Where There Is No David Werner: Setting the Record Straight

This is a story about how those who present themselves as saving lives uphold a system that features a fundamental, defining, life destroying exclusion—and unironically embrace the hipocrisy of exploiting the work of a man they have spent the past 26 years destroying.

David Werner is the Original Author of Donde no hay doctor and Where There Is No Doctor

There are rumors going around that Where There Is No Doctor wrote itself …

… or that anonymous individuals writing for an opaque organization wrote it, here …

and here …

The following quote is interesting in part because it reveals—yet again—how hard Hesperian leans upon the work of David Werner, while encouraging others to misattribute authorship to Hesperian, note: “Hesperian writes … " Both Where There Is No Doctor and Disabled Village Children are mentioned in the article, but David Werner’s name is not attributed. Instead we are told

Hesperian’s books give people the tools to make health-related decisions when they matter most.

JoAnna Haugen, who wrote the article for Worldview Magazine (Winter 2009), writes in her author bio:

JoAnna Haugen (Kenya 04-05) is the community news editor for the National Peace Corps Association. She read Where There Is No Doctor cover-to-cover as a Peace Corps Volunteer.

Notice that authorship is attributed to Hesperian, or that that the work “was written”—never “written by” any particular person? This is carefully crafted language.

And sometimes Where There Is No Doctor is just born:

As if to emphasize the ever growing absurdity of Hesperian’s self-regard, they posted this gem on Februrary 12, 2017:

This is yet another carefully crafted misappropriation of the accomplishments, principles, and character of David Werner. Before Hesperian was an organization, there was David Werner. It was he who believed that people could learn what they needed to know to improve their own health, and with growing awareness came to understand that health for the rural poor was not a matter of access to expensive treatments, but to the basic necessities—food, clean water, good shelter—access to which were determined by deeply rooted economic inequality. For David’s ideas about this, read Newsletter #29 which traces the development of radical political action within Piaxtla.

To set the record straight, the Hesperian Foundation did not author Donde no hay doctor or Where There Is No Doctor. The original author of Donde no hay doctor and the author / translator of Where There Is No Doctor is David Werner. David Werner set up the Hesperian Foundation to fund his Mexico Projects, and then began publishing under the rubric of the Hesperian Foundation years later.

It has been claimed by Todd Jailer, Managing Editor at Hesperian, that

Hesperian, not David Werner, holds all the copyrights to the materials created while he was being paid by Hesperian. This arrangement was his own design and he re-affirmed it when he separated from Hesperian.

It isn’t my place to contest the copyright. But Todd’s characterization of David’s relationship to Hesperian is misleading, if not deceptive. David Werner did not write Donde No Hay Doctor as the “paid” scribe of the Hesperian Foundation, because it did not exist when he began writing his book. David Werner created the Hesperian Foundation, which was not originally a publishing venture. In 1993, three board members of the the Hesperian Foundation staged a coup (while three other board members were out of the country) and voted David out. He wrote a letter of resignation, but spent thousands of dollars trying to regain the rights to his works, which he was not able to do. It is only in that sense that David “re-affirmed” Hesperian’s control of his writings after the split.

The officials of the Hesperian Foundation have long used David’s generosity of spirit, his desire to acknowledge everyone involved no matter how great or small the contribution, and his life-long solidarity with the people of the Sierra Madre to misconstrue authorship with the express purpose of denying David Werner the moral rights to his work—the right to be acknowledged as author.* While Hesperian dutifully acknowledges David wherever they are legally bound to do so—on the purchase page, or the copyright page—they routinely refuse to acknowledge his authorship whenever and wherever they can. It appears the staff of the Hesperian Foundation staff are trained in methods of distorting the true authorship of David Werner’s work to the public.

2013: Celebrating 20 Years of Where There Is No David Werner

One wonders why—in 1993—the three board members of the Hesperian Foundation did not themselves resign if they felt David Werner was not worthy of their respect and association. It is easy to see the truth: they seized by means of force the properties and legacy of David Werner and have been squatting on them ever since, profiting, and earning awards in the name of Where There Is No Doctor, while actively soiling the reputation of its author, and working behind the scenes to deny him opportunities to continue his life-saving work—even now, when David is in his late 80s.

As the designer of the new HealthWrights website, which I understand to be in part an archive of the life work of David Werner—which is to say, much more than a typical website—I had intended to create a detailed timeline of the publication of David’s books, including as many covers of as many translations of Where There Is No Doctor as we could get our hands on.

It came as a suprise to me to learn that David Werner wasn’t in possession of his own papers or original copies of Donde no hay doctor or Where There Is No Doctor. It turned out that he had treated the offices of the Hesperian Foundation as his personal store room—Hesperian was, after all, David’s life work—and the coup leaders seized it all and have refused him access to it.

And so of course, since they possess the original documents, Hesperian is at liberty to try to rewrite history however they see fit—except for the fact that everyone knows the truth.

The theft of David’s personal effects is not a false or exaggerated claim. Hesperian workers literally invaded David Werner’s home (then at Trudy Bock’s place) and removed his entire collection of Where There Is No Doctor books which he had collected over a decade, as well as many (and unknown) other documents, papers, and personal belongings. Just as David Werner had treated Hesperian as his home, Hesperian workers turned on David Werner and treated his home as their collective property. Hesperian stole David Werner’s personal property. They did so knowing that David was trapped by circumstances and would not be able to defend himself.

