HealthWrights: Newsletters from the Sierra Madre

In this newsletter, written in the time of COVID, we look at how the current pandemic affects the lives of poor people in the western state of Sinaloa, Mexico. We look at how “vaccination hesitancy” pervades even the most remote mountain villages. And we look at how improvised street theater and participatory roleplays based on observable evidence can help doubters sort reality from fiction and recognize the importance of getting vaccinated, not only for one’s own wellbeing, but for the collective wellness of all. The newsletter concludes with the proposition that if humanity is to overcome this pandemic and fend off far worse pandemics and global crises to come, we will need to radically transform our global economic model based on unbridled profit and greed of the few to a holistic approach based on sharing and caring, and on the well-being of all who live on our sacred but endangered planet. And we must do so soon, before we burn all our bridges to a livable and meaningful future.

Note: We are busy adding presentations from our 50 years of work at HealthWrights. The first is the Measles Monster, a slide show to combat vaccine hesitancy (see below). You can find a version with text captions here, or a version with voice-over narration here at Youtube. The images and captions are available in Spanish here and as well in the Spanish edition of the book Helping Health Workers Learn (Aprendiendo a Promover la Salud), pages 595-600, here.

In this brief Newsletter, David announces his new book Reports from the Sierra Madre: Stories Behind the Health Handbook Where There Is No Doctor, a collection of his Reports from the Sierra Madre richly illustrated with hundreds of photographs and drawing by the author. The Newsletter closes with a special request for electric wheelchairs.

On a visit to Thailand in May 2017—described in Newsletter #81—one of the most groundbreaking innovations I (David Werner) witnessed was the so-called “Buddy Home Care” initiative, organized by the Health and Share Foundation (HSF). This Newsletter provides an update on this promising initiative, and makes a special request for electric wheelchairs, and funding for wheelchairs for children.

We open this Newsletter sadly announcing that Mary Picos, the long-time director of PROJIMO, has passed away. The cause of her death, fulminating septicemia caused by an infected pressure sore, raises an issue near and dear to David’s heart: the use of cardboard to create and adapt low-cost solutions, a method originally developed by Bevill Packer, and discussed at length in Newsletter #82, and in Newsletter #34.

This Newsletter is, in ways, a sequel of #82 about Habilítate Mazatlán, a modest service program run by disabled recovering drug-users. Among services provided, they build—out of old cardboard—custom-made special seating for disabled children. Here we describe a related challenge the group has taken on: crafting custom-molded cardboard cushions to help heal chronic pressure sores…. We share this story because it conveys a great unmet potential. If more people and programs would make use of this low-cost handicraft, myriad dire complications and premature deaths from pressure sores could be prevented.

This Newsletter discusses how the extensive trafficking and consumption of drugs have created new challenges for Project Piaxtla and PROJIMO, the community health and disability programs we are involved with. We describe a groundbreaking initiative, Habilítate Mazatlán” (Enable-Yourself Mazatlán), run by and for disabled persons who got hooked on drugs and are now trying to stay off them by devoting their lives to assist others in need. Included in this Newsletter is an interesting photo documentary of Habilítate’s Child-to-Child workshop. and an extensive look at the projects work in Appropriate Paper-Based Technology providing customized seating to disabled children. Finally, HealthWrights requests funds to make a drug rehabilitation center accessible to disabled people.

In May 2017, David was invited to make two appearances in Thailand, the first by the Health and Share Foundation, an offshoot of SHARE Japan. The second, at the invitation of Mahadol University in Bangkok, was to speak at the “Eighth Public Health Conference on Advancing Sustainable Development Goals, 2030.” While this Newsletter outlines David’s observations about health developments in the country, it mainly concerns itself with the priorities and programs of SHARE in Thailand. These include peer counselling for people with HIV-AIDS, home visits to vulnerable children and the elderly, and the Buddy Home Care initiative. The Newsletter concludes with observations about the legalization of sex-work and drugs.

Since I first wrote and illustrated Where There is No Doctor in Spanish, in mountain villages of Western Mexico in the early 1970s, the book has been translated into at least 100 languages (that we know of), with more than three million copies in print. According to the the World Health Organization, it has become “the most widely used community health care handbook in the world.” We have received letters of appreciation from health workers and families in scores of different countries, often with stories of how they used the book to treat the sick, save lives, and take collective action to prevent disease. On a few occasions, families have been so pleased with the book, that they have named a new-born child after me. Here I give a couple of examples.

This Newsletter describes the experience of a boy named Tomás with the PROJIMO Coyotitán workshop. Tomás has CMT—Charcot-Marie-Tooth syndrome—the very same progressive neurological condition that David has. After some back-and-forth in email about improperly fitted braces, David invites Tomás and his mother to PROJIMO Coyotitán, where the boy is not only fitted with improved prosthetics and devices, but becomes more self-reliant under the encouragement and examples of independence exemplified by the PROJIMO team.

In this Newsletter, the second of two part series on the seredipitous connections emerging from David’s life work, we visit ARSOBO (ARizona SOnara BOrder project for inclusion) a wheelchair and prosthetics workshop modeled on PROJIMO Duranguito, and run by Dr. Boris Duncan from the University of Arizona. David traces Dr. Duncan’s struggle to begin ARSOBO, it’s current capabilities and master craftsmen, and talks briefly about Tomás, who had been a part of PROJIMO since he was six-years-old, as he transitions to work with ARSOBO.

This Newsletter is part one of a two-part series on the serendipity of the social connections evolving from David’s lifetime of work. To begin, David describes his personal near-death experienced many years ago caused by a snakebite modern medicine struggled to manage, explaining and defending the practice of “cryptherapy” or the use of ice packs to slow the venom’s progress. David describes his adolescent experience collecting scorpion specimins for Dr. Herbert Stahnke. In researching this topic, he serendipitously came into contact with Dr. