its land reform program. To prevent the return of huge plantations, limits were placed on the legal size of property holdings. Also, the famous ‘ejido system’ was set up: A group of villages could form an ejido or communal land holding. The local farmland was divided equitably among all families. Each family would receive provisional title to their parcel, could farm it and benefit from the produce as they chose. But ultimate ownership stayed with the ejido. The family could not sell its parcel nor have it seized for unpaid debt. This protected small farmers from losing their land.

Some social analysts say the ejido system contains the best of the political Right and the Left. It encourages the personal incentive and high production of private ownership. And it also guarantees the equity of land distribution intended by socialism.

the ejido system has worked better in theory than in fact. Since the Mexican Revolution, the biggest problem with the land reform laws—and with the Mexican Constitution in general—has been institutionalized corruption.

However, the ejido system has worked better in theory than in fact. Since the Mexican Revolution, the biggest problem with the land reform laws—and with the Mexican Constitution in general—has been institutionalized corruption. Although the Constitution calls for a democratic, multi-party system, for 60 years a single political party, the PRI (Institutional Revolutionary Party) backed by brutal military and police forces, has remained in power. To stay in power in spite of growing inequities and hardships for the poor, it has resorted to vote fraud, intimidation, torture, and strategic assassination of human rights leaders. (The killing of outspoken journalists has been wryly dubbed “the ultimate form of censorship.”)

Under such a heavy-handed oligarchy, the ejido system and laws limiting size of land holdings have often failed to protect small farmers’ land rights. The rich and powerful routinely pay off government officials to break the rules and to silence those who protest.

Nevertheless, the land reform statutes of the Mexican Constitution have, until recently, provided a legal and moral base whereby poor farmers could organize to defend their revolutionary rights to Land and Liberty.

Piaxtla’s Evolution: From Curative Care to Social Action

In its early stages, the Piaxtla health team did not consider itself especially political, except that its goal was to serve and enable those in greatest need. The program began with a focus on CURATIVE CARE, which was what people wanted. Then, after the village health workers became successful in meeting many of the curative needs, people became concerned that common health problems kept coming back. So the program’s focus gradually shifted toward PREVENTION: latrines, clean water systems, immunization, etc. As a result, the health of children improved somewhat. But still there were a lot of deaths, especially among children of the poorest families, who were landless, underpaid, underserved, in many ways taken advantage of. So the program’s main focus changed again: this time to ORGANIZED ACTION to defend people’s basic needs and rights. In this way, the village health program evolved from curative care to preventive measures to sociopolitical action.

The shift in the program’s focus from more conventional health measures to organized action was in part the result of a learner centered, discovery based, problem solving approach to health education: a methodology developed through and supportive of learning by doing. At the beginning of a course for health workers—and, in turn, of study groups for farmers, mothers, or schoolchildren—the group starts off with a situational analysis or community diagnosis in which participants discuss health-related problems in their community and how they interrelate. Rather than look at the death of a child as having a single cause (such as “diarrhea”) they learn to explore the chain of causes that leads to that child’s death. The links are identified as biological, physical, cultural, economic, and political, or (in simpler terms) having to do with worms and germs, customs and beliefs, money, and power.

In the early days when the focus was mainly curative and preventive, the links people chose to form a ‘chain of causes’ tended to be mostly biological, physical, and cultural. For example, the chain leading to a child’s death from diarrhea might have included

  • death < dehydration < diarrhea < gut infection < germs carried from feces to mouth < lack of latrines, hygiene, sufficient water; etc.

But as people began to explore deeper, their chains of causes tended to include more economic and political links. For example:

  • death < frequent bouts of diarrhea < undernutrition < not enough food < no money < father works as a share cropper < good farmland held by a few rich men < land reform laws not applied < pay offs and corruption < lack of participatory democracy < insufficient organization and action by the people.

After common problems and the root causes were defined, possible solutions were explored. Sometimes this was done through story telling or role plays . . . or, to involve a wider audience, by publicly staged “campesino theater.” Finally when the group agreed that the circumstances and timing were right, a strategy for action was developed.

The problem-posing methodology used by the Piaxtla health team—including situational analysis, awareness raising, and action-oriented learning—is presented in the book Helping Health Workers Learn. (This book—as well as Where There Is No Doctor and Disabled Village Children which also grew out of the Piaxtla experience—has been translated into many languages and is used by community based health and disability programs worldwide.)

Actions to Defend the Dispossessed

Actions organized by the Piaxtla health initiative mostly related to the ways in which poor campesinos were systematically cheated, mistreated, or exploited. Early activities included:

  • Demanding the owner of the local bus route to lower fares to the legal rates.

  • Organizing, led by village women, to shut down the public bar (to reduce drunkenness, violence, and undernutrition).

  • Organizing a protest to take control of the village water supply away from a wealthyman and to introduce a public water system controlled by the community.

  • Launching a cooperative maize bank (to halt the usurious loan system whereby poor families had to return 3 sacks of maize at harvest time for every one sack borrowed at planting time).

Another activity that helped to improve the economic base of disadvantaged campesinos was the cooperative fencing program. Among the poorest farmers are those who plant the steep hillsides by the slash and burn method. Each year they clear a new patch of land, and fence it to keep the cattle of the rich from eating their crops. To buy fencing wire, they borrow from the rich cattle owners. Unable to pay back the loan, each year they forfeit the fenced and cleared plots of land, and the cattle owners use them to corral and graze their cattle. Thus for only the cost of wire, the rich man gets pasture land fenced, cleared, and planted with fodder for free.

Analyzing this problem as a root cause of hunger and poor health, the health team organized groups of poor farmers to cooperatively fence whole hillsides, so that within the large enclosures they could plant their individual plots year after year. The program obtained seed money from a funding agency and loaned it to the first group of farmers to fence a hill side. After harvesting, the group rented the grazing rights to the rich cattle owners, and in two years managed to pay off the loan. From then on, the rental of the fenced hillside produced an income, which could be used for the food and health needs of their children. When the first group of poor farmers succeeded in paying off their loan, the same money was lent to a new group. Through this rotating fund, a growing number of poor farmers became more self sufficient. The gap in wealth and power between rich and poor narrowed somewhat, and the health of some of the poorest children began to improve.

Through these and other organized as servants. actions, people began to gain confidence, and experience strength through unity. Stoic resignation gave way to hope that by working together people could better their lives. This empowering process took fire, and neighboring communities began to join the informal but cohesive organization of poor farmworkers. As the numbers and solidarity among the campesinos grew, they and their health team began to combat bigger, potentially more dangerous issues. After several years, they felt that they were strong and organized enough to tackle what many considered the biggest barrier to health: the unfair and illegal distribution of land.

The Sierra Madre’s Long History of Conquest and Revolt

Historically in the Sierra Madre Occidental, the struggle of poor campesinos for their land rights goes back 500 years. When the Spanish conquistadores first entered the Piaxtla valley, they claimed to own the Indians’ land and tricked them into buying it back in exchange for their gold, some of their girls, and whatever else took their fancy.