Consider also the 40th anniversary celebration of Where There Is No Doctor, held by Hesperian on September 20th, 2013, at the David Brower Center in Berkeley, California—David Werner was not invited. Instead of asking the book’s author to revisit the early history of the publication of his book, Hesperian arranged for a volunteer to create a video titled 40 Years with “Where There Is No Doctor” that honored the 40th anniversary of Where There Is No Doctor. It was made using David Werner’s own 8mm films and photographs of Ajoya, and was meticulously crafted to leave David out. His name is not mentioned, his face is not shown.

 

 

It must be disturbing to see your personal home movies siezed from you and repurposed to show that you no longer exist and never existed. An 87 year old man must especially long to see these old images of his friends and places from long ago, but they are being withheld from him. This scenario must shock any right-thinking person.

But not Sarah Shannon, Executive Director of Hesperian. Having purposefully excluded David Werner from the 40th anniversary celebration of his own book, she introduced this video into the proceedings. The theft and misuse of personal recordings, the falsification of history, the radical marginalization of the author of Where There Is No Doctor: Sarah Shannon embraces these cruel behaviors with enthusiasm.

Let us first of all establish the obvious fact that 8mm film plays no part in the production of the books Hesperian has copyright over. There is no aspect of Where There Is No Doctor that involves the reproduction of 8mm film. There can therefore be only one conclusion: Hesperian Health Guides is in possession of materials produced, collected, and owned by David Werner that goes beyond what could be justified as part of the process of producing Where There Is No Doctor, Helping Health Workers Learn, or Disabled Village Children. The materials in question cannot be said to belong to the raw materials of the books—notes, drafts, manuscripts, illustrations, photographs, etc., used in the production of the books. These materials represent both the historical documents of the Piaxtla and PROJIMO projects, as well as David Werner’s personal effects.

As the designer of this website I have had many occasions to be frustrated with the quality of the images found in Newsletters scanned in low resolution years ago. Perhaps that is why the following discovery churneed my stomach: finding a high resolution scan of the photograph that graces the cover of Where There Is No Doctor placed as the banner image of Hesperian’s YouTube channel.

I have asked repeatedly for better photos, and for this photo specifically, but have never received the answer. Now I understand: Hesperian has seized probably the entirety of David Werner’s manuscripts, photographs, and films which comprise his time in Mexico circa 1965-1993. All that remains for David Werner are the leftovers.

The press release posted on the Hesperian website announcing the celebration of “40 years with Where There Is No Doctor”—which amounted to 783 words—mentioned Donde no hay doctor or Where There Is No Doctor 11 times, but mention David Werner zero times. Instead of acknowledging the actual history of Where There Is No Doctor, Sarah Shannon used the opportunity of the 40th anniversary to place herself at the center of the Where There Is No Doctor drama:

She makes no mention of the man who made her courageous acts possible, whose writing continues to put food on her table. And she was surrounded by “more than 200 friends and supporters of Where There Is No Doctor” who saw nothing wrong in this. In our post-Trump era, when stopping the rise of fascism has become highly fashionable, people routinely strain themselves trying to figure out how the Germans went full-Nazi in the 1930s. All anyone needs to do is examine the minds of the people running Hesperian Health Guides, and their supporters.

For Sarah Shannon and these 200 “supporters” of Where There Is No Doctor present at the “celebration” David Werner no longer exists—only his property exists. David’s inconvenient persistance on this Earth—like any refugee made stateless by war—must be obscured by the victors, who keep up appearances through carefully crafted, institutionalized mendacity. It is this Sarah Shannon trains into all Hesperian employees and volunteers.

IS THIS TRUE? Having reviewed the video interviews of Hesperian volunteers, we found zero mention of David Werner, who founded the organization and wrote its most iconic works. Almost everyone Hesperian contacts or who reaches out to Hesperian begins their story with an experience with Where There Is No Doctor, and yet all of these people know not to mention David Werner. Is that normal? No, it’s pathological. The only rational conclusion is that they are being coached by Sarah Shannon to avoid mentioning his name, which is to my mind a clear infringement on David Werner’s moral rights as author of his books.

And of course that really is the central problem for Sarah Shannon: Hesperian is legally required to pay David Werner the respect of attributing authorship to him, and yet not talking about David Werner is one of her primary objectives. The cognitive dissonance Sarah Shannon must experience everyday knowing she is personally profiting off the work of someone she hates, knowing at any moment she might slip and say his name, constantly being obligated to intitiate new recruits into the law of omerta—the dirty secret of Hesperian Health Guides—Sarah Shannon’s cognitive dissonance has to be off the charts. She probably has PTSD, too. Poor Sarah.

It is no accident therefore that the culmination of Sarah Shannon’s efforts—and the conclusion of Hesperian’s 40th anniversary video—is Hesperian’s New Where There Is No Doctor. I think the name says it all: it is a new way of squatting on David Werner’s legacy, only this time with the lofty purpose of entirely rewriting the work, topic by topic, so that Hesperian Inner Party Members need never mention the name of David Werner ever again, thereby finally airbrushing him out of history.

