PROJIMO’s Skills Training and Work Program Provides New Opportunities to Disabled and Jobless Youth

by David Werner

Socially Constructive Alternatives to Crime and Violence

The village of Ajoya, in the foothills of Mexico’s Sierra Madre Occidental, has been the location of community-based health and rehabilitation initiatives that have broken new ground in the fields of grassroots health and empowerment. Two programs that have had their training and coordination centers in this village have—through their innovative methods—contributed to the evolution of Primary Health Care and Community Based Rehabilitation worldwide. Several books have grown out of these experiences to become among the most widely used in their fields. Project Piaxtla (a villager-run health program) has given birth to Where There Is No Doctor, a village health care handbook, and also to Helping Health Workers Learn, a handbook on participatory, discovery-based methods of health education. PROJIMO (Program of Rehabilitation Organized by Disabled Youth of Western Mexico)–has inspired the books Disabled Village Children and, in 1998, Nothing About Us Without Us.

The PROJIMO Rehabilitation Program has decided to move to the safer, more accessible town of Coyotitan.

Recently, however, the village of Ajoya has been going through difficult times. The economic crisis in Mexico—and the widening gap between rich and poor that has resulted from the North American Free Trade Agreement (NAFTA) and the “global casino” of speculative investing—has led to a tidal wave of joblessness, falling wages, crime and violence throughout the country. As we have described in previous newsletters, the village of Ajoya, a strategically-located exchange point for illegal drugs grown in the mountains, has suffered more than its share of robberies, assaults, and kidnappings. As a response to so much crime and violence, many families have fled the village. In the last 4 years the population has dropped from 1000 to 700. The situation has also caused a split in PROJIMO into two sub-programs.

The PROJIMO Rehabilitation Program has decided to move to the safer, more accessible town of Coyotitan on the main west-coast highway.

The PROJIMO Rehabilitation Program has decided to move to the safer, more accessible town of Coyotitan on the main west-coast highway. And the PROJIMO Skills Training and Work Program has been formed to remain in the troubled village of Ajoya, with the goal of providing socially constructive alternatives to both disabled persons and to village youth who, for lack of job opportunities or hopes of a viable future, are too often lured into drugs, crime and violence. Already the new PROJIMO Work Program has given a new sense of hope to this beautiful but beleaguered village.

The Children’s Wheelchair Building Project

The PROJIMO Skills Training and Work Program has launched a number of projects to teach skills and to provide income generating work to young disabled and non-disabled youth. These projects to date have included chicken-raising, toy and ornament making, carpentry and coffin making, and welding and wheelchair making.

In Mexico, as in many poor countries, if disabled children manage to get a wheelchair at all, they are often given an adult-size chair. Such oversize wheelchairs tend to further incapacitate the child rather than to contribute to her freedom.

Creating a Demand for Children’s Wheelchairs

Unfortunately, most parents are so used to seeing children in adult-size wheelchairs that they do not realize how much their child could benefit from a chair that fits their child and is adapted to meet his or her needs. Therefore, the goal of the Children’s Wheelchair Building Project is to build and supply enough children with well-fitted, appropriate wheelchairs that parents and children alike begin to expect and demand them.

Cost is a major barrier for poor families. Although PROJIMO builds high-quality children’s wheelchairs at remarkably low cost (about $150.00 per chair), with the growing poverty, unemployment, and falling real wages in Mexico, many families simply cannot afford one.

For this reason, PROJIMO has sought ways to subsidize the cost of wheelchairs. A Dutch foundation, Stichting Liliane Fonds, has agreed to cover 60% of the cost of wheelchairs for children from poor families. (Liliane will also help with additional critically needed assistance for the child and family as needed.) For children living in the Mazatlan area, the government program, DIF (Integrated Family Development) has agreed to pay an additional 20% of the cost for a child’s wheelchair. Dolores Mesina, a social worker with DIF, who is herself a wheelchair rider and a PROJIMO “graduate,” is helping to coordinate this program. The office of DIF in the state capital of Culiacan is also entering into a similar agreement with PROJIMO to help children get the wheelchairs they need.

The two leaders of the wheelchair shop are Gabriel Zepeda and Martin Perez, both skilled craftspersons who first came to PROJIMO for rehabilitation after they were paralyzed by bullet wounds. Both have learned from Ralf Hotchkiss, a world-famous wheelchair designer (also paraplegic), who helped PROJIMO set up its original wheelchair shop many years ago. Gabriel periodically makes trips to California to help teach in Ralf’s “Wheeled Mobility” workshop at San Francisco State University.

The workers at the new wheelchair shop are still in the process of developing a series of adaptable designs for children with different needs. Their goal is to form an economically self-sufficient cooperative, which supplies a large number of children with low-cost, high quality chairs.