Quietly enduring this abuse, the Indians in this remote mountain region continued to plant and harvest their land in relative peace for many years. Then, in the late 19th Century, the dictator president Porfirio Díaz started giving huge tracts of land (all over Mexico) to his friends and cronies. Ignoring the land titles given to the Indians by the conquistadores, Díaz gifted the entire Piaxtla river valley to a wealthy man named Manjarrez. Manjarrez arrived in the valley and told the Indians they had to either move away or work as servants.

But the Indians, having already been tricked into buying their own land from the Spaniards, refused to yield. Manjarrez brought a squadron of soldiers to enforce his claims. But he was in for a big surprise. Indian chief Feliciano Roque blew on his conch and his warriors poured down from the hills. In a fierce battle the government troops were wiped out. According to the legend—which the elders still proudly tell to wide-eyed children in evening circles while shelling maize—“The soldiers’ blood ran down the dry arroyo into the river!”

Infuriated, Manjarrez asked Porfirio Díaz for more troops. Díaz refused. And for a while the Piaxtla valley became, in effect, a tiny independent nation governed (quite wisely, it is said) by Chief Roque. But Manjarrez was persistent. Using the tactic of ‘divide and conquer’, he bribed an Indian to assassinate Roque. This led to internal fighting and tribal disintegration. Manjarrez moved in with a few soldiers and soon subjugated the Indians. Some moved back into the hills. Others stayed to work as serfs and share croppers. Either way meant less food. Often a family’s supply of maize and beans ran out.

There were seasons of hunger, usually during the rains before the next harvest was in. Most adults could survive these hard times. Many children could not. These were the conditions, repeated throughout the nation, that led to the Mexican Revolution of 1910.

The new revolutionary Constitution with its Agrarian Reform policies, brought the promise of change. In the Piaxtla valley community of Ajoya, poor families joined together to form an ejido (communal land holding). They elected an ejidal president and requested the Office of Agrarian Reform in the state capital to come over see the redistribution of land.

But violence interceded. The day before the land engineers arrived, the newly-elect ejidal president was shot dead. The next day the ‘group of six’ large land holders paid off the land engineers, who left the large land holdings untouched. . . As the years passed the local latifundistas, backed by corrupt government officials and hired killers, managed to see that their unconstitutionally large plantations remained intact.

Over the following decades, from time to time the poor farmers of Ajoya tried to reassert their constitutional land rights. In 1965—shortly after Project Piaxtla began—a group of campesinos ‘invaded’ one of the large plantations. Posting armed guards day and night, they planted and harvested their crops. Then one day in the municipal seat of San Ignacio, in broad daylight, their leaders were gunned down with machine guns (available only through the Army). A pack of angry campesinos marched into San Ignacio in protest. But no investigation followed. The farmworkers’ effort to claim their ejidal land rights collapsed for several more years, until it was revived in the early 70s through efforts of the village health team.

Struggle for land as a strategy for health

When the Piaxtla health team began to involve campesinos in efforts to achieve greater equality, they started with smaller, politically less confrontational issues such as water systems and maize banks. Only after several years did they take on bigger, potentially more dangerous issues such as their constitutional land rights. In this way the organized campesinos managed to build their numbers and confidence until the rich minority knew they could no longer get away with intimidation through strategic threats and killings.

The last of these attempted killings was thwarted by decisive action. A rich cattle-man named Victor was angered by the hillside farmers’ fencing cooperative. So he offered a poor man from a neighboring village a bundle of money to kill three leaders of the farmworkers organization (two of those, Roberto and Florentino, were also key health workers). But the plot backfired. Enough unity had been achieved within the organization that the poor man who had been offered the money told his fellow farmworkers of the plot. So one morning a group of farmworkers waited in the bushes across the river until Victor rode out on horseback to check his cattle. As he rode by, the campesinos stepped from the bushes and grabbed the reins of his horse.

A rich cattle-man named Victor was angered by the hillside farmers' fencing cooperative. So he offered a poor man from a neighboring village a bundle of money to kill three leaders of the farmworkers organization

“Good morning, Victor,” they said. “We understand you put up some money to have our leaders killed. We want you to understand just two things. First, we have no leaders. We are all leaders. Second, if anything happens to any of us, not even your dogs will be left alive. Goodbye, have a nice day.”

After this confrontation, Victor—realizing that the campesinos were united and meant business—hurried to the other land barons and said, “For God’s sake, don’t touch any of them!” From that day on the wanton assassination of campesino leaders came to end. . . At times, perhaps, a strategic threat of violence is a means to achieve non-violence.

At last the organized farmworkers felt they had enough strength, numbers, and unity to tackle one of the biggest, highest risk issues contributing to hunger and poor health: the question of land. They began systematically to reclaim large holdings, divide them up, and then demand legal titles. At first, of course, they met strong resistance. The agrarian reform authorities at the state level, long accustomed to generous bribes from the land barons, either turned a deaf ear or made promises followed by endless delays. Not until a group of campesino health workers traveled to Mexico City and hounded the federal offices of the Reforma Agraria, were orders passed down, and state officials reluctantly issued ejidal land titles to the group of small farmers.

Animated by the farmworkers organization, a widening circle of landless campesinos in the Sierra Madre proceeded to invade large holdings and demand their constitutional rights. Over a period of 15 years, they succeeded in redistributing and gaining legal title to over 50% of the good alluvial (riverside) land in the river valley. In order to harvest two crops each year instead of just one, they were determined to irrigate. The health team got seed money from the Dutch Embassy for water pumps. To keep the irrigated soil fertile and productive, the farmers rotated crops and interplanted beans with their maize.

Results of this grassroots land redistribution—together with the cooperative maize bank, fencing program and other actions for greater equity—were impressive. Both the food supply and economic base of poor families were substantially improved. This contributed to a visible improvement in health. Serious malnutrition in infants became uncommon. The scrawny, pot bellied, sad-eyed children (a common sight a few years before) now were seldom seen. Gone were the sad processions to the burial grounds with shriveled bodies of youngsters who had succumbed to diarrhea during the hungry season of the rains. People’s social and psychological health also improved. Parents began to look toward the future rather than just for the next meal. And now that more families could afford notebooks and pencils, more children stayed in school.

All in all, people had a sense of greater control over their lives, of growing strength through working together. Since the early years of the health program, there had been a visible shift in power. In the first years, village council meetings—though democratic in theory—had been strongly controlled by a few forceful land barons and cattle owners. But as the poor gained strength and unity through a variety of health-related efforts, the few wealthy men who previously dominated decisions were so disempowered that they seldom attended ejido meetings. Outnumbered, they could no longer swing votes by threatening to evict sharecroppers or refuse them loans. . .In this way, the local struggle for health, which had turned into a struggle for land and liberty, also led to a more democratic and equitable community with greater accountability of leaders.

But the process remained incomplete. The local campesinos realized that if improvements in health were to be sustained, more good riverside land needed to be reclaimed and redistributed: not only in the Piaxtla valley but throughout the country.

Of course, this struggle for land, liberty and health in the Sierra Madre was not an isolated event. In many parts of Mexico, grassroots groups were beginning to organize and demand their rights. As these groups gained in numbers and strength, high level attempts to silence them became more frequent and repressive. On occasion, Piaxtla health workers were jailed. And in a program which the Piaxtla team had helped to start in a neighboring state (Durango) two health workers were killed by the state police. Grassroots groups felt the need to unite in mutual self defense.

