#86 | Coping with COVID : The Need for Equality, Inclusion and Global Solidarity

Coping with COVID—The Need for Equality, Inclusion and Global Solidarity A village health promoter in Mexico’s Sierra Madre immunizes a child with DPT, a vaccine against diptheria, pertussus (whooping cough), and tetanus.   The COVID Pandemic This last year, with the disastrous COVID-19 pandemic, has been a challenging one worldwide. Massive setbacks in health and livelihoods have accentuated the stark inequities within communities and between countries.

#85 | ANNOUNCING A NEW BOOK BY DAVID WERNER: Reports from the Sierra Madre: Stories Behind the Health Handbook Where There Is No Doctor

Announcing a New Book by David Werner: Reports from the Sierra Madre: Stories Behind the Health Handbook Where There Is No Doctor   David Werner and HealthWrights (Workgroup for People’s Health and Rights) are very excited to announce the release of this new book, Reports from the Sierra Madre. This is the backstory, the real-time day-to-day journals and reports of what David experienced in the backcountry of Western Mexico, living and working side-by-side with the campesinos.

#84 | INCLUSION OF THE MOST EXCLUDED — 'THE POWER OF STRING': Update on the Buddy Home Care Initiative in Ubon, Thailand

Inclusion of the Most Excluded—‘The Power of String’: Update on the Buddy Home Care initiative in Ubon, Thailand by David Werner As was described in Newsletter #81, the Health and Share program in Ubon was originally initiated by a Japanese NGO (non-government organization) called SHARE. Today the Health and Share Foundation is completely independent from its parent organization and is run by a collective of dedicated Thais.

#83 | Finding a Paper-Based Solution for Mónica: Cardboard Cushions Help Heal Stubborn Pressure-Sores; the Searching for Disabled-Friendly Drug Rehab Centers; and the Passing of Mary Picos

PROJIMO Leader Mary Picos Has Passed Away Very sadly, just a few weeks ago (Feb. 22, 2018) Mary Picos—the dynamic paraplegic leader of the PROJIMO community-based rehab program for 35 years—died from fulminating septicemia caused by an infected pressure sore.   David left the following announcement on the HealthWrights Facebook page: Mary Picos—Co-Director of PROJIMO—Has Passed Away

#82 | DISABLED RECOVERING DRUG-ADDICTS UNITED: A New Service Program Run by Disabled Recovering Drug-Users in Mexico; their Child-to-Child Workshop and Paper-Based Technology in Action

Drugs and Disabilities by David Werner In Mexico today, widespread use of addictive drugs has become a major social and health problem, especially among youth. In this newsletter we discuss how extensive trafficking and consumption of drugs have created new challenges for the community health and disability programs we are involved with, and we describe a groundbreaking initiative run by and for disabled persons who got hooked on drugs and are now trying to stay off them by devoting their lives to assist others in need.

#81 | Health Services in a Land of Contradiction: Innovations in Thailand to Meet Health Needs of the Most Vulnerable

Health Services in a Land of Contradictions: Innovations in Thailand to Meet Health Needs of the Most Vulnerable by David Werner My invitation to Thailand In May 2017 I was invited by Health and Share Foundation (HSF) in Thailand, and its parent organization, SHARE (based in Japan), to visit their innovative community outreach program in the Ubon-Rachathani province, on the Thai-Laos border.

#80 | NAMESAKES: Inspired by Where There is No Doctor in Ghana, Guatemala, Chile, and Mexico

Namesakes Resulting from Where There is No Doctor   Since I first wrote and illustrated Where There is No Doctor in Spanish, in mountain villages of Western Mexico in the early 1970s, the book has been translated into at least 100 languages (that we know of), with more than three million copies in print. According to the the World Health Organization, it has become “the most widely used community health care handbook in the world.

#79 | More Serendipitous Connections: A Boy with CMT Muscular Atrophy—Same as Me; Fitting him at PROJIMO Coyotitán

Serendipitous Connections: A Boy with CMT Muscular Atrophy—Same as Me by David Werner Three years ago, in 2013, I received an urgent email from a mother in Guadalajara, asking me if I knew anything about Charcot-Marie-Tooth syndrome. She told me her son, Tomás—born in July, 2003—had been diagnosed with CMT, a progressive neurological condition beginning in early childhood. At birth he’d seemed normal.

#78 | What Goes Around comes Around, Part 2: A Visit to the PROJIMO-Inspired ARSOBO Wheelchair and Prosthetics Workshop

Visit to ARSOBO by David B Werner   As planned, in mid-November, 2015, my friend Polo Ribota and I set off on the long drive from Mazatlán, Sinaloa, to Nogales, Sonora—on the U.S. border—to visit ARSOBO (acronym for ARizona SOnora Border), a workshop where disabled people make assistive devices for others with disabilities. Accompanying us was Tomás Magallanes, a young man with sequelae of polio, who was first brought to PROJIMO by his mother for braces when he was six year old.

Individual Sections

  1. Visit to ARSOBO
  2. End Matter

#77 | What Goes Around Comes Around, Part 1: A Life-Threatening Snakebite Teaches Lesson about Establishment Medcinine; and a Serendipidous Connection

From a Snakebite to Children’s wheelchairs: Going Full Circle   When I first wrote Donde No Hay Doctor (the original Spanish edition of Where There is No Doctor) in the early 1970s, I didn’t dream the village healthcare handbook would ever be used outside the remote reaches of Mexico’s Sierra Madre, where the villagers and I had set up a backwoods health program.