Already there is a growing interest in the children’s wheelchair program, with prospects for disabled apprentices to come from other parts of Mexico to learn the basic skills and set up their own shops. The team hopes for the day when every child who needs a wheelchair will have one.

From Coffins to Dining Sets: The Projimo Work Program’s Carpentry Project is Off to a Good Start

The purpose of PROJIMO’s new Work Program is to provide skills training and work opportunities for disabled and non-disabled young villagers. Of the new work projects started so far, one of the most exciting is the Carpentry Workshop.

The Carpentry workshop is headed by Mario Carrasco, who before he became paralyzed by a bullet wound was a street youth and drug runner. In PROJIMO, Mario became a skilled carpenter and builder of special seating for disabled children. He is a good role model for some of the vagrant village youth who have been turning to drugs and crime, because they see no economic future for themselves A number of these young men now work with the carpentry program and are earning a living while taking pride in their growing skills.

Production of Coffins

The production of low cost wooden coffins has proved to be one of the carpentry project’s most successful ventures. It is also a much needed and greatly appreciated public service. When a loved-one dies, the cost of a coffin is often a ruinous espense for the poor village family. The carpentry team now makes attractive, cloth-lined coffins and sells them locally for about one third the price of the commercial equivalent.

So far, the biggest buyer so far of PROJIMO coffins has been the municipal government, which receives a lot of requests from poor families. So far the government has bought over 20 coffins.

Environment-Friendly Use of Chainsaws

When the Carpentry Project began, the workers were using primarily pine planks purchased from lumber yards in the high sierra. But the wood is expensive. Worse still, the pine forests in the mountains are rapidly being destroyed by overtimbering. This has led to erosion of the mountain slopes and Increasingly devastating floods of the river valleys during the rainy season.

But now the team is taking advantage of the seasonal floods of the river to find high grade wood that does not deplete the forests. The flooding river carries huge fallen trees from the mountains. Some are high-quality hardwoods, such as Tepeguaje and Guinacastle, as well as mountain Cedro (cedar), all excellent for furniture building.

Today the team is turning out high-quality dining sets, bedsteads, and other furniture.

So the carpentry team bought a big (3 foot blade) chainsaw with money donated from the Mexican “TELETON” (Telethon). They sent villagers up river to hunt for and cut into big beams some of the best fallen timber, and drag them back with mules. In this way the carpentry project has managed to provide employment for local people, rather than to spend money on the environmentally costly products of the gigantic destructive timber companies.

The quality of the craftsmanship has steadily improved. Today the team is turning out high-quality dining sets, bedsteads, and other furniture, and has a waiting list for the items they produce. For full self-sufficiency, the team is now looking for ways to become more time-efficient.

The village of Ajoya has responded with enthusiasm to the skills training and work program, which is providing work not only for disabled persons, but also for the young people (and some not so young people), and thereby creating a source of income from other sources than drug growing and crime.

Alejandro Apprentices in the New Wheelchair Shop

For those readers of the Newsletter from the Sierra Madre who have followed the story of the boy, Alejandro Navarro, over several years, or who have read about him in our new book Nothing About Us Without Us, we are pleased to tell you that for the last few months Alejandro has been working eagerly in the Children’s Wheelchair Shop, learning to make wheelchairs and earning his way. He is now 18 years old.

Remember that when Aljandro was 12 years old and lived with his family in a poor barrio in the city of Mazatlan, he made the mistake of asking a policemen, “What caliber is your pistol?”

“This!” said the policeman, and drawing his pistol, he shot the boy through the spine.

When Alejandro arrived at PROJIMO a few weeks later, he already had severe pressure sores. Until they healed, he had to ride a wheeled cot, or gurney.

The PROJIMO team, with the help of disabled social worker Dolores Mesina in Mazatlan, worked hard to get the city government to assume at least some responsibility for Alejandro’s care.

Alejandro has found his calling in PROJIMO’s children’s wheelchair shop.

Alejandro has had a difficult life since he was shot. His family was evicted from their home and built a cardboard shack near the cemetery. His father and brothers have mostly been unemployed. Fortunately, Alejandro has had assistance from Liliane Fonds in Holland, to find ways to help the family meet their basic needs. From time to time, Alejandro has spent time at PROJIMO learning skills. For a while he worked in the carpentry shop. But now he seems to have found his calling in the children’s wheelchair shop, where Gabriel and Martin Perez, who are also spinal-cord injured, have taken him under their wings.

You can learn more about Alejandro and many other disabled children who have participated in the very innovative problem-solving process at PROJIMO, by reading our new book, NOTHING ABOUT US WITHOUT US, by David Werner.