The Piaxtla health team and the farmworkers organization knew that as long as a corrupt, unaccountable government ruled the country, their gains at the local level were tenuous. The health team began to organize ’educational interchanges’ with other grassroots programs, and eventually helped to initiate a national and then regional network of community-based health programs. These grassroots networks share the commitment that the struggle for health is a struggle for liberation from unjust social forces.

A New Setback to Health: NAFTA

In the 1990s a new and bigger obstacle now threatens to reverse the gains in land and health achieved over the years by the Piaxtla program. This stems not so much from local or state levels as from the national, international, and global forces. It is rooted in the neocolonial ‘New World Order’ with its pervasive push for a so-called free market system that favors large national and multinational corporate interests at the expense of poor people and the environment. As a result of this unjust system, the gap has been widening between rich and poor, both between countries and within them.

In Mexico this free market agenda has been spearheaded by the North American Free Trade Agreement (NAFTA), an agreement between the United States, Canada, and Mexico.

In preparation for NAFTA, the United States pressured the Mexican government to eliminate the progressive land reform statutes from Mexico’s Constitution. It argued that these statutes —including laws that limit the size of private land-holdings, and the ejido system that safe-guards small farmers rom losing their land through sale or debt—are barriers to free trade (since they prevent US agribusiness from buying up huge tracts of Mexican land to grow winter vegetables for export into the US). Therefore, the White House insisted that the Mexican Constitution be changed. And changed it was. In fact, President Salinas de Gortari was quite willing to disembowel the Mexican Constitution of its progressive land policies. The ruling party (PRI) is controlled by a powerful club of bureaucrats, businessmen and big land owners who for decades have sought ways to sidestep the equity-enforcing statutes of the Mexican Constitution. The US pressure for ‘free trade’ provided a good excuse to dismantle the revolutionary statutes that protected the needy from the greedy. So, even before NAFTA was passed, President Salinas and his Congress gutted the Mexican Constitution of its progressive land statutes. The ejido system was dismantled and the laws limiting the size of land holdings were repealed. . . . In effect, these regressive changes in the Constitution turned Mexico to the pre-revolutionary feudal system with its latifundia or giant plantations. As one old campesino said, “We’ve lost everything our grandfathers fought and died for!”

To convince poor farmers to accept the gutting of their Constitution, which is predicted to cause millions of small farmers to lose their land, the Mexican government has launched a massive disinformation campaign. It tells farmers that, with the end of the ejido system, at last they become full owners of their own land, to do with it as they choose.

This official disinformation—broadcast day and night on radio and TV—has caused a split within poor farmworkers’ organizations throughout Mexico. Even within the Piaxtla program a division arose. Some farmers swallowed the government line and said, “For the first time the land is completely our own!” But those who were more astute under stood that, with the loss of the ejido system, small land owners would soon begin to lose their land, either selling it in hard times or forfeiting it for debt.

Either way, one thing was clear: These constitutional changes put a stop to legal invasion and redistribution of large land holdings. Under the old Constitution, the campesinos had proudly invaded the large holdings as citizens defending their legal rights. Now, under the modified Constitution, if they invaded large holdings they would be common criminals, and treated as such. In 1993, even before the changes in the Mexican Constitution became law, some of the rich men whose vast acreage had been invaded and redistributed, were already giving bribes to local authorities in anticipation of repossessing their former plantations.

Free Trade in Poverty, Racial Violence, and Repression

Officially, the changes in the Mexican Constitution in preparation for NAFTA have been promoted as a decisive step toward national economic growth and prosperity. But many social analysts predict that these measures will have devastating human and environmental costs. The predictions are ominous. The rapid return of the plantation system will concentrate farmland into fewer hands. This will trigger a mass exodus of landless peasants to the mushrooming city slums and swell the ranks of unemployed persons competing for jobs. With such a huge surplus of hungry people ready to work under any conditions, wage levels will drop and the bargaining power of organized labor (which has already been largely coopted by the government) will be further weakened. The combination of falling wages and rising unemployment will inevitably take a high tollon people’s health, especially the health of children.

In the United States, NAFTA is almost certain to bring an upsurge of racism and human rights violations. As landlessness, poverty, and unemployment in Mexico increase, more ‘braceros’ will illegally cross the US border in search of work. Meanwhile in the United States, unemployment will rise and wages fall as more US industries move factories south of the border to take advantage of low Mexican wages and weak enforcement of workers’ rights and safety. Unless US workers become well informed of the root causes of this crisis, they are likely to blame the influx of Latinos for their rising unemployment and falling wages. Job competition is apt to spark racial violence and, in turn, harsher police measures to curb the flood of ‘illegal aliens’. Already there is talk of sending the US army to back up the Border Patrol. Thus so-called ‘free trade’ will lead to more restrictive, repressive control of workers and more violations of their rights, both north and south of the border.

NAFTA and the Increased Spread of AIDS

NAFTA will almost certainly contribute to an explosive increase of AIDS in Mexico. Social analysts are beginning to recognize that the rapid, uncontrolled spread of AIDS in certain countries is linked to unjust social structures and policies that deepen poverty. In Mexico—and in many countries subjected to ‘structural adjustment’ and neo-liberal market policies—as the rich grow richer, the poor grow poorer. In spite of Mexico’s reputed economic growth in recent years, since the early 80s the purchasing power of people’s daily wages has dropped by 40%. Today the official minimum wage buys only 25% of the basic food needs for a family of five. Meanwhile, the country’s elite live like royalty.

The exploitation and hardships intrinsic to such inequities accelerate the spread of AIDS. Mexico now has the second highest incidence of AIDS in continental Latin America (following Brazil, where the gap between rich and poor is even greater). With the recent demise of its agrarian reform policies, followed by NAFTA, Mexico may soon have the highest incidence of AIDS. From remote villages to expanding city slums, growing numbers of landless and jobless men will seek illegal temporary employment in the United States. Having left their wives back home, they will find sexual outlet in what ways they can, including with prostitutes and through casual homosexual encounters. Many of these migrant workers will contract sexually transmitted diseases and HIV (AIDS) infections. On return to Mexico, they will carry the infections back to their girlfriends and wives.

In this way, AIDS is likely to reach pandemic proportions in Mexico, just as it has in those parts of Africa where extreme neocolonial inequities cause massive seasonal migration of peasants into mines and labor camps of the cities.

What can be done to prevent such an AIDS pandemic? Clearly, where the rapid spread of AIDS is linked to un just sociopolitical and economic systems, it will take more than technological fixes and health education of ‘high risk groups’ to contain contagion. Condoms may help, but are not enough. Fairer socioeconomic structures are also needed.

For the poor of Mexico, however, concern about combatting AIDS is eclipsed by the more immediate need to combat landlessness, joblessness, and hunger.

In this context, the ratification of NAFTA was a devastating blow to Project Piaxtla and the farmworkers organization. With NAFTA came imminent danger of losing the land and the health gains for which they had struggled during the last 20 years. Campesino groups throughout Mexico staged protests against the dissolution of the ejido system and the signing of NAFTA. But as usual, the PRI and President Salinas turned a deaf ear.