#76 | Helping Shy Tonio: Making his Home and One-Room Village School More Accessible with Child-to-Child

Making A One-Room Village School More Accessible For a Nine-Year-Old with Muscular Dystrophy Juan ‘Tonio’ Antonio.   Tonio with his grandmother. His enlarged calf muscles are a key sign of Duchene's Muscular Dystrophy.   Like many children with congenital disabilities in rural Mexico, Juan Antonio—or “Tonio” for short—was given to and raised by his grandparents, who live in a small village called Tablón #2, south of Mazatlan.

#75 | The Story of Dr. Miguel Angel: From Village Boy to Kind Eye Surgeon; and Ramon Ayala's Eye Surgery

From Village Boy to Kind Eye Surgeon: Where Caring Goes Full Circle Efforts to Restore a Blind Boy’s Sight I first met Ramon and his parents through Rigoberto (Rigo) Delgado, a quadriplegic rehabilitation worker, who, in April 2013, invited me to visit a weekly “educational exchange” that he facilitates with disabled children and their families in Culiacán, the state capital of Sinaloa, México.

#74 | Struggle for Health and Rights in South America's Southern Cone: Health Professionals Who Side with the Disadvantaged

Struggle for Health and Rights in South America’s Southern Cone: Health Professionals Who Side with the Disadvantaged Introduction In April of 2014, I, David Werner, was asked to visit Chile and Argentina, the two countries that flank the imposing Cordillera de los Andes in South America’s southern cone. The corresponding groups that invited me—of occupational therapists and of community doctors –represent the more radical, social-change-seeking arm of their respective professions, much in the way that the “Theology of Liberation” is the socially progressive arm of the Catholic Church.

#73 | Child-to-Child Workshops: Making Schooling More Inclusive for Disabled Children and More Enabling for All Children; and a Photo Essay

Child-to-Child Workshops: Making Schooling More Inclusive for Disabled Children and More Enabling for All Children Facilitated by David Werner in February, 2014   In February 2014 I, David Werner, visited Burkina Faso, West Africa, at the invitation of the Dutch NGO, Light for the World–the Netherlands. I was asked to exchange experiences in Community Based Rehabilitation (CBR) and to facilitate workshops, using the Child-to-Child approach, to promote “educational inclusion.

#72 | 'THE SILENCE THAT SCREAMS': Wise Writings of a Boy Who had No Voice for 12 Years, from the First International People's Health Assembly

‘The Silence That Screams’: Wise Writings of a Boy Who had No Voice for 12 Years by David Werner First International Assembly of the People's Health Movement—Latin America Cuenca, Ecuador, October 2013. The Dream of Inclusion for All Participants at the Cuenca Assembly led by indigenous health workers from Guatemala, participate in a traditional ceremony of respect for Pacha Máma, the spirit of Mother Nature of which we are all part.

#71 | The Rehabilitation of Miguel Angel: A PROJIMO Duranguito Success Story

A 7-Year-Old with Spina Bifida Discovers New Life: An Online Photo Documentary Photos by David Werner and Tomas Magallanes; text by David Werner Miguel Angel.   This is the second HealthWrights Newsletter that is available only online, and is not in print. Cost of international mailing became too much. However, being “online only” gives a new degree of freedom.

#70 | Good News—And Not So Good News—From Bangladesh: David Werner Attends the 40th Anniversary of The People's Health Center

Good News—And Not So Good News—From Bangladesh Introduction   In February, 2012, I had the opportunity to attend the 40th Anniversary of Gonoshasthaya Kendra (The People’s Health Center) in Savar, Bangladesh. “GK,” as it is commonly called, grew out of the 1971 War of Liberation when the people of East Pakistan struggled for autonomy from West Pakistan. At that time Zafrullah Chowdhury, a young doctor who headed a medical brigade in the war, became concerned about the enormous unmet medical needs of his country’s impoverished majority, especially in the rural area.

#69 | PRIMARY HEALTH CARE IN EAST TIMOR: The Challenge for Human, Environmental and Political Health

East Timor–The Challenge for Human, Environmental and Political Health by David Werner I. Introduction 1 East Timor map—cap: Timor-Leste is the eastern part of an island in an Indonesian archipelago.   When I was invited to Timor-Leste this last November to share experiences in Primary Health Care, I jumped at the chance. I have long admired the Timorese people’s relentless struggle for liberation against overwhelming odds.

#68 | Rigo Delgado's Story: A Disabled Activist's Daring Work in Disability Rights

In this issue read about how Rigo Delgado, a disabled person, rehabilitated and educated in the PROJIMO program many years ago, is now creating exciting and innovative programs in Mexico. He focuses especially on people who not only face the physical and social problems associated with having a disability, but who are marginalized economically as well. Child-to-Child programs are central to his work.

#67 | Children of the Moon: A Haven for Children of Sex Workers in Oaxaca, Mexico; Help Request for Health Wrights

Children of the Moon: A Haven for Children of Sex Workers in Oaxaca, Mexico by David Werner After the close of the 2nd Continental Congress on Community Based Rehabilitation, in Oaxaca, Mexico, last March (see Newsletter #66), a friend took me to visit “Casa Hogar—Hijos de la Luna” (Home Shelter—Children of the Moon), in a poorer barrio of the city. What I had the privilege of observing there was so elevating and heartwarming that I wish to share it in this newsletter.

#66 | The Evolution of Community Based Rehabilitation: David's Impressions of the 2nd Continental Congress on CBR

The Changing Face of Community-Based Rehabilitation—New Features In the 2nd Continental Congress on CBR it was good to see how far CBR has moved toward being open-ended and inclusive.   Trend toward Inclusive Development In concept, and slowly but surely in practice, “Community Based Rehabilitation” (CBR) has been evolving in empowering and potentially liberating ways since it was launched by the World Health Organization (WHO) 3 decades ago.