Risking the comparison, I would say it’s like Good German’s seizing a Jew’s house and replacing it brick by brick so that they can declare “the Jew never lived in this house.” Technically true; morally bankrupt—like most of what Hesperian Health Guides presents as its history.

Nobody can say David Werner falsified his history. Indeed, it was because he told the truth that he was punished, and continues to be punished, vilified, and lied about. You can’t say the same thing about Sarah Shannon or the people working at Hesperian. Their entire professional lives are, at bottom, a Big Lie. And that is why they must work tirelessly at airbrushing David Werner out of history.

 

Cancel Culture: How David Werner was Erased from the History of the People’s Health Movement

In the run up to the 2018 People’s Health Assembly in Bangladesh, David Werner was informed that, though he had been invited to speak, there would be protests against his appearance. This was an event he had attended and spoken at before. Indeed, the People’s Health Movement was partly a consequence of David’s life-work. Although David was assured that people would defend him, it was decided that he would not attend. He was, after all, 84 years old.

Inquiring with David Werner, we have been able to piece together the story. The People’s Health Movement grew out of efforts David Werner was a major player in: the International People’s Health Council. This organization, led by Maria Zuniga and involving David Sanders, spearheaded international activism around Primary Health Care beginning in 1991. Although David’s involvement was not highlighted due to the controversies emerging in 1993, his relationship with IPHC is documented in the Newsletters from this time to 2006. (See: Newsletter #57.)

Leading up to 2000, the seeds IPHC (and other organizations) had sown began to take root, and the People’s Health Conference in 2000 led to the People’s Health Movement organization, of which the IPHC was a member in good standing.

However, continuous pressure was put upon IPHC because of David Werner’s membership. The European branch of the PHM demanded that David Werner be kicked out, or that the entire European membership would pull out. It was put to IPHC that they would have to remove David Werner, or IPHC would be kicked out. The IPHC members chose to dissolve sometime around 2006. Many of its key members joined the PHM—Fran Baum, Zafrullah Chowdhurry, and Maria Zuniga, for example. David Sanders became the PHM president until he passed away in 2019. That IPHC members took up such key roles provides good evidence that the IPHC, of which David Werner was a founding member, was crucial to the creation and leadership of the People’s Health Movement.

However, kicking David Werner out of official membership of the PHM was not enough for the anti-David Werner forces, as he continued to appear at conferences. In the run-up to the 2018 PHM conference in Bangladesh, considerable pressure was put upon organizers to keep David away, again by the European PHM. The person responsible for enforcing David’s exile? None other than Maria Zuniga, co-founder of IPHC with her long-time friend David Werner. She now played the role of Judas:

And she was very apologetic about it, but said, “well, we have to put the organization and the movement and the overall causes over the problems that have developed within, and therefore although I hate to throw you out, I think we need to to keep the whole European contingent in.” And so I was appologetically thrown out. But this led to a real separation between the Zafrullah [Chodhurry] and Maria. Zuffrullah had signed the letter, and then he and Mira and David Sanders who had all signed the letter decided that this wasn’t fair. And they pulled out [of the push to kick David out] But Maria was over the barrel because she had been appointed the sort of organizer-coordinator of the People’s Health Movement, and the European contingent had agreed to come up with her salary—they gave her a full time salary in this role—and if they pulled out, Maria was suddenly without a salary. So it was in her interest, you might say, to apologetically throw me out.

 

But David—being forgiving to a fault, a fault we cannot attribute to any of his opponents—doesn’t want this part of the story told because he and Maria are “best of friends” again:

And for a while, things were very strained between Maria and myself because she had agreed to talk with me about this. And then dragged her heels on it for years. And, uh, but finally we did talk about it. Finally made up. And now we’re best of friends.

 

Like David Morley, David Sanders had remained a loyal friend to David Werner through the controversies. It is well-known that David Werner co-authored an important movement book Questioning the Solution and a movement-defining paper FIND LINK with David Sanders, and they continued to work closely together in the IPHC until its forced dissolution. I am sure that Sanders defended Werner a lot in those years.

And so it does not surprise me that as soon as David Sanders passed away all trace of his involvement with David Werner was wiped off the record of the People’s Health Movement website. The phrase “David Werner” does not even merit even a “not found”:

 

Although Questioning the Solution is an important update to Sanders’ seminal book The Struggle for Health, the People’s Health Movement is not promoting it. (Hesperian, for their part, threatened Third World Network, who withdrew it out of fear of a lawsuit.) Instead, David Werner reports, the PHM is rewriting The Struggle for Health. From David Werner’s perspective this is a good thing. From my perspective, it is—like Hesperian’s rewriting of Where There Is No Doctor—a move calculated to remove David Werner from the historical record.

The final slap in the face—there can never be enough—is that David Werner is not the North American representative of the PHM, Hesperian is. The Hesperian blog reports that Sarah Shannon and Todd Jailer, among others at Hesperian—people who had practically nothing to do with creating the PHM—consider themselves to be leading members of the PHM:

When the PHM steering committee asked Hesperian to begin organizing a People’s Health Movement in the U.S., we felt that we had no choice but to participate.