The Chiapas Uprising to the Rescue

The recent, brief uprising by the ‘Zapatista National Liberation Army’ (EZLN) in Mexico’s most southern state came like a bolt from the blue. It has had an astounding impact on the politics and power structure of the entire nation (and beyond).

Described as “one of the most unexpected, brilliantly staged peasant uprisings in living memory” (Luis Hernandez, The Nation, March 28, 1994), the mini-revolution has forced Mexico’s ruling party, the PRI, to respond more seriously to popular demand for social justice than have legitimate political procedures in the last 60 years.

It is too early to know the long term results of this mini-war waged by Mexico’s poorest, most exploited indigenous people. But as things look now, the uprising may have done more to defend the rights and health of the Mexican people than any event since the Mexican Revolution 80 years ago. At least for the present, the Chiapas insurrection has helped the Piaxtla health team and farmworkers in far off Sinaloa to retain the gains of their 20 year struggle for land and health.

The peasant uprising in Chiapas was symbolically launched on January 1, 1994, the day the North American Trade Agreement (NAFTA) went into effect. The insurrection lasted only four days, until the Mexican Army drove the rebels back into the mountains. But brief as it was, the EZLN used the occasion to draw national and international attention to their well justified demands.

At the start of the uprising, the Mexican Army responded with brutal collective punishment: attacking, bombing, and destroying entire Indian villages. But throughout the nation, the majority of citizens (70% of the population according to polls) and much of the national press ardently sided with the rebels. The EZLN’s clear demands for land rights and social justice, voiced eloquently by the mysterious sub-comandante Marcos, struck a sympathetic cord with millions of campesinos. Fearing a possible national revolt (or possible overturn of the PRI in forthcoming national elections) the Mexica government was forced to call off the army. . . and eventually to capitulate to many of the Zapatista demands.

The Zapatistas’ demands are based on fairness and equity. They call for both restoration and honest implementation of the agrarian reform program, which due to corruption had never effectively reached the indigenous peoples of Chiapas. They call for reinstatement of the ejido system to protect the land rights of small farmers. They call for fair, genuinely democratic elections. (Initially they called for President Salinas to step down, pointing out that he had gained his post through electoral fraud. Eventually, the EZLN withdrew this demand as Salinas conceded to others.) They call for an end of discrimination against the indigenous people and the poor. They call for a minimum wage high enough for poor people to adequately feed their children. Above all, they call for the government to up hold the statutes of the Mexican Constitution, especially those that protect the rights of the common citizen. And they demand an end to institutionalized corruption and graft.

The EZLN made it clear they did not want to take over and run the government. They simply want it cleaned up, to make it more representative of and accountable to the people.

At the bargaining table, President Salinas offered to pardon the Zapatistas if they gave up their weapons and called off the insurrection. However, sub-comandante Marcos—his face, as ever, masked in a ski cap—publicly replied:

Why do we have to be pardoned? What are we going to be pardoned for? For not dying of hunger? For not being silent in our misery? For not humbly accepting our historic role of being the despised and outcast? . . . For carrying guns into battle rather than bows and arrows? For being Mexicans? For being primarily indigenous peoples? For having called on the people of Mexico to struggle, in all possible ways, for that which belongs to them? For having fought for liberty, democracy, and justice? . . . For not giving up? For not selling out? . . .
Who must ask for pardon and who must grant it?
Those who for years and years have satisfied them-selves at full tables, while death sat beside us so regularly that we finally stopped being afraid of it?
Or should we ask pardon from the dead, our dead, those who died ’natural’ deaths from ’natural’ causes like measles, whooping cough, dengue, cholera, typhoid, tetanus, pneumonia, malaria and other lovely gastrointestinal and lung diseases? Our dead—the majority dead, the democratically dead—dying from sorrow because nobody did anything, because the dead, our dead, went just like that, without anyone even counting them, without anyone saying “ENOUGH ALREADY,” which would at least have given some meaning to their deaths, a meaning that no one ever sought for them, the forever dead,who are now dying again, but this time in order to live?

Among the various concessions that Salinas made to the EZLN, two at least (if the government keeps its word) may be a breakthrough in terms of the people’s and the nation’s health:

  1. First, Salinas agreed to a fairer, more open election process with greater accountability to the public. (The forthcoming national elections will show how true this promise is. However, the March, 1994, murder of Salinas’ candidate for his successor, apparently the result of in-fighting within the PRI itself, shows that making the ruling party more accountable will not be easy. But at least the PRI will be under more critically alert public scrutiny.)

  2. Second, Salinas agreed to partly reinstate the land reform and ejido system which he had dismantled in preparation for NAFTA. He has, in fact, signed a presidential decree whereby the members of previously existing ejidos (communal land holdings) can decide by vote to keep or dissolve their ejidal structure. The government, of course, continues its propaganda to induce campesinos to dissolve their ejidos. Government operators from PROCEDE, the federal agency for the privatization of lands, visit villages and tell people that if they don’t dissolve their ejidos and privatize (privately register) their ejidal land now, they will soon be required to do so at high cost. They also promise them that as soon as they register their private holdings, they are entitled to big loans. (They of course do not mention that this is the first step toward losing their land for unpaid debt.) But throughout Mexico, many small farmers— inspired by the clear thinking and just demands of the EZLN in Chiapas—are determined to keep their ejidos.

Among these, in the Piaxtla valley of Sinaloa, the community of Ajoya—base of Project Piaxtla and the related farmworkers’ organization—has voted strongly to preserve its ejido. Roberto, health activist and leader of the farmworkers’ organization, is delighted. He and others had feared that the villagers’ 20 year struggle for land and health had been irrevocably lost. Then, thanks to a mini-uprising in southern Mexico, their hope has risen again from its ashes.

Roberto is the first to acknowledge that the ‘barefoot revolutionaries’ in Chiapas—better organized, more daring, and perhaps with less to lose—have given a new lease on life, and possibilities for a healthier future, to the children of Sinaloa’s Sierra Madre.

Village Health Now Inseparable from Global Health

Roberto and his fellow campesinos are relieved that in their corner of Mexico the people’s land rights have, at least for the present, been preserved. They know that their RIGHT TO LAND is crucial to FREEDOM FROM HUNGER which is KEY TO HEALTH. Yet Roberto and the Piaxtla health team also realize that, at best, their gains are partial and tenuous.

The plight of poor farming and working people in Mexico is not an isolated event. Similar hardships are being wrought on disadvantaged peoples in every corner of today’s endangered planet. The global power structure—comprised of big government, big business, and the international financial institutions—have imposed their New World Order worldwide. They have tied most areas of production and ‘development’ to the global market in a way that benefits powerful interests and weakens the bargaining power of the poor. Today no village—and, indeed, virtually no nation—has the liberty of self-determination.

Like many community workers, Roberto has learned that the biggest threats to health are now on a global scale. The small farmers of Mexico’s Sierra Madre may, for the moment, have partially recovered their land rights. But the inequities of the world economic order persist. NAFTA remains in place, legally binding Mexico to the greed driven, supply-side market system of the United States. And as ever, the poor are the losers. Already, many small farmers in Mexico are being forced off their land. With the tariffs lifted by NAFTA, the United States is now exporting tons of urplus maize into Mexico. Subsidized by the US government, its price is half that of Mexican maize. Unable to compete, countless campesinos are giving up farming and moving in desperation to the growing slums of the cities—where in spite of the market forces of ‘free trade’, the price of food staples rises faster than wages.