#65 | 'Where There Is No Doctor' in Japan: Exploring the Uses of a Village Healthcare Handbook in an Advanced Nation

Where There Is No Doctor in Japan by David Werner Dr. Toru Honda, the founder of SHARE, holds a copy of the new Japanese translation of Where There Is No Doctor, by David Werner. The book will be used not only by Japanese health and development workers in poor countries, but by the growing population of the homeless and destitute in Japan, and by the many local NGOs and "free clinics" offering assistance.

#64 | Workshops in Peru with Stichting Liliane Fonds: Making Low-cost Assistive Devices for Disabled Children; Demystifying Rehabilitation; Paper-Based Technology

Community Based Rehabilitation Workshop Video by Allison Akana HealthWrights board member Allison Akana made a video documentary of the activities described in this Newsletter. The video shows the pre-workshop preparations, the home visits, and the workshops where participants made assistive devices for disabled children, Please click here to see this video. Hands-on Workshops with Disabled Children in Peru by David Werner The workshops were held in Lima and Chimbote, two cities on the western seaboard of Peru.

#63 | Remembering Marcello Acevedo: The Life of PROJIMO Co-Founder and Core Member, Husband, Father, Friend

Remembering Marcelo by David Werner Last May (2008) Marcelo Acevedo fell ill and rapidly succumbed to brain cancer. The event was briefly noted in our last newsletter, but because Marcelo touched and changed so many people’s lives, we decided to devote this newsletter to his memory. Marcelo was one of the founders and core members of PROJIMO, the Community based rehabilitation program run by disabled villagers in western Mexico.

#62 | Stichting Liliane Fonds in Columbia: Training Mediators to Create Assistive Equipment for Children in Medellín, Montería, and Cerro Vidales; In Memoriam: Marcelo Acevedo

Workshops For and With Disabled Children in Colombia by David Werner The two cities in Colombia where I led workshops on “Community Based Rehabilitation and Assistive Technology” are geographically and climatologically very different. Yet in terms of the vast and growing gulf between rich and poor, they are distressingly similar. The first is the large, rapidly growing city of Medellín, nestled 5000 feet above sea level in a broad bucolic valley in the Andes.

#61 | Health in Harmony in Indonesia: Linking Local Health and Environmental Protection, and Helping Ocu to Walk

In November 2007 I (David Werner) had the opportunity to visit Health in Harmony, an innovative new program in a remote area of West Kalimantan, on the Indonesian portion of the island of Borneo. This pioneering program is crucially relevant to our imperiled times because it strives to address, in an integrated participatory way: 1) the pressing health needs of the local villagers and 2) the environmental protection of endangered tropical forests.

#60 | EDUCATION REFORM IN MEXICO: David Werner Leads a Child-to-Child Workshop; and PROJIMO Updates

In December 2006 in Morelia, the state capital of Michoacán, Mexico, David Werner was a keynote speaker at an international Congress on Education and Culture on “Educational Reform.” He shared experiences using a “Child-to-Child” approach both to facilitate the inclusion of children with special needs, and to make schooling more enabling for all children. This stimulated so much debate that Professor Juan Hurtado, Director of the Technical Educational Consultancy (CEE) for the State Dept.

#59 | Focus on South Africa: Community-Based Rehabilitation in Cape Town and Western Cape Province; Notes on Post-Apartheid Socioeconomic Polarization

South Africa’s Uphill Battle for Equity and Health A Report by David Werner on Workshops Facilitated with the Western Cape Association for Persons with Disability February—March 2007 Two Worlds Side by Side Despite the official end of apartheid in 1994, the nation remains divided into two worlds: the haves and the have-nots. Nowhere is this divide more glaring than in the fast-growing city of Cape Town.

#58 | HealthWrights Omnibus: Fighting for Incluion in Regular Schools; CBR Program near Patzcuaro; Innovative Toys from the 'Museum of Garbage'; Book Coming Soon: Choosing Our Future

The Paradoxes of Educational Reform in Michoacan From December 6 to 8, 2006, a potentially groundbreaking event took place in Michoacan, Mexico. An international seminar—called the “Congreso Estatal Popular de Educación y Cultura” (Popular Statewide Congress on Education and Culture)—was held in the huge state-run Convention Center in the state capital of Morelia. Convened jointly by the state Department of Education and the most progressive branch of the CNTE, Michoacan’s powerful, independent Teachers’ Union, the aim of the Congreso was to try to reach an agreement for “educational reform” between the government and the union.

#57 | Partnerships for Empowerment in Occupational Therapy: David's Keynote Address for the NYSOTA Conference; a New Book: Occupational Therapy Without Boarder; and PROJIMO Updates

Building Partnerships Beyond Borders: Empowering the Vulnerable The Annual Conference of the New York State Occupational Therapy Association, Aug 27, 2006 In August, 2006 David Werner was invited to speak at the Annual Conference of the New York State Occupational Therapy Association, held at the United Nations headquarters in New York City. The theme of this year’s NYSOTA Conference was Building Partnerships Beyond Borders, with a special focus on “Empowering the Vulnerable.

#56 | Honduras—New Damage from Old Wounds: Consequences of U.S.-Backed 'Contra' War; Community Based Rehabilitation Initiatives; Migration to the U.S. and Struggles in the Wake of Hurricane Katrina

Honduras—New Damage from Old Wounds: US-backed ‘Contra’ War on Nicaragua in the ‘80s still takes heavy toll When Hurricane Katrina struck the coastal towns of Louisiana and Mississippi in September 2005, among those who suffered great hardships were the uncounted thousands of destitute, undocumented immigrants from Latin America, most notably from Honduras. Honduras, in spite of its fertile lands and bundant natural resources, today remains one of the poorest countries in the Americas.