It is more evidence of Hesperian’s shamelessness in deposing and occupying the place of David Werner. To hear it from them: “We had no choice.”

When Sarah Shannon won the “Social Justice Leader Award” honoring Ruth Roemer in 2015, she said:

Outwardly concerned about those “pushed to the margins of society” and making “inclusivity a priority” (link), Shannon has been the driving force of the radical exclusion of David Werner. Today, David Werner, 87 years old, lives alone and eats out of tin cans, practically excommunicated from the global health movement he helped create, while Sarah Shannon wraps herself in the honor of Where There Is No Doctor, whose author she has trained others to vilify and lie about. Sarah Shannon is a cruel and ruthless person undeserving of the awards and honors bestowed upon her. That much is sure. But she is also duplicitous, as I shall now show.

The Politics of the Health, Hesperian-Style

In 2011, Hesperian changed its name to Hesperian Health Guides because, as they put it, “the name more accurately reflects the work we’ve done for more than 30 years”. This is true in part because, though the publishing venture emerged from the rural Mexico projects, the two aspects of Hesperian enjoyed an increasingly independent relationship over the years. After the Board voted David Werner out in 1993, Hesperian had nothing to do with Piaxtla or PROJIMO. Not only did Hesperian abandon David Werner, they abandoned to obscurity and poverty the very projects that gave birth to Where There Is No Doctor—notwithstanding Sarah Shannon’s constant milking of the book’s romantic dusty-trail origins.

In truth, the Hesperian Foundation was twice-born: originally as a funding conduit for David Werner’s projects in rural Ajoya Mexico, and for a second time as a publishing venture located in Berkeley, California. These two very different projects may have shared a name, the personnel may have at times overlapped, but the fact that the schism divided precisely here testifies to the reality that those typing up and packing books in air-conditioned offices in Berkeley California had really little to do with the on-the-ground realities in rural Mexico.

Although Hesperian holds the wealth of all of the accumulated historical documents of decades of David Werner’s efforts, Hesperian Health Guides have produced nothing in the past 26 years that explores the Piaxtla and PROJIMO experience—except, as we have shown, a willful distortion of the historical record by denying the existence of David Werner.

There will never be a documentary about David Werner based in the images and film which he took and collected at the earliest times of the projects at Ajoya.

The record shows that Hesperian under Sarah Shannon wants to have nothing to do with Piaxtla and PROJIMO. They say that possession is 9/10ths of the law, but Hesperian has no moral authority over the historical documents of Piaxtla or PROJIMO, and they continue to hold onto it only to spite David Werner, and to no good purpose, which reveals the ruthless nature of Sarah Shannon. Far from wanting to honor David Werner’s Mexico projects, Sarah Shannon doesn’t want their history to be explored at all. She wants them to go away …

Do you wonder why?

I am sure I know exactly why. Sarah Shannon knows that Hesperian would be financially liable due to the decisions of Hesperian board members to tolerate David Werner’s sexual behavior. It’s on the Hesperian webpage itself—at the very link Todd Jailer provided Shimizu of AHI (above). It turns out that Hesperian leadership is so obsessed with making David Werner look bad that they failed to realize that the story they used to damage his reputation provides powerful and detailed evidence of the organization’s own culpability:

These include board members Deborah Bickel and Dr. Lonny Shavelson.

Incredible. If Hesperian could ever identify a boy (now adult) willing to testify that David Werner sexually abused him, Hesperian itself would be on the hook for potentially millions of dollars in damages. It would completely destroy Hesperian. And given their now 26 year ongoing evasion, a judge would most certainly rule against them.

The most obvious candidate would be Miguel Angel, mentioned above and featured in Newsletter #75—but, oh, that story has a happy ending. The entire basis of the accusation, the entire reason for David Werner’s excommunication is that he’s an evil sex abuser, not a friend and supporter of the boys in his life. Not that people care about such distinctions anymore as they shovel human lives into the incinerator of the sex offender system. But, you know, morally it actually does matter.

But it seems nobody asked Miguel Angel to testify, or any other boy, even though Hesperian members knew the identities of at least two boys they suspected of being sexually abused. Instead of calling the police immediately, Hesperian members facilitated their exit from the United States back to Mexico. (It’s in the news article Hesperian hosts!)

Interesting.

Let us make the following case: The fear of financial liability explains why, although Hesperian officials have systematically isolated and excluded David Werner in every possible way they can, the organization

• failed to thoroughly investigate their suspicions, and
• have refused to hand over the historical documents of Piaxtla and PROJIMO, and the personal documents of David Werner, while
• failing to do anything substantive with them.

And that explains why—convenient heroic stories aside—Hesperian under Sarah Shannon wants to have nothing to do with Piaxtla or PROJIMO, and has done nothing with the historical documents they are squatting on. Far from even disrespecting David Werner, they recognize that he’s a live grenade they are all squatting over. Even now, as we tear off the veil, they know there is nothing they can do. It’s a Catch 22.

Earlier I asked why the board did not resign, rather than forcing David Werner out, if he was someone they did not want to associate with. Let me follow up on that question.

