(This page is adapted from a chapter of the HealthWrights book, Questioning the Solution: The Politics of Primary Health Care and Child Survival).

Project Piaxtla in western Mexico is a rural primary health care program run entirely by local villagers. Named after a nearby river and located in the foothills of the Sierra Madre mountain range, Piaxtla was started 30 years ago to serve a large, rugged, sparsely populated region in the state of Sinaloa. Until recently the area was traversed only by mule trails and footpaths. The program is based in Ajoya, the largest village (population l,000) in Piaxtla's area of coverage. David Werner, author of Where There Is No Doctor, has been involved with this program as an advisor and facilitator since its inception.

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

This adverse situation stemmed in large part from an inequitable distribution of land, wealth, and power. Most campesino or poor rural families owned little or no land, and what land they did own was of inferior quality. In contrast, a handful of rich local families held large tracts of fertile, river valley land, owned large herds of cattle, and were quite wealthy. These few wealthy families completely controlled Ajoya's community council. They repeatedly blocked all attempts by poor farmers to organize or demand their constitutional land rights, resorting to violence when they felt it was necessary in order to maintain their dominant position.

Land distribution has long been a critical issue. The 1910 Mexican Revolution was largely triggered by the feudal land policies of the president-turned dictator, Porfirio Diaz, who had given huge tracts of land to wealthy cronies. As the best farmland had become concentrated in giant plantations, or latifundia, the landless peasants had few options. Either they worked for the powerful landholders as serfs or sharecroppers, or they retreated into the hills to grow scanty crops on steep slopes using slash-and-burn farming. Either way, survival was difficult.

In the Mexican Revolution--with the war cry: "Tierra y Libertad!" (Land and Liberty!)--landless campesinosthroughout the countryside united behind popular leaders such as Pancho Villa and Emiliano Zapata. At last, the Diaz dictatorship was overthrown and a new revolutionary Constitution was drawn up.

At the heart of this Mexican Constitution was, until recently, its agrarian reform legislation, which included the famous ejido system. According to this system, a group of villages could join to 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, and they 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. To further prevent the return of huge plantations, legal limits were placed on the size of property holdings.

Some social analysts say the ejido system contains the best of the political Right and the Left, encouraging the personal incentive and high production of private ownership, while guaranteeing the equity of land use intended by socialism. However, the ejido system has worked better in theory than in fact. Since the Mexican Revolution, the biggest problem has been institutionalized corruption. Although the Constitution calls for a democratic multi-party system, for 60 years a single political party--the Institutional Revolutionary Party (PRI) backed by brutal military and police force--has remained in power. In spite of growing inequities and hardships for the poor, it has clung to power by resorting 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 corrupt regime, both the ejido system and the laws limiting the 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.

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