#55 | Community Based Rehabilitation in Rural India: Three CBR and Assistive Devices Workshops; PROJIMO Wins Film Award

WHERE ARE THE SLIDESHOWS FROM INDIA? SEE INSERT Community Based Rehabilitation in Rural India: the Strengths and Weaknesses of Different Models In October and November 2005 David Werner was invited to India to facilitate three Community Based Rehabilitation workshops in the Creation of Low-cost Technical Aids. These hands-on workshops were attended by local “mediators” of Stichting Liliane Fonds (SLF), a Dutch foundation dedicated to helping disabled children living in difficult circumstances.

#54 | Double Issue 53-54: Hands-on Workshops in Nicaragua Making Low-Cost Assistive Devices for Disabled Children; Open Copyright and Health; Update on PROJIMO

Nicaragua—Hands-on Workshops: Learning to Make Low-Cost Assistive Devices for Disabled Children In May, 2005, The Association of Parents of Disabled Children, better known as “Los Pipitos,” invited David Werner to visit them in Nicaragua. Los Pipitos began in 1987 when a small group of parents in Managua came together to look for ways to meet their disabled children’s needs. But it has grown amazingly.

#53 | Double Issue 53-54: Hands-on Workshops in Nicaragua Making Low-Cost Assistive Devices for Disabled Children; Open Copyright and Health; Update on PROJIMO

Nicaragua—Hands-on Workshops: Learning to Make Low-Cost Assistive Devices for Disabled Children In May, 2005, The Association of Parents of Disabled Children, better known as “Los Pipitos,” invited David Werner to visit them in Nicaragua. Los Pipitos began in 1987 when a small group of parents in Managua came together to look for ways to meet their disabled children’s needs. But it has grown amazingly.

#52 | Focus on Cuba 2: Adapting Community-Based Rehabilitation to the Cuban Context; Updates on PROJIMO

Cuba’s Pilot Project in Community Based Rehabilitation In May, 2004, Handicap International Belgium (HIB) invited David Werner to conduct an external evaluation of Cuba’s first experiment in Community Based Rehabilitation (CBR). The year before he had evaluated a CBR program for HIB in Cartagena Colombia. The Cuban project’s new director, Ana Calvo—who accompanied David in Cartagena—urged him to evaluate the pilot program in Cuba.

#51 | Focus on Cuba 1: Surviving the U.S. Embargo; Health and Welfare Achievements; Politics of Health in Cuba; and a PROJIMO Update

Twenty years ago David Werner visited Cuba as part of the California-Cuba Health Brigade. Afterwards he wrote a paper: “Health care in Cuba today: a model system or a means of social control—or both?” For this paper, in which he tried to analyze strengths and weaknesses of the Cuban system, he was jumped on by both Cuba-philes and Cuba-phobes.

#50 | Struggle for Social Justice and Fair Trade in Bolivia: David's Workshop Interrupted; The Situation in Bolivia; an Update on the Politics of Health

Struggle for Social Justice and Fair Trade in Bolivia by David Werner; written in Santa Cruz, Bolivia, October 2003 I Picked the Wrong Time to Go to Bolivia I had been invited to speak in La Paz at a national seminar on Communications and Disability with a focus on Human Rights, scheduled for October 15-16, 2003. On the 13th I flew from California to Miami and there boarded American Airlines flight #922 to La Paz.

#49 | Life After Injuries from Landmines in Columbia: Training Street Youth as Community Health Workers; Workshop on Assistive Devices for Disabled Children; and a PROJIMO Reunion in Mexico

Life after Injury from Landmines—in Colombia Inequality as the Root of Violence In the beautiful equatorial nation of Colombia, armed violence has increasingly become a way of life—and for many, a way to death or disability. Different factions, vying for money, power, drug trade, or redistribution of land and governance, have been at each other’s throats for decades. As a result, countless innocent persons, many of them women and children, have had their bodies, lives and dreams torn to shreds.

#48 | Helping the Disabled in Rural Andhra Pradesh, India: Conducting a Survey; Exploring Sangams; and Visits to 'Neighborhood Houses'

The Role of Disabled Persons in Overcoming Rural Poverty in Andhra Pradesh, India: Enabling the ‘Poorest of the Poor’ In February/March, 2002, I (David Werner) was invited to India as a consultant to a comprehensive program to reduce poverty throughout the rural area of Andhra Pradesh. Aware that many large-scale, top-down programs to combat poverty have failed to reach the most destitute and marginalized persons—and consequently have marginalized them more—the designers of the Andhra Pradesh Rural Poverty Reduction Program are taking a different approach.

#47 | Tragedy and Hope: The Ajoya Massacre, the Evolution of PROJIMO, and introducing the Politics of Health Knowledge Network

The quality of the images in this Newsletter leave something to be desired. Bad News and Good News from the Sierra Madre… First the Bad News: The Ajoya Massacre Overlooking the Rio Verde in the foothills of Mexico’s Sierra Madre, the village of Ajoya has for the last 37 years been the nucleus of the innovative community-based health and rehabilitation initiatives, Project Piaxtla and PROJIMO.

#46 | Health in the Time of Twin Terrors: The Health Situatiuon in Iran's; the Root Causes of Tensions in the Middle East; and a Review of Molly Bang's Book 'Tiger Falls'

The Changing Pattern of Health in Iran In an effort to adapt to the rapidly changing problematic of health in Iran, the Iranian Ministry of Health is rethinking its strategies, updating its methodology, and reorganizing its infrastructure. Its “Bureau of Communication and Health Education” is being reformed as the Department of Health Education and Health Promotion, with a mandate to become more participatory and proactive at the community level.

