Village Health Worker Becomes Doctor—And Returns!

When more than 10 years ago, the Hesperian Foundation agreed to help sponsor two of the young village leaders of Project Piaxtla through medical school, everyone knew it was a gamble. Could the vision and commitment of two village health workers, outstanding as they were, survive all those years in the big city? Would the peer pressure, elitist values, and misdirected priorities of medical school corrupt them? Would they still be willing to work for farmer’s wages, and treat their fellow villagers as equals? Would they even return?

Although some members of the Piaxtla team were convinced that the two village health workers would never return, the decision was made to send them to medical school. Medically, the village team felt little need for a doctor. Experience had taught them that a well trained village health worker can often help people overcome common health problems more effectively than the average doctor and with fewer barriers of language, attitude and education. Politically, however, the team had felt an increasing need for a titled doctor, as a strategy for self defense.

Since it began in 1965, the villager-run health program has suffered repeated attacks from the medical establishment. Although it has had suport from the Ministry of Education, and has helped to train health workers for the Ministry of Agrarian Reform, the Ministry of Health has repeatedly tried to close down the program. So have certain private doctors from larger neighbor- ing towns. Medical professionals have opposed the program mainly because the village health team has often assumed the role of “patient advocate,” defending and educating people about the standard abuses of self serving doctors and medical facilities.

Confrontations between the village team and government health services became more extreme when, eight years ago, a government medical post was opened in Ajoya (the base village for Project Piaxtla’s training and referral center). In spite of offers by the village team to cooperate with the government center, its young doctors consistently tried to undermine the villager run program. Tension came to a peak when one young doctor went too far. Not only did he leave his two village “auxiliary nurses” pregnant, he economically ruined family after family by sending patients to a corrupt surgical center in the city for surgery they did not need. During his year of “service” the local incidence of appendicitis tripled. One old man who could not raise the money for an appendectomy was treated by a village health worker with antacids, and recovered. When the village health team began to protest the abuses of the doctor, he threatened to kill them. He then called in a group of health authorities who threatened to close down the village program, “unless it had a doctor who would assume full medical responsibility.”

So the village team began to feel the need for a doctor but for a doctor who was first a village health worker.

Project Piaxtla now has two dedicated young doctors

Both of the health workers who the program sent through medical school finished at the top of their class. And both did return to work with Piaxtla. The first, however, had difficulty reintegrating into the village team. And after a year, he left for the U.S. to live in California.

The second health worker who is also a doctor, Miguel Angel Alvarez, not only reintegrated well into the village team, he brought with him another young doctor, Ana Luisa, his wife. Ana Luisa, like Miguel Angel, is committed to living and working in the village. So, Project Piaxtla now has two dedicated young doctors. Neither likes to make it known that they are doctors. They prefer to be called promotores de salud —health promoters—and share the same responsibility as their village peers.

After Great Difficulties—A New Start

During the first half of the 1980s, Project Piaxtla went through hard times. The introduction of the government health center in Ajoya undermined the people’s commitment to the villager run program, and lowered the morale of the team. At the same time, violence related to increased drug growing in the mountains made travel to visit health workers in outlying villages dangerous. With the economic crisis and devastating inflation, farmers, school children, local officials, healers, and even some of the best health workers turned to growing opium poppies. Little by little the villager run health program in some ways became a shadow of the proud pioneer in primary health care that it had once been.

In some ways, however, the Project continued to evolve. Its main focus shifted from health care to organizing poor farmers. It has helped them to defend their land rights, to start cooperative corn (maize) banks, and to take a united stand against corrupt local authority. As a result, a substantial amount of land has been reclaimed by the poor farmers. Along with other measures this has led to a stronger economic base for the poor. In the long run, this process of empowerment and struggle for justice may serve to improve people’s health more than ‘health services’.

With the return of Miguel Angel, the village team has become determined to rebuild the primary care program. It has already made a good start. In spite of the risks of travel into the mountains, the team has made visits to many villages, reestablishing contact with health workers and recruiting new ones.

Cantina Finally Closed

Another important accomplishment of the Piaxtla team, has been to close the local bar. Five years ago the health workers organized the village women to protest the opening of the bar. As a result, Roberto, Miguel and several other health workers were jailed without charge. Protest by the village women led to the release of the health workers and an order by the State Liquor Authority not to open the bar. But a year later, the bar sud- denly opened. The right palms had been greased and a permit issued. While Governor Toledo Corro (who promoted both public bars and narcotics trade) was in office, there was no way to close the bar in Ajoya. As a result of drinking, there were many beaten wives, hungry children, and at least 12 killings.

After the new governor took office in January 1987, the health team, backed by most of the village, again took up petition to close the bar. With the help of an editor of a major newspaper El Debate (whose disabled daughter has been served by PROJIMO) an open letter to the governor was published, calling for the closure of the bar. Five days later the bar was abruptly closed. Most people in the village (even some of those with a drinking problem) are delighted.

Formation of an Inter-Program Team of Villagers as Trainers

This February, local village instructors from Ajoya, joined by two village level instructors from community based health programs in Honduras and El Salvador conducted a training course for village health workers with a new feature. (The visiting instructors participated through an arrangement with the Regional Committee of Community Health Programs of Central America and Mexico.) Participants will become an international, training team of experienced village health workers who can guide new programs in teaching their new health workers.