Many health workers, including Roberto, are already suffering from NAFTA. During 20 years and at considerable sacrifice, Roberto had gradually built up a small herd of eight cattle. The cattle were an investment with which he planned to send his oldest son to college and then medical school (in the hopes his son would be come one of those rare doctors who return to serve the villagers). But now with NAFTA, the US beef industry is shipping hybrid cattle into Mexico at wholesale prices, thus undercutting the value of local cattle. Almost overnight the sale price of Roberto’s cattle has dropped to half what it was. So NAFTA has slashed Roberto’s life savings and his son’s dream of medical school.

Yet things could be worse. Whatever his losses, Roberto knows he is relatively lucky. His family still has a plot of land to plant. His children for the time being do not hunger. He knows that millions of families in Mexico and throughout the world are much worse off.

The global trend is far from healthy. With NAFTA and other free market strategies designed to favor the privileged, the plight of the poor is worsening, in both poor countries and rich. Today the wealthiest 20% of the world’s people earn 140 times as much as the poorest 20%. One of every four human beings—a billion and a half children, women and men—do not get enough to eat, do not receive adequate health care, and lack safe drinking water and decent shelter. Yet the world’s power brokers still promote policies designed to further enrich themselves. With their powerful lobby, they push through regressive laws that increasingly free the affluent from social and economic obligations to those who are struggling to survive.

Internationally there has been much high-level discussion about Universal Human Rights: the Rights of Children, the Rights of Women, the Rights of Indigenous Peoples, etc. But the New World Order—spearheaded by the international financial institutions (the World Bank and IMF)—has denied humanity the most fundamental rights of all: the RIGHT TO EAT and ultimately, the RIGHT TO LIVE.

Many traditional societies revered these basic rights. Human life—and indeed all life—had intrinsic value and was sacred. If our neighbors were hungry, we shared what little we had. That was part of what was called community, and was encouraged by every great religion. But under the current global economic order, the value of a human being has become a dollar value. A person who does not “earn his daily bread” according to the heartless rules of the marketplace is left to wither and die. Or he is forced to steal, beg, or traffic drugs. Or sell her body to buy crumbs for her hungry children. There is no such thing as a free lunch.

In the face of these new global obstacles, the Piaxtla health team continues its uphill struggle. Thanks to the uprising in Chiapas, the small farmers of the Sierra Madre have so far managed to hang onto their land, which they recognize is their key to health. But they know that the battle for land and health must continue, against more powerful odds than before. No longer is their struggle that of an isolated group of campesinos uniting against the exploits of local land barons. It has become part of a much larger struggle against international forces that systematically violate the sovereignty of the nation, the village, and the home.

In sum, the villagers realize that the improvements in health that they have achieved through years of struggle may be lost tomorrow due to greeddriven global policies. They have seen the Constitution that their forefathers fought for violated by foreign powers in conspiracy with their own self-seeking leaders. For them, the ‘free trade’ agreement is not free; it has cost them their land, their health, their most basic human rights, and the dignity of self-determination.

The same is true for poor and disadvantaged people around the world. Times are gone when a remote community, through hard work and organized action, could realize sustainable improvements in health.

When will we learn? When will we, the world’s people say “ENOUGH ALREADY” and unite to return SANITY TO HUMANITY.

Economic Growth: But for Whom?

Mexico, considered a success story of free market economics and structural adjustment policies imposed by the World Bank and IMF, has experienced a true, if modest, “economic growth.” But growth for whom? In Mexico in the last 10 years, the real wages of working people (how much they can buy with what they earn) have dropped by 40%!

Need of a Grassroots United Front for World Health

The sense of disempowerment felt by health workers and farm workers of Mexico in the face of overwhelming national and international forces is an experience shared by grassroots initiatives worldwide. It derives from the new strategy of global governance that denies people the right to defend their rights. Activists, analysts, and alternative thinkers the world over have come to the same disturbing realization (a realization which the mass media—controlled by the same powerful interests—refuse to seriously


The dictators of the New World Order—with their goal to achieve economic growth regardless of human and environmental costs—are steering our planet and its people on a collision course with disaster. Democracy, fair play, and even common sense have been forsaken in pursuit of the Almighty Dollar. As a result, earlier gains in health, equity, and social responsibility have in the last decade been reversed. Rather than advancing toward the World Health Organization’s goal of Health for All by the Year 2000, we are backsliding toward the state of Health for No One.

Today more people are living in extreme poverty, and more children dying from diseases related to undernutrition, than ever before in human history. This is not because of total shortage, but because of unfair distribution. It is because the disadvantaged have no say in that distribution. Because they have been stripped of decision-making power. Because they are cruelly exploited. Because their attempts to defend themselves and demand equality are repressed. Their empty stomachs tell them that the world’s so-called democracies are a sham. Yet they are officially informed that it is all for their own good. That the multinationals and the bankers know best. That today they must tighten their belts (while their masters continue to over-consume) so that in some far-off tomorrow a bit of the surplus will trickle down. Lies upon lies!

Disinformation has become the neoolonial weapon of social control. It has proved more effective than clubs and bullets at keeping populations compliant and the poor in their place.

These observations are echoed from many corners of the Earth. For example, Al Senturias of the Asia-Pacific Task Force on Human Rights argues that as long as the international financial institutions dictate, and self-seeking government officials implement policies that cause massive unemployment, unjust low wages, and loss by peasants of their control over land and resources, there will never be improvements in the rights or health of our peoples. Like the Piaxtla health team and many others, Senturias notes the loss of local self-determination in the face of global forces, and stresses the need for a global struggle for healthier social structures, from the bottom up:

We have seen that as soon as people organize themselves, as soon as they get together, as soon as they demonstrate and march together, they also get the iron hand of the government, again following the dictates of these unjust economic and political structures that are dictated and abetted by the IMF and World Bank. . .
You cannot talk about human rights [or health rights] for all, as long as the neo-colonial hold on the economic and political structures in the Third World remains untouched.
In order to guarantee that human rights are respected, we have to collectively mobilize the strengths of entire peoples, not through a coup d’état or some political party coming to power in one country or other. It means the education and mobilization of the entire population in order to transform society so that the society will truly be in the hands of the people. Only in this way will the people themselves be able to decide their own future and come to enjoy the rights that are due them, to have dignity as human beings.
—from Justice Denied: Human Rights and the International Financial Institutions. Published by Women’s Institute for Human Rights; and International Institute for Human Rights, Environment and Development. 1994

In many parts of the world—especially in the South—activists, members of popular health movements, and grassroots organizers are arriving at a similar conclusion: “We have to collectively mobilize the strengths of entire peoples.” In order to change the course of development so that it corresponds more closely to the needs of all people, more people need to actively participate. This means that the global power structure, which is dangerously undemocratic, must be replaced by a truly participatory democratic process. The United Nations needs to be rebuilt from the bottom up—transformed into the United Peoples—so that it responds more directly to the demands of the whole of humanity, and not just to the elitist cliques that run governments and international institutions.