#45 | Working Toward a 'Livable Future': A Strategic Meeting led by Mulago Foundation; China's Struggle Against Tobacco; Conservation and Health; and a New Leg for the Professor

Prospects for a ‘Livable Future’—Dream and Reality by David Werner In August, 2001, the Mulago Foundation held a meeting of leaders from different community-based health and development programs that it assists in different parts of the world. The meeting took place at the bucolic headquarters of Future Generations near Franklin, West Virginia. The purpose of the interchange was to help Mulago and the programs reexamine their overall vision and consider strategies for immediate and farreaching change, in view of the problematics of the age we live it.

#44 | Shouting Down The World Bank: High Points and Shortcomings of the First International People's Health Assembly, 2000

LIBERATION FROM WHAT?: A Critical Reflection on the People’s Health Assembly, 2000 by David Werner and David Sanders Over three months have passed since the first major international event of the People’s Health Assembly (PHA) took place in Bangladesh, from December 3 to 8, 2000. Yet only now, after this long period of rumination, are we able t sort out our thoughts and feelings about this extraordinary event.

#43 | Global Ills and Popular Struggles in Ecuador: The People Speak Out at a Regional Forum in Cuenca, and Community Based Rehabilitation Training in Quinto

This newsletter looks at the struggles of disadvantaged people in Ecuador. The first article gives an account of a groundbreaking Regional Forum in Cuenca, in preparation for the People’s Health Assembly, scheduled for December, 2000 in Bangladesh. At this Forum over 40 groups from diverse ethnic groups and habitats gave testimony to how the health of both people and the environment is being compromised by high level policies in the global marketplace that put corporate profits before basic needs.

#42 | Seeing the Forest for the Trees: Constructive Thoughts on the Deluge of Development Workers, Change Agents, Ecologists, and Evangelists in Oaxaca, Mexico; and Updates on PROJIMO and the People's Health Assembly

Struggle for Sustainable Human and Environmental Well-Being on the Coast of Oaxaca, Mexico by David Werner In May 2000, a group from ASHOKA, a US-based charitable foundation that gives grants to innovators for the common good, visited a number of projects for sustainable development on the coast of Oaxaca in Southern Mexico. Here David Werner, who accompanied the Ashoka group, relates his observations and raises challenging questions abou unforeseen contradictions and pitfalls in these visionary ventures.

#41 | From Genocide to Paternalism: Facing the Intractable Health Problems of Australia's Aboriginal People; Flying Foxes; PROJIMO Splits in Two; and an Update on the People's Health Assembly

From Dispossession to Self-Determination in the Australian Outback In September/October, 1999, David Werner had a chance to visit parts of Australia he had not seen before. He had been invited to Darwin in the Northern Territory to speak at the annual meeting of the Public Health Association of Australia (PHAA). But while “down under,” he also visited aboriginal settlements in and around Alice Springs in the central desert.

#40 | Making Life Better for Special Needs Children: Los Chavalitos & Child-to-Child in Nicaragua, a Custom Designed Seating Course, and Announcing the People's Health Assembly

This newsletter looks at a number of innovative efforts to make life better for children who have been living in difficult circumstances and who have especially challenging needs. It starts with a look at Nicaragua, where growing economic disparity has made it necessary for many families to choose between buying food and educating their children. But dire need gives rise to some encouraging and soul-warming initiatives.

#39 | PROJIMO for Disabled and Jobless Youth: The Skills Training and Work Program; WHO Meeting in Kazakhstan; and New Japanese Translation of 'Questioning the Solution'

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.

#38 | THREE GLOBAL HEALTH UPDATES: A 'Learning by Doing' Workshop at PROJIMO; Disability Activism in Singapore; and mental health institutionalization in the United States

This Newsletter looks at diverse disability-related issues in Mexico, Singapore, and the United States of America. It starts with an account of a hands-on training program in Community Based Rehabilitation, conducted at PROJIMO in rural Mexico. The next article looks at the paradoxical situation in Singapore, where disabled people are well cared for, but where little effort is made to achieve their full integration into society.

#37 | HealthWrights Omnibus: Disability in the Philippines; PROJIMO-built Bus Ramp; IPHC Updates; Review of 'Questioning the Solution'; and a Warning about New International Treaty

Disability and Poverty in the Philippines: Efforts of Families to Cope CBR workshops in the Philippines In January 1998, Stiching Liliane Fonds (SLF), a Dutch foundation that helps disabled children in difficult circumstances, held two 3-day workshops in the Philippines. More than 130 SLF mediators from many islands participated. “Mediators” are volunteers, backed by local organizations, who find disabled children with urgent needs and arrange for them and their families to get essential support from SLF.

#36 | PROJIMO Moves to Coyotitán: Through Overlapping Crises, Disabled Health Workers Discover a Renewing Solution

Recreating PROJIMO to Meet Tougher Challenges Friends who have read the Newsletter from the Sierra Madre for years are by now quite familiar with PROJIMO, the Program of Rehabilitation Organized by Disabled Youth in Western Mexico. Begun in 1981, PROJIMO grew out of Project Piaxtla, a villager-run health program started in 1964, based in the remote pueblo of Ajoya. Piaxtla and PROJIMO are best known internationally for the self-help manuals they gave birth to: Where There Is No Doctor (now in 83 languages), Helping Health Workers Learn, and Disabled Village Children.

#35 | 'Health, Economics and the Environment': Toward Sustainable Develpment; Excerpts from 'Nothing About Us Without Us'; and IPHC Updates

This newsletter begins with a presentation on “Health, Economics and the Environment” given by Jason Weston at TOES (The Other Economic Summit), which he and David Werner attended in Denver in June, 1997. Jason shows that the biggest threat to global ecology, and hence the future health of humanity, comes from an economic system based on growth-at-all-costs rather than on a healthy and equitable balance among all people, and between humanity and the natural world.