Hesperians who cared about sexually abused boys might have abandoned the Hesperian Foundation—disassociated themselves—and went to Mexico immediately to dig up David Werner’s supposed victims. Presumably Rob Rosenfeld knew the names of the boys whose nocturnal sex-play (occuring during his watch) initially raised his suspicions that ultimately led to the coup. Instead of reporting his findings to the police immediately, he let the boys return to Mexico. Even so, Hesperian had their names on record and, by virtue of the fact they were returning them to their homes, they also knew where their homes were located in Mexico. Yet there is no report whatsoever that Hesperian conducted their own investigation in the absence of police intervention.

Curious.

Had the Hespies abandoned Hesperian, David Werner would have remained in charge of the organization, and so also effectively in possession of his books—the books written by other people, much less popular, could have easily been spun off into another publishing venture run by the former Hesperian members, if they didn’t want his dirty hands on them. So that wasn’t really the deal breaker.

The real reason was that if they had let that happen, the Hespies knew they wouldn’t be on the lifetime gravy train of Where There Is No Doctor.

So they grabbed Hesperian from David Werner by voting him out on July 30, 1993, and just reported their suspicions to the local police, knowing that (a) the Mexican police would probably do nothing, and (b) the California police would probably also want to do nothing since the investigation would necessarily involve—and and probably destroy the reputations of—many prominent people in posh Berkeley that were attached to David Werner’s work. It was a problem that had to go away in a way that protected those people, people like Davida Coady and Marjorie Wang McClaren, who were given the opportunity by friendly journalists to virtue signal in the press while effectively doing nothing. Remember, Davida Coady took over Hesperian after David “resigned.” It was her responsibility to make sure David’s supposed victims were uncovered, but she never did anything. Did Hesperian provide details like names and addresses to the police? If not, that could explain why the investigation went nowhere.

Read the article for yourself and tell me I’m wrong.

So in the end it’s really all about money, control, virtue signalling, job security, and avoiding liability; and almost not at all about protecting children from sexual abuse or finding out the truth. Why else did Hesperian fail to conduct a fact-finding mission in the projects they claim to have been responsible for? Davida Coady didn’t want to know the truth, and neither does Sarah Shannon. She just wants the witnesses—like Deborah Bickel and Dr. Lonny Shavelson—to die so there can never be a successful civil lawsuit.

If you doubt it’s about money, consider Hesperian’s attitude toward Open Access:

Far from being principled to the bone, Hesperian under Sarah Shannon is pragmatic—in other words, they don’t possess any principles they wouldn’t budge on to make their budget. And this is why David Werner’s Open Copyright has been whittled down to the size of a toothpick and hidden amongst piles of ever-increasing requirements imposed upon those who formerly required no permission to alter or reproduce Hesperian books. Survival of Hesperian is more important than free distribution of Where There Is No Doctor—that’s just the tool Hesperian overlords use to keep the revenue machine churning. (Has anyone ever compiled the changes made by Hesperian since the 1992 edition to see whether all their amazing “updates” are really worth it?)

But I digress.

 

Returning to the topic at hand, luckily for everyone involved, David Werner never sexually abused anyone—go ask Miguel Angel. For all the puffed up heroism in the bare-foot rural health game, where everyone brags “I saved a refugee by flipping to a page in Where There Is No Doctor in a war zone!” I am sure that nobody reading this has the courage to go up to Miguel Angel and ask him what happened, and to accept his answer. Nobody has that courage. They would rather hate and radically exclude David Werner than face the personal consequences of that answer. They would rather be sure in their established assumptions and prejudices than discover something new—the fundamental difference between an Author and mere Readers.

And so this is also a story about moral cowardice and sexual fascism masquarading as the highest virtue by a busybody-culture incapable of distinguishing loving embrace from rape and abuse, a culture of worry and complaint that valorizes victimhood over the victory of health, and finds a boogie man under every bed and in every pizza parlor in order to drive their paranoid and violent fantasies.

After all, in what kind of world is the consensual sexual acivity between boys—to cite Rosenfeld himself about the inciting nocturnal sex-play incident—“not appropriate” and a good reason to conduct a witch hunt and destroy the reputation of “a living saint”? Whatever it is, it’s not a sane world.

In the final analysis, David Werner did nothing illicit that Oscar Wilde didn’t do—probably much less—and Oscar Wilde is held up today as a martyr to the cause. So will David Werner be one day—a martyr and a saint. Why not? In Heaven, Hespies like Sarah Shannon and Todd Jailer will be hunched over shining David Werner’s shoes and grumbling bitterly, just as they do today.

Further Reading

• The Return of Health for All (2014)
• The People’s Struggle for Health and Liberation in Latin America: A Historical Perspective (2013)
• Communication as if People Mattered: Adapting Health Promotion and Social Action to the Global Imbalances of the 21st Century (2000)

Appendix 1: Evidence from the Newsletters of David Werner’s Authorship of Where There Is No Doctor

The following excerpts from the Newsletters prove that David Werner is the original author of Donde No Hay Doctor and Where There Is No Doctor, and not something vague called the “Hesperian Foundation” or “Hesperian Health Guides”.