To order this exciting book, see the buff flyer.

From “Four Women with Spinal Cord Injury: Their Different Mobility Needs”

An excerpt from David Werner’s new book Nothing About Us Without Us

Rita lives in the mountains of Mexico in a small, pole-walled hut. She broke her lower back when she fell carrying water from a ravine. Like Mira, Rita’s fancy wheelchair is of little use at home. She cannot ride it on the rough, narrow trails. Her hut has 2 small rooms for 8 people. The tiny kitchen has a big mud stove and no room to move around in a wheelchair. The kitchen counter, also made of mud, is at a height made for working standing up. And there is no space under it to position a wheel-chair. There is simply no way for Rita to move or work effectively in her wheelchair.

Solution: If after her accident, Rita’s rehabilitation workers had involved her in thinking through her therapy and assistive equipment, they might have found more useful alternatives. They would have realized how unsuited her environment is for a wheelchair (especially a clumsy, oversized one). Because her injury was low on her spine (L4), it may make more sense to see if she can learn to walk with crutches—or at least figure out a way to stand up to work in the kitchen. To do this, leg braces might help: possibly simple, lightweight ones made from plastic (see Part 2).

To prepare for standing and walking, Rita will need an exercise program (1) to strengthen her arms and upper body, and (2) to maintain or increase the range of motion of her hips and knees. If she can gradually stretch her hips and knee joints until they bend backwards a little, she may be able to stand and even walk (with crutches) without the need for long-leg braces. She can do this by “locking” her legs in a back-knee position, and by leaning her upper body backwards to stabilize her hips. She may even be able to work standing up, with her hands free (without her crutches).

By leaning backwards over her hips, Rita can keep her body upright, even with no strength in her lower back. (To prevent doubling forward, her center of gravity must be behind her hips.) With knees bent back, she can bear weight on her weak legs.

Simple below-the-knee plastic braces prevent foot-drop and help her avoid ankle-twisting on rough paths.

Rocker-bottom shoes allow a smoother gait (walking). A flat area in the middle of the shoe soles permits greater stability for standing permits greater stability for standing

A slight downward angle of the foot pushes the knee back, adding stability.

With practice, Rita should be able to work standing in the kitchen. A strap around her hips may let her work more freely and securely.

With effort, she may even learn to walk with crutches on the steep trails. But she will need to develop good balance, strong arms, and not get over-weight.

Perhaps the best solution for travel on the steep trails will be for Rita to learn to ride the family donkey.

A Wheelchair Carriage for Rough Terrain

Design sent by Severine Dumas of Handicap International—Brazil. Reproduced with permission of Handicap International, Lyon, France.

In the front of our new book, Nothing About Us Without Us, we include an invitation to readers to send us their own innovative ideas and designs, in the hopes of putting together another, better book. The design below for a “Joelette” or wheelchair carriage was recently sent to us by Severine Dumas of Handicap International—Brazil. In 1996 Severine attended a course in Community Based Rehabilitation which I (David Werner) gave in Recife, Brazil. At that time I shared with participants the draft of a story of “Four Women with Spinal Cord Injuries—Their Different Mobility Needs.” Depending on the circumstances in which they live (in Bangladesh, Mexico, the Philippines, and Egypt), each woman finds a different solution The story of Rita, from Mexico, copied from page 16 of Nothing About Us Without Us, is on the preceding page.

The one-wheel carrying device is designed for steep mountain trails such as those where Rita lives. It requires two persons to navigate it, and includes a piston-like mechanism (# 4) that allows the disabled rider to sit in the same comfortable upright position when being transported either up or down a steep slope. A coil spring mount (# 22) on the single wheel allows for shock absorption on rough ground.

In addition, the device has a hand-powered chain drive mechanism (#12, 13, 14, 20 and 21) that allow the rider to help her assistants climb a steep slope.

All in all, this is a very ingenious mobility device for mountain trails. I wish I’d had the design to include with the story of Rita. We will certainly include it in the next book.



We welcome innovative ideas like this one. Please send us yours!

News and Activities from the International People’s Health Council (IPHC)

The International People’s Health Council (IPHC) 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. The vision of the IPHC is to advance toward health for all — viewing health in the broad sense of physical, mental, social, economic, and environmental well being. If you want to learn more about IPHC, become part of the coalition, or communicate with the regional IPHC coordinator in your area, contact either David Werner at HealthWrights, or the global coordinator of IPHC, Maria Zuniga, at CISAS, Apartado 3267, Managua, Nicaragua (Fax: 505-2 661662; e-mail: <>).