#34 | Helping Disabled Children in Brazil: David Leads a Workshop Featuring Child-to-Child and Appropriate Technology; Announcing 'Nothing About Us Without Us'

A Hands-on Learning Event in Brazil for Multipliers of Community-Based Rehabilitation David Werner Striking Contrasts in Brazil Brazil is a vast country which does not tolerate—but celebrates—DIFFERENCE. With its warmly human yet seductively candid vitality, the country is less a melting pot than a motley collage of races and cultures. A diversity of tropical, temperate, and ‘cool’ personalities-black, indigenous, caucasian-convive with daunting variations of harmony and discord while passionately preserving ethnic roots and rites.

#33 | Violence and Health in South Africa: A Child-to-Child Workshop led by Martín Reyes; Landmines; the Dictatorship in Chile; and Announcing our New Book 'Questioning the Solution'

Sick of Violence: The Challenge For Child-to-Child in South Africa In January, 1996 three health educators from the Americas—Martín Reyes, Maria Zuniga and David Werner—went to Cape Town, South Africa to facilitate a Child-to-Child training-of-trainers course. Called “Participatory Methods of School Health Education,” this intensive oneweek course was part of the new Summer School Community Health Program at the University of the Western Cape.

#32 | HealthWrights Omnibus: Disabled Karate in Madras; Taking the Best From the Indepenent Living and Community-Based Rehabilitation Movements; and Book Reviews

Karate for Fun (and Therapy) of Children with Cerebral Palsy: An Astonishing Innovation in Madras (Chennai), India In many countries today, children are fascinated by Karate and eager to learn this ancient, artful form of self-defense. Youngsters with cerebral palsy share this fascination with Karate-but rarely have a chance to learn it. In SPASTN (The Spastics Society of Tamil Nadu), an innovative program in southeast India, children with mild to moderate CP are taught Karate.

#31 | Giving the Disadvantaged a Fair Chance: Helping a Disabled Boy Stay in School; NAFTA's Effects on the Poor; Russian Translation of 'Disabled Village Children'; and the Greed Based Paradigm

Classmates Help Disabled Child Stay in School David Werner In January, 1995, PROJIMO (Program of Rehabilitation Organized by Disabled Youth of Western Mexico) hosted a four-day workshop to discuss th organization and problems of small community-based programs. Participants came from 13 different programs in Mexico and one in Nicaragua. One afternoon the lively workshop, held under a giant laurel tree, was interrupted by one of the disabled children staying at PROJIMO.

#30 | Bad Air, Weak Blood, and Domination in Sierra Leone and Kenya: African Women Confront Health Threats; Against Proposition 187; and the Financialization of Health by the World Bank

Capitalization issues, and structure of first section. Bad Air, Weak Blood, and Domination: African Women Confront Their Biggest Threats to Health David Werner This Newsletter takes us to Africa (Sierra Leone and Kenya) where David Werner has recently been consulting with the World Health Organization (WHO) in an initiative to help rural women identify and seek solutions to their biggest health-related problems.

#29 | The Politics of Health in the Sierra Madre: How the Uprising in Chiapas Revitalized the Struggle for Health in Sinaloa

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.

#28 | FROM THE GLOBAL HEALTH FRONT: The Health Struggle in the Slums of Nairobi, and John Fago Visits a Local Prosthetics Workshop in Cambodia

In this issue of our Newsletter, we take a look at different rehabilitation projects. Our articles deal with different particulars, but we feel that together they paint a broad picture of the types of initiatives that make for truly successful rehabilitation programs, while pointing out some of the common mistakes that doom other projects to failure. We would appreciate hearing your reactions to these articles and learning about your own experiences in this field.

#27 | American Foreign Policy in the Americas: the North American Free Trade Agreement; and a Report from John Fago

In this election year, US foreign policy has been noticeably absent from the forefront of electoral politics.Yet, while most people in this country have turned their attention to domestic issues, policies are being formed at the international level which could have a drastic impact on the health and general welfare of poor people throughout the Americas. In this issue, we look at the North American Free Trade Agreement (NAFTA), which is currently awaiting approval by the US Congress.

#26 | Focus on Nicaragua: Healthcare Systems and Health Trends; and Letters to the Editor

Captured by the Free Market: A Visit to the New Nicaragua by David Werner In November and December of 1991, Martín Reyes (from Projects Piaxtla and PROJIMO) and I went to Nicaragua to take part in three separate but connected events: a large regional workshop on Child-to-Child activities, a meeting of the Regional Committee for the Promotion of Community-based Health Care in Central America and Mexico, and

#25 | A CRISIS OF VIOLENCE: Gunshot-Disabled Youth Bring the Consequences of Mexico's Drug Trade into PROJIMO

My Side of the Story by Juan Pérez Translated by Patrice Gormand Editor’s note: Juan Pérez is a pseudonym for one of the sixteen spinal cord young adults who currently form an important part of the PROJIMO community. I am going to tell you the story of my life. When I was five years old, my mother died. From then on, my father took charge of our family and life went on.

#24 | On the Brink of War, Part 2: a Report from the Middle East focusing on Egypt; and Celebrating Trudy Bock's 70th Birthday

Egypt: Another Approaching Storm on the Desert David Werner The paradoxes that underlie the state of health and development in Egypt are graphically symbolized by the urbanization of the pyramids. The pyramids no longer dominate an empty desert, as portrayed in our schoolbooks. Instead, they crouch forlornly on the outskirts of Cairo, the world’s second biggest city with a rapidly growing population of about sixteen million.

#23 | On the Brink of War, Part 1: a Report from the Middle East focusing on the Israeli Occupied Territories; and a Critical Examination of U.S. Policy in the Region

We believe that this is one of our most timely and important newsletters. When David Werner was first invited to visit the Middle East—specifically, the West Bank / Gaza Strip and Egypt—several months ago, he had no idea he would he going to a region poised on the brink of a major conflagration. Given what has happened in the meantime, however, we felt that we should pass on David’s impressions to you as quickly as possible, since they appear to cast grave doubt on the Bush Administration’s hasty resort to war.