1971-1973: The Very Earliest Hints

From Newsletter #07 (1971)

In the past months I have been working diligently preparing a handbook to be entitled, La Práctica de MEDICINA SIN MEDICINAS: Una Guia para los Campesinos Retirados de Recursos Médicos. This field-guide to The Practice of Medicine without Medicines is an attempt to answer the enormous need, among villagers who live far from sources of medical assistance, for a simplified manual which explains what they should and should not do when sick and injured. It is written in the village idiom and has many self-explanatory drawings. It not only indicates what to do, with minimal medicine, to avoid or combat certain ailments, but describes how to recognize those maladies for which every effort should be made to reach medical aid as quickly as possible. It outlines the importance of diet and hygiene to avoid certain illnesses, and emphasizes the protection afforded by vaccinations. The Guia also explains which folk cures are beneficial, which may be harmful, and why. It tells which local herbs have genuine medicinal value. It discusses the use and popular misuse of the various medications available in village stores, and finally, it indicates the emergencies which justify that a person without experience give injections, explains how to give them, and stresses the precautions and the risks.

My original intention when I began to prepare this handbook, was to make it available principally to the villagers in our area. However, I feel that the book, if prepared with sufficient care, has the potential for making a significant difference in the health of villagers throughout all remote areas of Mexico and perhaps other parts of Latin America.

From Newsletter #08 (1973)

This last November, [Dr. Kent Benedict] returned to California to begin a practice in Watsonville, and although his loss is deeply felt at the Ajoya clinic, the young “medics” who work there, American trainees as well as village apprentices, are able to carry on far more competently for having had the opportunity to work with Kent. Insofar as Kent, or “Andrés”, as he is better known in Ajoya, has been the Big Daddy of our medical program during the past year, it is only fitting that our friends who make Project Piaxtla possible, have a chance to hear from him directly. I particularly appreciate Kent’s taking over the responsibility for this newsletter since I have put off writing one myself for far too long. Lately, nearly all of my spare time has gone into preparing the manuscript for the medical handbook for campesinos (which I mentioned in my last newsletter.) This “Guía de Medicina” is now about four fifths completed, with over 160 pages and 300 illustrations. Thanks to a contact made by Dr. Norman Sissman, who arranged the open heart surgery for Manuel Alarcón three years ago, Syntex Laboratories of California has offered to publish the handbook for us as a public service.

1974: Early Acknowledgement of Help

From Newsletter #09 (1974)

Dr. Val Price, who went through the text with me word for word, both for content and for clarity. Also, I am enormously grateful to the American drug company which underwrote the cost of publication, thereby placing the book within financial reach of our villagers. (The drug company chooses to remain anonymous.) My deepest admiration and appreciation go to Myra Polinger, whose tireless effort on the book, as well as phenomenal patience with its author and his cohorts converted Donde No Hay Doctor from an ugly duckling into … well, at least, a duck.

1974: Early Reception of Donde No Hay Doctor—‘The Book Was, of Course, My Own.’

From Newsletter #09 (1974)

Some aspects of folk medicine are favorable, others detrimental. One might think that in time the harmful elements would be weeded out through trial and error. But not so; for folk science is grounded less on empiricism than on faith, dogma and fear of the uncertain. Traditional cures, even when blatantly injurious, are simply not to be questioned … and woe to the outsider who would question them. I speak from experience.

Since I first came to the Sierra Madre, in talking with patients I have tried in vain to counter some of the folk myths and home remedies which are most clearly pernicious … [ … ]

For eight years, I have talked myself blue in opposition to these damaging, but time honored traditions. Always the villagers have listened politely, but a little amused, as if to say, “Poor Gringo, he means well, but he is so naive”: And of course they are right.

This was brought home to me by the incident of Micaela and the orange. Old Micaela is the matriarch of the household where I set up our first dispensary in Ajoya years ago. She, like other villagers, believes that to eat citrus fruit when one has a cold will cause a deadly attack of “congestion”. Micaela has heard me explain to dozens of patients the merits of orange juice for colds (admittedly, a bit of American folk mythology). Yet, one day when her son offered her small granddaughter a section of orange, old Micaela snatched it away and snapped, “Do you want to kill her, eh?” Turning to the old woman, I said, as gently as I could, “Micaela, how many times do I have to tell you that oranges do good, not harm, when one has a cold?” The old woman smiled and replied, just as gently, “I don’t know. How many?”

So much for the value of oral repetition.

The written word, on the other hand, is Law … especially for those who can barely read: For me this has been a recent and—for my own purposes—happy discovery. The following incident helped me to realize this. A few days ago a young man arrived at El Zopilote asking for a hunk of copper to use, he said, in finding buried treasures. He explained that by heating the copper red hot and pouring “vino” over it, the “vino” would flare up and this, in turn, would cause a burst of flame to appear directly over the spot where gold coins lay buried. Like a fool, I told him I thought it wouldn’t work and he laughed, good naturedly, at my simplicity. After giving him a piece of copper tube, I asked him about his chronically ailing mother. He replied that she was doing poorly, that for years if one part of her didn’t hurt, another did; that she couldn’t sleep, etc. Knowing the family’s weakness for blaming everything and anything on witchcraft, I asked him with tongue in cheek if he didn’t think his mother had been hexed. To my amazement, the young man not only refuted this, but earnestly explained to me that the power of the hex is simply the power of suggestion, that a person who doesn’t believe in witchcraft can’t be hexed, etc. His lecture was such a reversal of roles that my jaw fell open. I asked him where he had heard such stories. He assured me that this was no story, for he had read it in a book.

