1. Educational Exchanges Aamong Community-Based Programs

The health team of Project Piaxtla has made more effort to share the innovative ideas it has developed over the years with other programs in other parts of the world.

In Mexico and Central America, there are dozens—indeed, hundreds—of community based, non-government health programs. In recent years, an increasing effort has been made to build communications between different programs, to share ideas, and to learn from each other. The Ajoya team has cooperated closely with the Regional Committee of Community Health Programs, until recently based in Guatemala, to promote such communications.

The third biannual “Encuentro Regional” or regional meeting of community health programs was held in Ajoya, Mexico in the spring of 1980. In addition, members of Project Piaxtla attended a regional meeting of Mexican health programs in Ixmiquilpan, Hidalgo and have traveled throughout Mexico visiting other local programs.

Project Piaxtla has also held two “Intercambios Educativos,” or educational exchanges, two to three weeks long, in which village-level instructors come together to share ideas and to compare approaches and problems. These educational exchanges have been both a source of information for our new book, Helping Health Workers Learn, and occasion for field testing of preliminary drafts.

2. Visits by Piaxtla Leaders Outside Latin America

In many health programs around the world, increasing importance has been placed on the need for villagers and people working in their own communities to take responsibility and play a leading role in planning and decision making. But when it comes to conferences and policy-making on a regional or international level, usually only the professionals and experts attend. We feel there is a desperate need for village-level health and development leaders to be involved in more conferences and interchanges at the international level.

This has begun to happen in Latin America. Several times in the last three years, health workers and village-level instructors from Project Piaxtla have visited other programs in Latin America. Health workers from other programs have also visited Ajoya for training programs, apprenticeship in dental skills, and other activities.

The conference closed with an official decision to change its title from “Let the Village Hear” to “Let the Village Be Heard.”

Also, in 1980, Martín Reyes, coordinator of Project Piaxtla, had an opportunity to attend a conference in India entitled “Let the Village Hear.” As it turned out, he was one of only a few villagers present at the conference. Yet his impact was considerable. He stressed the need for more villagers to have a chance to exchange ideas rather than to be talked about. The conference closed with an official decision to change its title from “Let the Village Hear” to “Let the Village Be Heard.”

In the month of August, 1981, a unique interchange was arranged in which village health workers from Central America had an opportunity to visit the Philippines and exchange ideas with health workers there. Arrangements were made and funding raised by an Inter-Agency Committee of health programs in the Philippines.

Participants from Latin America were:

• Martín Reyes and Roberto Fajardo, coordinators of Project Piaxtla,

• Exequiel Gómez, village health worker and president of ASECSA, a Guatemalan association of community-based programs,

• Julia Saldanas, leader in an outstanding all-women’s health promoter program in Honduras, plus

• Bill Bower and David Werner from the Hesperian Foundation.

This interchange was of enormous value and stimulus to the participants both from the Americas and the Philippines. A great many insights were gained on both sides about health, politics, and the need for the poor of the world to work together for change. The idea for the women’s sewing cooperative mentioned earlier came from a visit to such a co-op in the Philippines.

We hope that more such interchanges between village-level workers of community based programs within countries and between countries will be possible in the future.

3. Prospects for a Unique Rehabilitation Program in Ajoya

For years, Project Piaxtla and the Hesperian Foundation have been bringing children with infantile paralysis and other disabilities to the Shriner’s Hospital for Crippled Children in San Francisco.

But the disabled children for whom hospital care can be arranged (or is appropriate) represent only the tip of an iceberg. The Ajoya team has begun to work with the families of handicapped children so that supportive care and basic therapy can be provided at low cost by parents, brothers, and sisters at home.

Now the Ajoya health team—several of whom are handicapped themselves—has determined to start a villager-based rehabilitation center. This will be run by disabled villagers to serve handicapped children and their families. The main focus will be education of the family and integration of the disabled child into family, school, and community. Already there is a lot of interest in the village. The son of the blacksmith—a young man with a leg crippled by polio—has offered to provide a large inside porch as an orthotics workshop, and to teach blacksmithing to other disabled participants. A village welder is eager to learn techniques of low-cost wheelchair making from a paraplegic craftsman in San Francisco, and to teach others. Contacts have already been made with self-help disabled groups in Nicaragua, Bolivia, and Thailand, exploring possibilities for exchanges for villagers to learn skills including physical and occupational therapy, brace and artificial limb making, appropriate technology in wheelchair construction, educational toys for the handicapped, homemade therapeutic aids, etc.

Already a set of color slides, taken in Ajoya, on simple home rehabilitation methods at the village level, is being used by UNICEF, Rehabilitation International, and other groups.

For those interested in a detailed prospectus of the proposed community-based rehabilitation program, to be called “Project PROJIMO,” please write the Hesperian Foundation. We are looking for donations of funds, tools, materials, and volunteer help (preferably by disabled persons able to teach rehabilitation-related skills.)