#22 | Personal Experiences in a Changing World: Conchita's PROJIMO Story; a Workshop in Angola; The Other Economic Summit; and an Interview with Medea Benjamin

Conchita’s Story Concepción Lara de Zamora with translation by Bruce Hobson Concepción Lara—Conchita, for short—is a long-time member of the Project PROJIMO team. At the Hesperian board meeting in June, she recounted the personal history that led her to the project and talked about what her involvement with PROJIMO has meant to her. While her story is uniquely her own, it is in many ways typical of the experiences of others who come to PROJIMO for treatment or rehabilitation and end up staying on as workers.

#21 | Report from the Philippines: David Teaches Midwifery in Manila; Notes on the Election in Nicaragua; Consequences of the Drug War

Report from the Philippines Susan Klein Introduction In November 1986 I went to Nicaragua to attend the Fourth Annual Nicaragua/North America Colloquium on Health. I had been working for Hesperian on a manual on midwifery for use in the Third World, and went to the colloquium to meet people, especially traditional midwives and community health workers, to learn a little more about the Nicaraguan situation, and to give a presentation on childbirth education.

#20 | Marcelo and Luis: Friendship at PROJIMO; Updates on 'The México Projects'; the Health Consequences of the 'War on Drugs'; and News from Hesperian

Marcelo and Luis by Oliver Bock Marcelo feels caught. Once again he doesn’t know what to do. He is sure that a joke is being flayed on him and he is confused. Lacking the tools for understanding, Marcelo resorts to his tried and true response. “Don’t look at me.” he demands. And, with a quick jerk of his head away from the insult, he trundles off, looking for more hospitable company.

#19 | From Local Health to Global Politics: an Analysis of the Political and Health Consequences of Apartheid in South Africa

The Yellow Bulldozer or Some Good Things are Happening in South Africa by David Werner As I was preparing to depart from South Africa, a five-year-old boy—Anglo-Indian by birth but generically ‘Black’ by the rules of apartheid, the son of my hosts in Johannesburg—pressed a large, thin, brightly colored booklet into my hands. “This is a present for you,” he said, “to remember us.

#18 | From Trees of Blood to Traffic of Drugs: An Important Update on Violence and Drug Trafficking in Mexico

From Trees of Blood to Traffic of Drugs by David Werner Among the issues that most trouble the West, and especially the United States, are the international traffic in drugs and the third world debt. The linkage between the two is often missed. Both involve corruption, but there is a lot more to the relationship than that. –Olusegun Obasanjo, former president of Nigeria

#17 | LUPE THE WILDCAT: a PROJIMO Rehabilitation Story; Hesperian Wins WHO Award; and Announcing a New Book: Disabled Village Children

Lupe, The Wildcat Story by Molly Bang Based on real-life experiences at PROJIMO Lupe was a wild little girl. Her two brothers, Paulo and Jorge, were almost as wild as she. They all swam in the deepest water holes. They swam when the river was running high. Once Paulo was swept a mile downstream before he was caught in a tree half-submerged in the water and was able to pull himself out.

#16 | Stories from PROJIMO: Bruce's Experience with Mari and Updates from PROJIMO; News from Project Piaxtla and Hesperian Foundation

Mari by Bruce Curtis EDITOR’S NOTE: Bruce is a quadriplegic wheelchair rider who for years has worked as an organizer, advocate and peer counselor for disabled people, both in the U.S. and abroad. His experience in advising local groups of disabled people in Mexico and Central America makes him a valued guest at Project PROJIMO. This is Bruce’s account of an interaction he had with Mari, one of the PROJIMO workers, during a UNICEF-funded and PROJIMO sponsored rehabilitation course held in Ajoya earlier this year for rehabilitation workers from all over Central America.

#15 | THE BIRTH STORY OF PROJIMO: the Team Helps Teresa Smile; Piaxtla Versus the Government Health Center; and Where There Is No Doctor Now Part of Mexican Health Ministry Efforts

Once again, the health workers of Ajoya, Mexico, have shown their pioneering spirit and creativity. Their new rural rehabilitation project, which we mentioned briefly in our last newsletter (#14, Jan. 1982) has evolved into an exciting and comprehensive program. It is the main topic of this newsletter. But first we would like to bring you up to date on some of the other news and events that have taken place in Ajoya over the last 19 months.

#14 | Women Unite Against Drunkeness: Project Piaxtla Updates; and Announcing 'Helping Health Workers Learn'

Women Unite to Overcome Drunkenness Word that she had been shot reached the village of Ajoya only a few minutes ahead of the stretcher bearers. People said that she was dying, shot in the back by her husband. A few minutes later, a crowd of men, women, and children—shouting and wailing—streamed into the old adobe clinic. Sweating stretcher bearers carried Laura into the patio and lowered the homemade stretcher onto a cot.

#13 | Self-Sufficiency, Internationalization, and Child-to-Child: Major Updates on Project Piaxtla and the Hesperian Foundation

An Update on Project Piaxtla’s Growing Self-Sufficiency Project Piaxtla is alive and kicking. The Hesperian Foundation is up to its ears with work—some of it old hat, much of it new and exciting. If a long time has gone by since the last newsletter came out, it is not because little has been happening, but rather too much. The villager-run health program in the mountains of Mexico (Project Piaxtla) has become increasingly independent from the Hesperian Foundation and other outside support.