But the obstacles to creating healthier social structures are enormous. Big government and big business have formed a powerful united front. To replace such a greed-driven force with equity-oriented power by the people will require, in turn, a united front from the bottom up.

With this goal of global change in mind, a wide range of international groups and networks have been forming. Their interests focus on diverse areas, such as human rights, women’s and children’s rights, minority and indigenous rights, disability rights, gay rights, environment, alternative economics, education, communication, and health. However, since all of these areas are interrelated— and since strength comes through unity that respects differences—alliances need to be formed between these various networks and movements.

In the health field, one of these new, progressive networks is the International People’s Health Council. The idea for the IPHC grew out of a meeting on “Health Care in Societies in Transition” in Managua, Nicaragua in December, 1991. Two of the network’s founders are health workers who have been involved with Project Piaxtla in Mexico for more than 25 years. Others include health rights activists and leaders of progressive community health programs from Africa, South East Asia, the Far East, and Latin America. The IPHC has close links with the Third World Network and the People’s Health Network, based in Penang.

The above article is a modified version of a chapter to appear in a forthcoming book entitled Society and Health Case Book, edited by Benjamin Amick III and Rima Rudd of the Harvard School of Public Health.

The International People’s Health Council

What is it? The International People’s Health Council is a worldwide coalition of people’s health initiatives and socially progressive groups and movements committed to working for the health and rights of disadvantaged people . . . and ultimately of all people. The vision of the IPHC is to advance toward health for all people—viewing health in the broad sense of physical, mental, social, economic, and environmental well being. We believe that:

  • “Health for All” can only be achieved through PARTICIPATORY DEMOCRACY (decision-making power by the people), EQUITY (equal rights and meeting everyone’s basic needs), and ACCOUNTABILITY of government and leaders, with strong participation of people in the decisions that affect their lives.

  • The policies of today’s dominant power structures—tied as they are to powerful economic interests— have done much to precipitate and worsen humanity’s present social, economic, environmental, and health crises. Those who prosper from unfair social structures are resistant to change. They also have vast power and global reach. Today, changes leading toward a healthier world order must be spearheaded through a worldwide grassroots movement that is strong and coordinated well enough to force the dominant power structures to listen, and finally to yield.

The IPHC intends to facilitate sharing of information, experiences, methods, and resources among a wide range of persons and coalitions involved in community healthwork oriented toward empowerment and

self-determination. Its goal is to contribute toward a broad base of collective grassroots power which can have leverage in changing unfair and unhealthy social structures at local, national, and international levels.

Who can participate? The IPHC has no formal membership. It is an informal coalition of persons and groups who identify with its objective and wish to participate. Although most of the founding members of the IPHC are from the ‘South,’ we feel the IPHC should be a South-North network, including grassroots struggles for health and rights among the growing numbers of poor and disadvantaged people in the overdeveloped countries as well.

If you want to learn more about the IPHC, its plan of action, future meetings, publications, or the addresses of the regional coordinators—or if you want to join the network or help out either on projects or with donations, please contact:

David Werner, Northern Coordinator, IPHC


c/o Jason Weston

3897 Hendricks Road

Lakeport CA 95453 USA

Growth At All Costs: How Current Global ‘Free Market’ Policies Speed the Increase of the World’s Population

—David Werner

“Take care of the people’s problems, and the ‘population problem’ will take care of itself.”
—a popular slogan from the ’70s

The United Nations has declared 1994 the Year of Population. The International Conference on Population and Development (ICPD) is planned for September 5-13, in Cairo, Egypt. Its preparations have fueled the fire of a long standing, politically charged debate:

The International Financial Institutions, most Northern governments, and much of the global power structure clearly intend to use the Global Conference as a forum to promote population control (which today they call “family planning”). They argue that the planet has reached—and in some areas exceeded—its “carrying capacity.” In other words, one of the primary reasons for today’s rapidly worsening crises in health, development, and environment is that there are too many people: because so many people have so many children. Therefore a prime strategy to overcome global hunger and achieve sustainable economic growth (which has become synonymous with “development”) must be to limit population growth. For their own good, parents who have the least means to support large families must be educated, empowered, or otherwise induced to “accept” family planning—i.e. fertility control. . . When stripped of all its sugar-coated rhetoric, the primary target of these high-powered policy makers is poor women in poor countries in the South.

Many non-government organizations (NGO’s) and popular movements— especially women’s groups—protest. Rather than focus on population or birth control, they see the basic issue as one of reproductive rights—especially for women. They consider that linking questions of population to development is a strategy of “blaming the victim.” It tends to place blame for growing poverty, hunger, and environmental demise on the poor and hungry rather than on those who consume far more than their share. And indeed, the average person in the USA and Europe consumes about 50 times as much of the world’s energy and other resources, and creates 50 times as much garbage and toxic waste, as does a poor person in the South.

According to the Reproductive Rights advocates, not the growing world population but rather today’s unfair global economic policies are the primary cause of the spiraling human and environmental crises on our planet. All women should have control over their own fertility. Well-informed choice of methods should be available to everyone. But fertility control should be the free decision of each couple or individual, never an obligation.1 They point out that pushing family planning as a development strategy—or making it a required central theme of health programs as a precondition to funding—has led to enormous abuse. Too often women (and sometimes men) have been subjected to “social marketing” and various pressure tactics to get them to accept or comply. Or they have been coerced to barter their reproductive functions for a pittance to feed their hungry children. In many countries, incentives and quota requirements for health workers have led to deception and even forced sterilizations.

In short, tremendous violations of human rights have been—and in many countries still are—committed in the name of population policy. Human rights activists cry out that these practices must not be further institutionalized. Increasingly, however, development aid is tied to strong “family planning” (read “population control”) components in program design.

Those who criticize top-down population policies argue that the best approach to combat poverty, world hunger, and ecological degradation is not through heavy-handed population policy but through more equitable socio-economic policies and fairer distribution of wealth and resources. They see the current strong focus on population as an attempt by those in positions of wealth and power to forestall global disaster without changing the status quo of an unjust social order.

Socioeconomic Factors, Not ‘Family Planning,’ as the Chief Determinant of Birth Rates

In the current debate over population policy, what both protagonists and critics have failed to emphasize strongly enough (although both refer to it in passing) is the strong link between fertility rates and socioeconomic security. There is a wealth of evidence which demonstrates that birth rates are much more substantially and sustainably reduced by increasing social equity than by pushing family planning.

Both current events and history bear this out. There is a wide range of examples that show how population growth rates decline as societies succeed in providing guarantees for meeting the basic needs of their whole populations. Socially disadvantaged parents tend to have many children as a way to provide the securities that society fails to provide. Many families, both rural and urban, who live marginally by day to day subsistence, depend on their children, who from an early age, contribute to family income. Children provide a source of support and care in times of parental unemployment, sickness, and old age.

In short, for a family that is despeately poor, to have many children is an economic necessity. The worse the family’s socioeconomic situation, the more children are needed. And where child mortality is high, a make-shift insurance plan (for those who have no other) is to have lots of children.

