What’s Going On In Ajoya?—In the Shadow of The Government Health Center
Big changes have taken place in the community-based health programs in Ajoya—in the ‘home’ village of Project Piaxtla. Nearly 3 years ago the Mexican government put a health center in Ajoya with a doctor who provides free services and lots of free medicine. Meanwhile, the focus of Project Piaxtla is turning from ‘medical care’ toward more fundamental factors affecting health—namely social and political issues. The village team has put much emphasis on organizing groups of campesinos to define their constitutional rights in questions of land tenure, grazing rights, public water supply, etc. The local people have begun to discover that there are alternatives to silently suffering the abuses and corruption of those who hold the land and power. They have learned that in unity they have strength. They have succeeded in recovering communal land for the poor, removing a corrupt administrator (of the public water system) from office, taking the government subsidized store out of the hands of a profiteering rich family and putting an honest peasant in charge, and organizing campesinos in several villages to start cooperative corn banks in order to escape the exploitative loan system of the rich.
In the process, health workers and village leaders have been jailed, and several attempts have been made to close down the village clinic. But newspapers, friendly doctors, and university groups have stood up for it, and Piaxtla struggles on.
The new government health center has had a demoralizing effect on the village health team. For years, the health workers have worked with the community to help people toward sensible self-care. They have tried to demystify medicine and have discouraged the overuse and misuse of medicines, especially injections, vitamin tonics, cough syrups, diarrheal ‘plugs’, unnecessary antibiotics, and unnecessary IV’s (intravenous solutions). It took years, but people were learning to use medicines more sensibly. In 15 years, child mortality dropped to one quarter what it had been when the program began. Spending less on medicines and more on food was, of course, only one factor in lowering child mortality—but an important factor.
Now, with the new government health center, people forgot almost overnight the sensible approach to medicine that they had learned over the years. Today people flock to the government health center to stock up on cogh syrups, diarrheal ‘plugs’, antibiotics and vitamins. Old and anemic persons are once again routinely given IV solution (known as ‘artificial life’) as a pick up. It is all supposed to be free—but many of the doctors who rotate through the center find ways of taking a great deal of money from the people (by referring patients to private ‘surgical centers’ in the city for costly surgery they often do not need). One of the government doctors stole hundreds of thousands of pesos from gullible farm families and caused the death of a child through wrongly administering a dangerous medicine. The village team tried to expose this doctor by putting on village theater potraying his deeds. As a result, this doctor threatened to kill the village health workers if they continued to expose him. He lied about the village clinit to government authorities, who once again tried to close it down. Only when the doctor made both his young village auxiliary nurses pregnant did the government fire him.
Through this and countless other experiences, the village health team has learned a most important lesson: Only when the whole corrupt system is changed so that health personnel at all levels hold the people’s interest at heart, can health education really be lasting and effective.
Sharing Experiences, Learning New Skills
The Ajoya health workers are trying hard to share their experiences with others. They have conducted 3 ‘educational exchanges’ in Ajoya which village workers from other programs in Mexico and Latin America have attended. In the spring and summer of 1982, they led workshops on teaching methods for health educators and health workers in Nicaragua and participated in the first international Child-To-Child seminar in Guatamala. Refresher courses have been held in nearby mountain villages.
Although the Piaxtla team has trained health promoters for the Ministry of Agrarian Reform and rural “cultural promoters” in the case of Where There Is No Doctor (WTND) the Ministry of Health has, until recently, done more to obstruct than to assist the village-run program.
This September, however, IMSS/COPLAMAR, the Mexican government agency that set up the new health center in the first place, has invited Piaxtla team members and David Werner to participate as instructors in an upcoming international course. The same agency is also estabilshing a new promotores system for all of Mexico. They will use WTND as their text, and they have asked Piaxtla members to advise them. As for the government center in Ajoya, 2 of Piaxtla’s senior health workers now in medical school expect to be assigned here when they graduate as doctors.
Decentralizing the Piaxtla Corn Bank
In the same spirit of widening their area of action, the Project decided to decentralize the corn bank that has been effective in reducing malnutrition and getting poor families out of debt. So many families wanted to participate that the corn bank could not be managed out of Ajoya alone. Now there are 5 new independent corn banks in outlying villages. Following a visit this September by Roland Bunch, World Neighbors’ Mexico and Central America Coordinator, the health team decided to invite a Guatemalan campesino to Ajoya. This campasino will introduce local slash-and-burn farmers to a simple low-cost contour ditch system suitable for the marginal hillsides that the poor are forced to cultivate. The villagers expect that the system will triple corn yields, improve their plots, and protect the dwindling forests and eroded lands of the area. The Piaxtla team will be paying part of the Guatemalan’s expenses with their monthly income from WTND. Roland Bunch’s book on community-based agricultural improvement, Two Ears of Corn, is not being distributed by the Hesperian Foundation.