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. Today the entire program is organized and run by a team of campesino health workers based at the training and referral center in Ajoya, a small village at the foot of the Sierra Madre Occidental. No longer are any Gringos—or Mexicans who are not campesinos from the immediate mountain area—continually active in the project. Yet the village team continues to welcome, on its own terms, short visits by outsiders with special skills—medical, dental, veterinary, and appropriate technologies. Such visitors are usually requested not to practice but only to teach their respective skills, thereby upgrading the capabilities of the local workers who provide the continuity of care.
The village health team has learned the hard way that visiting professionals have a tendency to try to take charge. This not only obstructs the growing responsibility of the local team, but also undermines the campesinos' increasing confidence in their own health workers (and therefore in themselves). For this reason, the village team has learned to carefully select the professionals it permits to visit. To avoid the growth of dependency, it also limits the length of their visits and requests that they stay as much in the background as possible. Thus, the visiting doctor becomes an auxiliary to the village health workers, helping out with advice and specialized knowledge when asked. He is also encouraged to pitch in with the agricultural and janitorial work, as do all the members of the village health team. In this way, the village workers help the doctor to demystify his role; education becomes a two-way process.
Today Piaxtla is organized and run by a team of campesino health workers. No longer are any outsiders continually active in the project.
The team of young campesinos—some of whom, like Martin Reyes and Miguel Angel Manjarrez, have been closely involved with the project for twelve to thirteen years, since they were children—now takes assertive pride in planning and running the program itself. Not only has the group become self-reliant in terms of local personnel, but it is also determined to become financially self-sufficient. To do this, the team has had to look for ways to produce subsistence income. This includes modest fees for service. Except in exceptional circumstances, there are no hand-outs or giveaways. People are asked to pay for services, either with money or with work. However, to keep the cost of services low, all the members of the health team spend a part of their time working at various “self-sufficiency projects,” which include hog and chicken raising, vegetable farming, and a cooperative corn bank. By loaning corn at planting time to poor campesinos at low interest rates, the corn bank actively opposes the usurious interest (250-300% in six months) charged by the local land barons. Thus, the corn bank helps the poor of the village in their struggle for self-reliance—and social justice.
The Hesperian Foundation now provides only about 50% of the village health program’s ongoing costs. At times it also responds to infrequent requests by the village team for “seed money” to initiate or expand its self-sufficiency projects.
The village health team has found that economic self-sufficiency does not come easily. Their biggest hurdles have been the mastering of management skills and learning to work together democratically as a group. Nevertheless, in both these areas they have made astounding progress, through a process that might be called “continual productive crisis.” The obstacles and dilemmas they have had to overcome, especially at the human, intragroup level, have been formidable, but the team has somehow struggled through them. Gradually, the group has learned to work together more cooperatively, more realistically, and mare unselfishly. They have discovered that the building of constructive, more truly human relationships between people is what most influences health—be it of individuals, programs, or communities. Preventive and curative medicine are secondary.
Phasing Myself Out as Leader
As for myself—as the initiator of the program and as an outsider (though I feel more at home in the Sierra Madre than anywhere else)—Project Piaxtla has evolved to the point where the most positive thing I can now do for it is to keep out of the way. The village health program has grown up, or at least has reached its adolescence. It is fourteen years old. The community team feels its budding strength, its youthful hard-won integrity, and is determined to make it on its own or bust. With personal sorrow yet vicarious pride, I have accepted that my ongoing presence in the village program is no longer wanted or needed. So I have undertaken to phase myself out.
At the request of the village team I have, during the past two years, been spending about one quarter of my time with the project as a friend and advisor. When I am there, I play a minor role and leave the running of the program completely to the village team. It has been easy for me not to make decisions directly. But it has been much harder to avoid manipulating decisions indirectly. Because I had played a leading role in the project for so long, at first the local team tended to take my ideas and suggestions too seriously. Now they are learning to take them more for what they’re worth—weighing them against their own experiences and views. (A few really stupid suggestions on my part have helped this learning process no end.)
To become an effective leader is difficult, but to cease being an effective leader is far more difficult—and in the long run far more important. I’m just beginning to learn.
The Village Team Organizes and Runs the Ajoya Training Program
Although both the Hesperian Foundation and Project Piaxtla are now far less dependent on each other, they often work together on exploring alternative approaches within the field of community-based health care and health education. Both have a growing commitment to encourage a productive interchange of experience and methods with other persons and community groups who share the goal of helping people gain more control over their health and their lives. We have approached this process of sharing experience and information in several ways.
For example, during the annual two-month training program for village health promoters the Ajoya team makes a point of inviting participants from other community health programs in Mexico and Central America. Last year, two young men came from a radical, very exciting program training “medicos campesinos” in Nuevo León, two nuns working with the Cora and Huichol Indians came from the mountains of Nayarít, and two very active leaders came from a spirited campesino women’s health promoter program in Olancho, Honduras. All these persons contributed a great deal to the Ajoya training program and also learned a great deal from it.
Through constructive criticism and group self-evaluation, the trainees helped the teachers learn to teach.
All the teaching and organization of the health promoter training program was done by the village team. My co-worker, Bill Bower, and I attended the training program, but did not give classes ourselves. We remained in the background and helped the local health workers prepare their classes when they asked.
Last year was the first year that the teaching and organization of the training program was done completely by the campesino team. Everyone felt fairly much on equal footing, and shared in both learning and teaching. Through constructive criticism and group self-evaluation, the trainees helped the teachers learn to teach. It is significant that those who had attended the previous year’s course, which in large part had been taught by Gringos, all agreed that the campesino-taught program was superior. I thought so, too. One of the most important things that persons from other programs learned was how rich an educational experience can be when a group of unassuming people teaches and learns from each other.