Alternatively, when societies begin to assure that the basic needs of the whole population are met, low income families can afford to have fewer children. Hence population growth rates begin to decline. This decline is obvious when we compare the population growth rates of Northern industrialized countries to many of the poor countries in the South. Those European countries that have adequate minimum wages, universal health care, and equitable social security for all have almost zero population growth (and many would have declining populations, except for the influx of immigrants and refugees).

There is a wide range of examples that show how population growth rates decline as societies succeed in providing guarantees for meeting the basic needs of their whole populations.

By contrast, the United States, for all its enormous wealth, also has colossal inequities: one of every four children lives in poverty, 22 million persons daily go hungry, and nearly 40 million have no health coverage. Not surprisingly, the USA is experiencing a higher birth rate than more equitable European countries, although the rate is lower than in many poor countries which it economically exploits.

Several years ago the Rockefeller Foundation sponsored a study called Good Health at Low Cost.2 In this study social scientists investigated whether reports were true that certain poor countries (Costa Rica, Kerala State of India, Sri Lanka, and China) had achieved relatively high levels of health. The study confirmed that, indeed, each of these countries, despite quite low per capita income, hadachieved child survival and life expectancy statistics close to those of much richer “developed” countries. The reason, they found, was that these countries had followed a path of development based on equity rather than on lop-sided economic growth. Political commitment to equity included

  1. basic heath services for all, including rural areas,
  1. universal primary education, and

  2. assurance that all people have enough to eat.

It is of interest to note that several more recent studies, which look at population trends in different countries, point out that these same four countries—and certain other poor countries which have similarly low ‘income inequality’—have dramatically China, of reduced birth rates.[^3] course, in addition to residual policies of socioeconomic equity, has forcefully pushed its “One child, one family” population policy (with frightening results in terms of human rights violations, including widespread killing of baby girls by parents who want a boy). However, Kerala, Sri Lanka, and Costa Rica all have lower fertility rates than neighboring states, in spite of less aggressive family planning campaigns. In contrast, countries like Mexico and South Africa, with relatively high per capita incomes but great ‘income inequality’ have higher birth rates.[^4]

Cuba, both historically and when compared to neighboring countries, also validates the above observations. During the Batista dictatorship, where the gap between rich and poor was enormous and people had few social guarantees, Cuba had one of the highest fertility rates in Latin America. After the overthrow of Batista, the revolutionary government introduced one of the world’s most equitable systems, in terms of basic physical needs (if not always political rights). These in cluded: universal high quality health care and education, universal employment opportunity; adequate housing and sanitation for all; full care for the elderly, equal rights and opportunities for women, etc. Although Cuba made a variety of contraceptive methods available, for many years it had no policy to promote family planning. Yet during the first decade of the Revolution, the birth rate plummeted dramatically—far more than in those Latin American countries with strong family planning campaigns but few social guarantees for their impoverished masses.3

John Ratcliffe, a population scientist formerly with the Berkeley School of Public Health, has done some interesting macro studies of population trends, comparing fluctuations in growth rates of different countries at different times and under varying socioeconomic and political systems. His studies confirm that fertility rates are determined much more by societal factors (relative equity and social guarantees) than by the resence or relative aggressiveness of family planning initiatives.

Those who are genuinely concerned about population growth (as distinct from those who harp on ‘population’ to divert attention from social injustice as the root cause of our global crises) need to take the above facts very seriously. What the hard facts imply is that:

Population growth cannot be substantially reduced through family planning programs alone. The only way to bring about substantial and sustainable reduction of fertility rates is through far-reaching social change. Such change entails more equitable systems, with policies to guarantee that the basic needs of all persons are met. Only under conditions of social justice can most people afford—and experience substantial advantages to having—few children.

Unfortunately, many of the world’s high level planners have little commitment to a sustainable development model based on fair sharing. They are blindly committed to the dominant development model with its so-called “free market” policies that place higher priority on economic growth of the few than on the well being of the many. They are unwilling to see how the globalization of the market economy—with its massive debt burdens, impoverishing structural adjustment policies, increasing net flow of wealth from poor persons and countries to rich, and authoritarian puppet governments armed by the global powers to keep such inequities in place—is the root cause of today’s global crises. Nor do they admit that these same injustices give rise to the apparent shortages and very real strain on resources for which they blame ‘overpopulation.’

Tragically, today’s global decision makers are too attached to their disproportionate wealth and privilege to see how the avid pursuit of economic growth contributes to the rapid population growth which they fear and wish to control.

It is therefore the job for those of us who are concerned about our children’s and the planet’s present wellbeing, to organize in struggle for a more healthy and sustainable world order. We must mobilize action from the bottom up, both locally and globally, so that all people’s basic needs and basic rights—including their reproductive rights—are met.

In preparation for the forthcoming global conference in September, we must help decision makers realize that if they want to reduce the population growth rate they must first look to social justice . . . and above all else, make sure all children get enough to eat.

Healthier people make (and demand) healthier decisions.

Update on PROJIMO

PROJIMO—or Program of Rehabilitation Organized by Disabled Youth of Western Mexico, now with 14 years of experience—has entered into the multiplying phase. It now puts more time and energy into sharing and disseminating its methods, skills, and philosophy of empowerment with other groups of disabled persons in other parts of Mexico, Latin America, and beyond.

One of the most exciting new ventures of PROJIMO has been a series of short courses and workshops for participants from other parts of Mexico, Central America, and Cuba. Preference has been given to disabled persons, especially disabled leaders from community programs who plan to return home, share their experiences, and teach others what they have learned. Courses and workshops—which average 10 days to 2 weeks long—have focused on the following areas:

  • wheelchair design and construction

  • artificial limb making

  • orthopedic appliances: evaluation of needs, construction, & evaluation

  • special seating for disabled children

  • arch supports

  • physiotherapy

  • massage therapy

  • clinical evaluation and special medical

    needs of disabled persons

  • rehabilitation and peer counselling of

    spinal cord injured persons

  • assessment and handling of children

    with cerebral palsy and spina bifida

  • organization and leadership role of

    parents of disabled children

  • Toy making, carpentry, and income-

    generating activities

  • human rights of disabled persons

  • sexuality and disabled persons

  • independent living

  • integration of disabled kids in schools

These courses are taught by members of the PROJIMO team together with visiting outside specialists, some of them disabled, and many of them outstanding leaders, innovators, or designers in their fields. The response to these ‘mini-courses’ has been enthusiastic, and after they return home, many participants report that they are putting into practice what they learned.

Future courses are planned for this Fall. A new course—or ‘interchange of ideas and experiences’ has been proposed, to explore the organization, management, financing, and dynamics of small grassroots groups. We hope that Kelly Reineke—who is preparing a practical work-book on this topic—will come to help facilitate this interchange.

Innovative Participatory Technology: Experience and a Forthcoming Book

At the end of 1993 PROJIMO completed a 3 year grant, sponsored by the Thrasher Research Fund, on “Innovative Methods and Technologies for Community Based Rehabilitation of Disabled Children and Young People.” 34 of the most useful and important low cost technologies have been described in a final valuative report (available for $5.00 upon request from HeathWrights).

One of the most exciting innovations is a simple home-made device for measuring the pressure against the skin of spinal cord injured persons. Made at very little cost from small balloons and IV tubing filled with colored water, this simple instrument holds the promise of helping save many thousands of lives from pressure sores, the primary cause of death of spinal cord injured persons in the Third World.