#12 | Thinking About Community: Exploring the Americas for Community-Supportive and Community-Oppressive CBR Programs; Updates on 'Donde No Hay Doctor'

Dear Friends, During the past year the village health team in Ajoya has made some giant steps forward, toward self-sufficiency. Today the entire program, consisting of the referral and training center in Ajoya and a dozen health posts in outlying ranchos and villages, is completely directed and run by campesinos. There are no longer any Americans or other “outsiders” continuously participating in the ongoing program.

#11 | Vignettes from the Pueblo Viejo: Victor Miller Describes his Experiences Setting Up Health Outposts; and the Changing Role of American Volunteers

Preface and Project Piaxtla Updates by David Werner Dear Friends of Project Piaxtla, The substance of this Newsletter has been prepared by Victor Miller, a 28 year old Californian who, as a volunteer for Project Piaxtla, spent the last two years in the back country of the Sierra Madre helping villagers set up their own “clinics” or health outposts, and in training the village workers to take them over.

#10 | A Crisis of Principles: The Curative Mission-Creep of the Ajoya Clinic; Debating 'Excellence' and Simplicity; Adapting to an Educational Mission; and the Tragic Story of María

Dear Friends of Project Piaxtla, I ask your understanding. This newsletter is admittedly too long, largely because of the story of María, the circumstances of whose last days and moments have been eating at me, and which I have need to get out. I might have divided up the newsletter, but the first part, I think, helps set the stage for the main accounting.

#09 | Of Mules and Dances, Death and Books: David Pays Respect to Heraclia the Mule; Ajoy's Violent Dance Tradition; a Birth Goes Wrong; and 'Donde No Hay Doctor' is Published

Dear Friends of Project Piaxtla, Upon reading this newsletter, you may wonder that I carry on at such length about mules. Remember, however, the unique importance of these sure-footed animals to the actual delivery of health services in roadless wilds where the ambulance is still as fabulous as the unicorn. Remember also, that here in the barrancas what is often most crucial to patient survival is not great medical know-how, is not a wide spectrum of medicines, but is getting to where one is needed in time.

#08 | Dawn in Ajoya: The Piaxtla Diaries of Dr. Kent Benedict; First Indications of a 'Guía de Medicina'

Preface and Project Piaxtla Updates by David Werner The participation of Dr. Kent Benedict, pediatrician from California, at, the Clínica de Ajoya for most of the past year and a half has been a great boon. Not only have the villagers received better medical care than ever before, but all of us amateurs who have had the opportunity to work with Kent have learned a tremendous amount from him about the practice of medicine, for not only is Kent a first rank practitioner, he is an inspiring teacher.

#07 | A More Personal Report from Project Piaxtla: The Orphan, the Flood, and the First Inklings of Where There Is No Doctor

¡Fíjese! Que no la fijaba nada, Ni me levantaba los ojos Y allí estaba, al oscurecer Sonriendo tranquilamente por abajo Sin agitarse: La luna, casi llena. Imagine! I had not even noticed her, Had not even looked up And there she was, at dusk Smiling quietly down Unruffled: The almost-full moon. Taking a Personal Turn Sometimes, alone at night at my mountainside clinic, as I sit on the stone bench beneath the huge Royal Pine in the patio and look up through its black silhouette at the vast and muted sky, I, like the moon, find the needed distance and stillness to reflect.

#06 | PIAXTLA PROJECT UPDATES: An X-ray machine and A Portable Dental Drill for the clinic, Making Dentures, and New Clinics Opening

Updates on the Ajoya Clinic Our back-woods clinic in Ajoya is still a far cry from the emergency room of a modern America hospital. You can still write your name in the dust of the sterilizing tray after a wind storm in the dry season. Mud still trickles down the white-washed walls from recalcitrant leaks in the tile roof during the monsoon season.

#05 | Fifth Newsletter: The Story of Manuel; Piaxtla's Medical Personnel; Operation Fill and Drill; Ecological Problems in the Barrancas; Education Updates; and More

All It Took Was Heart: The Unexpected Recovery of Manuel Alarcón After the wedding and the wedding feast, the entire village, from the tottering young to the tottering old, turned out for the wedding dance. In Ajoya, weddings don’t happen very often. Of the three types of marriage—iglesia (church), civíl judge) and matorro (underbrush)—the matorro espouse most newlyweds, with only the stars and mosquitoes attending the ceremony.

#04 | Fourth Newsletter: The Hurricane; The Water Project; New Staff; El Zopilote; Developments in Education; Medical Successes and Challenges

The Hurricane By the end of August there was new hope in the barrancas of the Sierra Madre. Heavy storms had been lighter than usual during the summer monsoons, and seldom had the river left its banks. Yet the rains, though gentle, had been persistent, and the campesinos had begun to rejoice at the prospects of a bumper corn crop. On the slope below my new upper dispensary I, too, had my own small patch of corn, planted for me in appreciation by villagers of El Llano, about a mile away.

#02 | Second Newsletter: The Political Origins of the Piaxtla Project Corn Bank; and Project Updates

The Political Origins of the Project Piaxtla Corn Bank When I first came to the barrancas, I had no intention of taking part in political issues or getting involved in any village problems other than strictly medical ones. I did not wish to champion major changes in the way the people live. For I felt that in spite of the many hardships and inefficiency of labor there was still a great deal of beauty and joy in the lives of the villagers.

#01 | First Newsletter: Visits by Students, Dr. Brock, and Dr. Prince; Update on Martín; David's Dental Training; Prospects for a Birth Control Program; and Sourcing Medical Supplies

The series of journals titled “Report from the Sierra Madre” (see: 1 2 3 4) terminated with No. 4. However, many subscribers have shown so much interest in my continuing Mexican Project that I would like to keep them informed, if briefly, of my activities in the barrancas since the last Report came out in February. One: A Visit by Students and Dr.