The book was, of course, my own. The first chapter of my new medical handbook for villagers, Donde No Hay Doctor, (Where There Is No Doctor) is devoted to folk remedies, helpful and harmful, and includes almost word for word the comments on witchcraft which the young man had just recited back to me. I was delighted.

Donde No Hay Doctor also promises to have some impact on other parts of Mexico and Central and South America.

In general, the reception of Donde No Hay Doctor has been far better than I had dared to hope. As only about half of the villagers can read, and most of these so poorly that they never do, I had imagined that at best one or two persons in each small village might take interest in the book and, perhaps, mediate its information to others. However, to my joy, the book is not only selling like hotcakes, it is being read and used and gossiped: Visitors at El Zopilote pour through it in small groups, pointing to the drawings and reading aloud and haltingly the adjacent information. What is more, some have begun to follow the book’s advice. [ … ]

The new medical handbook is a step toward our goal of encouraging “self help” among the *campesinos in questions of health and hygiene. A few months ago, several small villages and rancherías on the upper reaches of the Rio Verde—an area out of range for most of our medical services—petitioned us to set up a clinic in their area. While this is more than we feel we can take on at present, Mike Carstens, one of our young American volunteers, has gone to the area and is now giving classes to adults and children, using Donde No Hay Doctor as a text. Following the recommendations in the book, he is helping the community to set up a comprehensive medical kit and understand its use. After Mike spends several weeks at Rio Verde, he plans to go on to other communities which have, likewise, petitioned our help. We hope, in this way, to help improve health conditions in areas beyond those which we might otherwise reach.

Donde No Hay Doctor also promises to have some impact on other parts of Mexico and Central and South America. We have been swamped with requests, many from projects and persons we have never heard of. For example, a Profesór de Mirjyn, of the Academía Hispano América in San Miguel de Allende, writes that for five years he has been training a group of ten paramedics on a nearby rancho and that he finds the handbook “just exactly what is needed to fill the void in the smaller rancherías of Bajío which do not rate high enough on the State scales to merit a Centro de Salud or a pasante.” Although the book is not designed as a text for paramedics, one backwoods health program in Guatemala is already using it as such and another group is considering doing so.

1977: Planned Revision and an English Edition

From Newletter #12 (1977)

The Spanish edition of Donde No Hay Doctor (my villagers’ medical and health care handbook) has a number of shortcomings of which I am becoming increasingly aware. A revision is needed and will be undertaken as soon as time and resources are available. Nevertheless, the book has been enthusiastically received throughout Latin America, especially by villagers themselves. In Costa Rica it is distributed to all the rural nurse-auxiliaries working for the Health Ministry, and in Colombia it has been translated into Guajivo, the main Indian language of the Llanos.

An experimental edition of the modified English version, Where There Is No Doctor, is almost ready, and should appear in the Spring of 1977. Hopefully, it will fill a need in Anglophonic parts of Africa and Asia, as well as provide the prototype for translation into other languages; interest has been expressed for Portuguese, French, Hindi, Urdu, Swahili, and Indonesian.

Appendix 2: A Short History of David Werner’s Open Copyright

In a video Titled “Sarah Shannon - 30 years in public health,” Shannon says:

So Hesperian pioneered an open copyright policy. Nowadays people talk about open source more frequently. Back 35 years ago when Where There Is No Doctor was first uh … uh Hesperian pioneered an open copyright policy that basically says so long as you’re doing it not for profit, take this, adapt it, make it your own. And through that policy that where there is no doctor and our other books are in over 80 languages and used in more than 100 and 6 countries.

Again, we observe Sarah Shannon using Hesperian to claim the work of David Werner. It was David’s decision to apply a radical open copyright to his works, including Where There Is No Doctor. It was not a decision passed down to him from the Hesperian Board—David was the Hesperian board. However, as we shall see, Hesperian’s present committment to the open copyright is in question. Though Hesperian is forced to continue publishing Where There Is No Doctor with a liberal copyright regime, it does not stop them from trying to introduce limitations and restrictions gradually over the years.

Below find a brief overview of David Werner’s use of open copyright, and subsequent developments at Hesperian.