David Werner is at present working on a short supplement to Disabled Village Children which will include the most important of the innovative technologies. Unlike other books on “appropriate technology,” however, here the focus will be on the innovative process, not just the product. Indeed, the purpose of the book will be to stress the idea of adapting the technology to the person rather than the person to the technology. Results tend to be much better when the disabled person takes part as an equal partner with the rehab technician in the problem-solving process.

We hope that this new booklet will be in print by early 1995. In the meantime, we plan to include write-ups and designs for some of the most useful innovations in forthcoming issues of Newsletter from the Sierra Madre.

Child-to-Child as a Transforming Educational Process

One of the real ‘breakthroughs’ in a more liberating approach to health education this year has been in the field of Child-to-Child. Child-to-Child, at its best, is an approach to help school-age children learn to take practical action to meet the health needs of their younger brothers and sisters (and other children in their communities). When introduced into schools, Child-to-Child can help make schooling more relevant to the immediate needs of the children and their families. Also, the discovery-based ’learning-by-doing’ methodology of Child-to-Child can contribute to the desperately needed transformation of the educational process from authoritarian rote learning to a more participatory, problem-solving approach. Thus it can help prepare children to become active agents of change rather than passive recipients of the charities and cruelties of an unjust system.

Unfortunately, this more liberating approach to Child-to-Child has not been put into practice universally. Many of the programs as practiced in different countries have used more standard, ‘do as you’re told’ methodologies typical of the authoritarian classroom.

In Latin America, however, the approach to Child-to-Child has been much more inspiring. Much of the initial impetus for Child-to-Child has come from Project Piaxtla in Mexico. In the early 1970’s, the Piaxtla team of village health workers helped to develop and conduct early trials of many of the original Child-to-Child activities. Since then, through a series of ’educational interchanges’ with community programs in Central America, Piaxtla workers helped to disseminate the more liberating, learning centered approach to Child-to-Child. Members of the Piaxtla team introduced the methodology in Nicaragua in the early ‘80’s, and recently Martin Reyes and David Werner helped to lead a nation-wide Child-to-Child ’trainer of trainers’ workshop in Managua, coordinated by CISAS, a politically progressive health education association closely linked with the IPHC and HealthWrights.

A Village Health Worker Gains International Position in Child-to-Child

Twenty five year ago, Martin Reyes, when he was 14 years old, began working with Project Piaxtla. In time he became a leader, first of that program, and later of PROJIMO (Program of Rehabilitation Organized by Disabled Youth of Western Mexico).

Over the years Martin has remained creatively active in Child-to-Child. In 1993 he won an ASHOKA fellowship to further extend the ‘discover-based’ approach to Child-to-Child throughout Mexico and Central America. In January, 1994—under the sponsorship of CISAS, the Regional Committee of Community Health Programs of Central America, and the international Child-to-Child headquarters in London—Martin was appointed Latin America coordinator of Child-to-Child, with sufficient funding to help him introduce the progressive approach to Child-to-Child throughout Latin America.

Martin was appointed Latin America coordinator of Child-to-Child

So far, Martin has conducted workshops in Mexico, Honduras, El Salvador, Nicaragua, Ecuador, and Bolivia. In all of these workshops, the ’trainers of trainers’ learn the methodology by actually working with groups of children (not just school children, but also non-school children and street children, all learning together.) The first activity is always a ‘community diagnosis’ in which the children define and prioritize the health-related problems that most affect their own lives and those of their families. This open-ended, learner-centered approach is a revelation for many of the participants, especially the teachers. The response has been enthusiastic. Many of the new Child-to-Child initiatives are going strong and being extended to neighboring areas.

Martin now has more requests than he can fill. Fortunately,some of his earlier trainees have also become trainers and the multiplying process continues to spread. One such person is Celene Wosnicka, a Maryknowl sister who was involved in the first Child-to-Child workshop in Nicaragua. With Martin, Celene helped launch an extremely successful Child-to-Child initiative in Oaxaca, Mexico, which in turn has served as a training ground for other areas (and countries).

Child-to-Child reaches the Third World within the USA

At last Child-to-Child is now being introduced into the United States, in poor communities where older children often do a lot of the caretaking of the younger children while their parents are at work. The initiators of these US programs are mostly persons who have been involved in Mexican and Central American programs facilitated by Piaxtla workers. In a depressed area of Chicago, Celene Wosnicka (who studied with Martin in Nicaragua and later initiated a very successful Child-to-Child initiative in Oaxaca, Mexico) has begun a program. There she is finding that—much more so even than in Mexico—many of the health needs as defined by the children relate to violence, substance abuse, broken homes, and other social problems.

Another group with experience in the Mexican programs David Werner has worked with is starting a Child-to-Child initiative in East Palo Alto, California (the poor Mexican Black side of the city, where recently the murder rate was with highest in the USA). Persons who have worked with PROJIMO and HealthWrights are advisors to both these US projects.

Internationally, the more liberating approach to Child-to-Child is also making headway. Ann Peterson, a film-maker, has produced a short Child-to-Child video for UNICEF. In the process she became so excited by the revolutionary approach used in Mexico that she has raised money independently to make a longer film. In this film, now nearing completion, children themselves explain the empowering dynamics of Child-to-Child. For years the World Health Organization has known about Child-to-Child but never backed the approach very seriously. Then, during a consultancy with WHO in Geneva, in October 1993, David presented slides on the Mexican version of Child-to-Child. The WHO staff involved in Schoolaged Children’s Health became so excited by the possibilities of using Child-to-Child to help make schooling more relevant to children’s lives and wellbeing, that they voted to give Child-to-Child top priority. WHO has asked David to help write a booklet for Third World school teachers, suggesting ways to introduce Child-to-Child activities into the standard curriculum. Although David has at times clashed with WHO over health care strategies, he has accepted this offer because it may be an entry point for a more meaningful and humanized approach to education of children. If it helps enough children begin to look at their health-related needs more analytically and critically, who knows where it could lead!

End Matter

Board of Directors
Allison Akana
Trude Bock
Roberto Fajardo
Barry Goldensohn
Bruce Hobson
Myra Polinger
David Werner
Jason Weston
International Advisory Board
Dwight Clark — Volunteers in Asia
Maya Escudero — USA/Philippines
David Sanders — South Africa
Mira Shiva — India
Michael Tan — Philippines
Pam Zinkin — England
Maria Zuniga — Nicaragua
This Issue Was Created By:
Trude Bock — Editing
Alicia Brelsford — Art & Layout
David Werner — Writing
Jason Weston — Technical

End Notes

  1. See Declaration of People’s Perspectives on “Population” Symposium, Comilla, Bangladesh, Dec 12-13, 1993. Available through UBINIG, 5/3 Barobo Mahanpur, Ring Road, Shaymoli, Dhaka, Bangladesh. ↩︎

  2. Scott B. Halstead, Julia A. Walsh, and Kenneth S. Warren, eds. Good Health at Low Cost (a conference report). New York. The Rockefeller Foundation. 1985. ↩︎

    1. David Werner. Health Care in Cuba Today: A model system or a means of social control. November, 1978. (Available through HealthWrights.)