Piaxtla, the villager-run clinic, continues to provide a wide range of services for the people of Ajoya and the surrounding, more remote villages and ranchos, despite the continued presence of the free government-run clinic. An unfortunate impact of the government clinic has been to reinforce a dependency among the villagers on unnecessary medications, a custom the Piaxtla team worked hard to discourage, promoting sensible self-care instead.

Today, although the Piaxtla team does fewer consultas, their services are preferred over the government clinic’s when there is a medical emergency and someone needs to be hospitalized. Over its 20-year history, Project Piaxtla has developed a good relationship with physicians and private hospitals in Mazatlán and Culiacán who will usually provide free or low-cost services for Piaxtla-referred patients. The government clinic, on the other hand, sends emergency patients to a referral hospital that is farther away and more difficult to reach by public transportation. In addition, the referral hospital provides only a limited range of services. Patients often have to return several times for treatment, and frequently end up not getting treated at all.

The long-term effects of the Piaxtla team’s efforts are impressive. Before Project Piaxtla, 34 percent of all children in the Ajoya area died before age five, mostly from diarrhea and dehydration. Now, only five to seven per cent die. In the village of Ajoya alone, 20 or 30 children would die in one rainy season, when the river water would be especially dirty. Now, thanks to the work of the promotores, most village mothers understand the danger of dehydration and give their children Suero para Tomar (homemade rehydration drink) at the first sign of diarrhea. Only about one or two children die now during the rainy season.

Before Project Piaxtla, 34 percent of all children in the Ajoya area died before age five, mostly from diarrhea and dehydration. Now, only five to seven per cent die.

Similarly, the cause of death of one in ten women used to be a complication of pregnancy or childbirth. With the help of Project Piaxtla, village midwives have learned more about sterile technique, safe management of births, and family planning. With better hygiene and vaccinations in the last trimester of pregnancy, the incidence of tetanus in newborns has been greatly reduced, and more women have safe births and healthy babies. Neonatal tetanus is almost a thing of the past. In the few cases that have occurred, mortality was reduced by having promotores and the mother provide round-the-clock intensive care including feeding the baby breast milk through a nose-to-stomach tube.

One of the most remarkable impacts Project Piaxtla has had is in reducing the incidence of polio in the 5,000-square-mile area the Project serves. The disease is the most frequent disabler of children in the Third World, but in the Piaxtla area, there has been only one (questionable) case of polio in 16 years. In the last three years, by contrast, Project PROJIMO has seen nearly 200 children disabled by polio, all of them from outside the project Piaxtla area. This reduction in polio has been achieved through vaccination programs administered by locally trained village health workers, not by visiting health professionals.

The Mexican government’s rural health program does conduct vaccination programs, but they only visit villages that are reachable by road. At the request of villagers in more remote areas, the Piaxtla team continues to ride a day’s journey up into the mountains to areas that the government doesn’t serve.

To improve nutrition, over the years the team has promoted reliance on local resources such as breast feeding and locally grown crops. Following the lead of the Piaxtla team’s demonstration garden, many families now raise their own crops.

In addition, a recently started program to vaccinate all the chickens and pigs in the area should prevent these much-needed food sources from being wiped out by epidemics every three or four years as they have in the past. The improved nutrition that has resulted from, all this has helped resistance to disease, especially in small children.

Miguel Angel Manjarrez and Miguel Angel Alvarez, who began as village health workers with Project Piaxtla when they were young teenagers, are both nearing completion of their training as physicians. Miguel M., who finished third in his class, is doing his year of government service at a hospital in San Ignacio, and Miguel A., who finished first in his class, is doing an internship at a government clinic in Culiacán. Both men have become valuable resources for the Piaxtla and PROJIMO teams because they return to Ajoya on their days off to share with the village health workers the skills they have learned.

Before coming to Piaxtla, Miguel A. lived in a remote, single rancho where he helped his family raise goats. His medical school class elected him to give the graduation-day address. Miguel, dressed neatly but simply, (all his classmates wore tuxedos), spoke of the necessity for doctors to work both for a modest wage and in rural areas.