1999: David Werner’s Notes on Open Copyright

From Newsletter #41 (1999)

One of the best tools for family and community based rehabilitation I encountered in Australia is an attractive booklet titled “A Good Life for Disabled and Old People.” It builds on ancient traditions of caring and sharing within Aboriginal communities. The drawings (by Aboriginal and white artists working together) are wonderful. I wanted to include some of the drawings in this newsletter, and wondered how I could arrange permission. Then I discovered, on the title page, the following invitation:

Any part of this book, including the illustrations, may be copied, reproduced, or adapted to meet local needs, without permission of the authors or publisher, provided that [they are] distributed free or at cost, not for profit. …

I recognized at once this invitation (so unlike the standard warning prohibiting copying in any form). The wording for the invitation was taken, almost word for word, from the title page of Where There Is No Doctor, Nothing About Us Without Us and our other self-help manuals! So our spirit of free sharing has come full circle! †

2005: Jason Weston: Open Copyright For Health and For All

From Newsletter #53-54 (2005)

 

As most readers of this newsletter are aware, David Werner’s book Where There Is No Doctor broke new ground in self help health care. The book demedicalized and demystified health information and put the power of knowledge into the hands of people the world over for whom it had previously been out of reach. But before getting to the table of contents, David broke new ground in another arena as well. He “de-legalized” the book with an innovative and progressive open copyright policy, allowing any and all people and groups to copy and adapt the book to their needs and circumstances, as long as it is done on a non-profit basis. This would become the open copyright statement in the front of each and every book by David Werner.

To understand why David did this, it is important to understand how the book evolved. Where There Is No Doctor, originally written and published in Spanish as Donde No Hay Doctor, grew out of Project Piaxtla in the rural mountains of Western Mexico. It holds within its pages the stories of many whose lives, and sometimes deaths, provide a window into a much larger community. The book was truly a labor of love.

I recently read some early editions of this newsletter, and the following passage from 1971 stood out. David wrote,

A baby is born … and begins to fail shortly after birth. An urge deep within us, almost as basic as hunger or lust, demands we do our utmost to save that baby’s life … . The infant deserves to be saved, not because it is living but because it is loved! Love is the ultimate and the only justification for all life and any life, for any and all action. There is no other. None.

(See Newsletter #7 for the full quote in its poetic context.)

It is David’s deep personal connection with the people in his community that inspired all his books, and inspired the open copyright. Even though David was the focal point for the books, the village of Ajoya and the surrounding region contributed immensely to their development. The open copyright printed in the front of each of these books is, in large part, a reflection of what was learned in this community over many years. These books truly belong to the community that spawned them, and to the much larger community of humankind.

Today, David’s books assist health and disability workers in communities around the world save lives and help disabled people regain or increase their capacities, thus their copyrights are a sacred trust. The only real reason to copyright these materials is to maintain their quality, and to assure no one tries to limit access to them.

It is in the spirit of the open copyright that HealthWrights has put all of David’s books in electronic form, and published them on our web site. We realize that for many the Internet remains beyond reach. But more and more, it is becoming a truly world wide web, and disadvantaged people around the world are slowly gaining access.

David initiated the open copyright to help assure that these materials would be available to those who most need them. Since its inception, the open copyright has stood as a model that many other groups around the world have emulated, creating a large body of work that puts the needs of people before profit. Putting David Werner’s books online for all to use is a contemporary expression of the open copyright.

Today there is a thriving open-copyright movement. How much of it has been directly influenced by David’s pioneering example is anyone’s guess.

2003-2020: The Curious Evolution of the Copyright of Where There Is No Doctor

Below are two copyright notices from different editions of Where There Is No Doctor.

Note that the 2003 edition excises “without permission from the author or publisher” from the original copyright notice of Where There Is No Doctor? Hesperian’s history with David Werner’s radical open copyright has been one of gradual mutilation. While Hesperian of 2003 “encourages” reproduction for non-profit uses, clearly the change is meant to degrade the radical quality of the original open copyright notice. Otherwise, why remove it?

We can see that by 2015, Hesperian has made further changes to the original copyright notice. They have added in the 2015 copyright notice: “Hesperian encourages you to copy, reproduce, or adapt any or all parts of this book … provided that you … follow the other requirements of Hesperian’s Open Copyright License.” Just to be perfectly clear, this sentence amounts to the following statement: “Hesperian encourages you … provided that you … follow the other requirements of Hesperian’s Open Copyright License.” Or, in other words, if you fail to follow those requirements, all that Hesperian can do—based on the languages of the copyright notice—is not encourage you. In other words, the changes are toothless.

Also notice the more substantial changes in the red box. Note especially the phrasing “we ask that you first obtain permission.” Obviously what they would like to imply is that “you must,” but the language does not enforce an obligation upon the reader. Contrast Hesperian’s language with that found in Thomson Reuter’s copyright notice:

(c) Thomson Reuters. All rights reserved. Republication or redistribution of Thomson Reuters content, including by framing or by similar means, is prohibited without the prior written consent of Thomson Reudters.

Nowhere does Hesperian claim that digital reproduction is “prohibited”—because they can’t say so. Hesperian cannot legally prohibit anyone from distributing free digital copies for publications released under David Werner’s radically open copyright since they have already authorized free and or not-for-profit reproduction “without permission from the author or publisher.” That’s why the word “prohibited” does not appear, and that is why they deploy “we ask that you first obtain permission”—a powerless phrase.

If Hesperian under Sarah Shannon is proud to be a pioneer of open copyright, why does the organization keep undermining the original open copyright notice by attempting—and failing—to introduce novel restrictions and conditions? Apparently David Werner’s open copyright is too radical for Hesperian, and they have been fighting against it—and David Werner—for decades now.

It is a familiar story, of a vision fenced in by aparatchiks weilding institutional power. We are sure that is why David traveled down the dusty road to Ajoya in the first place.