Alma Ata: Revisited After 20 Years

In 1978 the World Health Organization and UNICEF called an International Meeting in the Central Asian city of Alma Ata, now Almaty in the Republic of Kazakhstan. That meeting gave birth to the ALMA ATA DECLARATION in which the world’s nations affirmed HEALTH AS A UNIVERSAL HUMAN RIGHT and approved the ambitious goal of HEALTH FOR ALL BY THE YEAR 2000. The goal was to be approached through a comprehensive, potentially revolutionary strategy known as PRIMARY HEALTH CARE (PHC). This called for multi-sectoral cooperation to construct a NEW ECONOMIC ORDER based on EQUITY, to be achieved through STRONG COMMUNITY PARTICIPATION.

This year, in November 1998, on the 20th ANNIVERSARY OF ALMA ATA, the WHO held another big meeting in Almaty. Its purpose was to assess how the health of the world’s people has changed since the Declaration, to analyze why we are still so far from Health for All, and to formulate a plan for HEALTH FOR ALL IN THE 21st CENTURY.

A Stronger Role for Civil Society.

The 1998 Almaty Conference was attended by many more voluntary and non-government organizations than was the 1978 Alma Ata meeting. This reflects the growing realization that non-profit and community organizations often are more in touch with the people’s needs and try to take a more holistic and sustainable approach to meeting those needs than do many governments and international agencies. Indeed, it was agreed that in planning and implementing a strategy for “HFA-21” (Health for All in the 21st Century) “civil society” (NGOs and people’s organizations) should play a much more prominent role.

IPHC Well Represented

Three leaders in the IPHC were asked to take part in HFA-21. These were David Sanders and David Werner (authors of our book Questioning the Solution, the Politics of Primary Health Care and Child Survival) and Fran Baum, president of the Australian Public Health Association. These speakers helped to gain a consensus that a major obstacle to Health for All is the globalized market economy which is widening the gap between rich and poor. Pursuit of economic growth (of the rich) has led to privatization of health services, cuts in wages and welfare, and growing poverty, hunger, crime, violence and social unrest. This has undermined PHC.

Strategy for the 21st Century

At the time of this writing, the final statement and agenda for action resulting from Almaty 1998 have not yet been completed. (Participants’ comments on the drafts are still being integrated.) We will include a follow-up on this report in our next Newsletter.

In brief, the proposal for action for “PHC-’21” calls for a model of social development based on human needs and greater equity. To move toward Health for All, the market system must be regulated to put sustainable human and environmental well-being before unchecked corporate profits. For this, civil society must take a united stand.

For a copy of the talk, “Health and Equity: Need for a People’s Perspective in the Quest for Health for All,” by David Werner at the ‘98 Almaty Conference, send US$4 to


c/o Jason Weston

3897 Hendricks Road

Lakeport CA 95453 USA

Launching the Japanese Translation of Questioning the Solution

In November, 1998, David Werner traveled to Nagoya and Tokyo, Japan, to speak at book launchings for the Japanese translation of the book Questioning the Solution, the Politics of Primary Health Care and Child Survival by Werner and Sanders. The response to this iconoclastic new book in Japan has been incredible. At the Tokyo launching 120 persons were expected; 250 came!

In terms of the goal of “Health for All-’21” it is encouraging to realize that Japan has a strong and growing “counter culture” of citizens who are concerned with the human and environmental costs of the global market system, who are committed to working toward a sustainable model of development based more on caring and sharing. Leaders in this progressive movement are Yoshi Ikesumi and Susumu Wakai. Yoshi and Susumu headed the team of 13 health and development activists who, in record time, translated Questioning the Solution into Japanese. Yoshi, who for many years was a leader of the Asian Health Institute, is currently the Asia-Pacific Coordinator of the IPHC.

While in Japan, David gave presentations and facilitated workshops in Community Based Rehabilitation for enthusiastic groups from JANNET and other organizations of disabled persons.

End Matter


Board of Directors
Trude Bock
Roberto Fajardo
Emily Goldfarb
Barry Goldensohn
Bruce Hobson
Eve Malo
Myra Polinger
David Werner
Jason Weston
Efraín Zamora
International Advisory Board
Allison Akana — United States
Dwight Clark — Volunteers in Asia
Donald Laub — Interplast
David Sanders — South Africa
Mira Shiva — India
Michael Tan — Philippines
Pam Zinkin — England
Maria Zuniga — Nicaragua
This Issue Was Created By:
Trude Bock — Editing and Production
David Werner — Writing, Illustrating and Layout
Efraín Zamora — Layout and Scanning
Marianne Schlumberger — Proofreading

Quote for a happy (if not quite so prosperous) new year:

Rats and roaches live by competition under the laws of supply and demand; It is the privilege of human beings to live under the laws of mercy and justice.”
— Wendell Barry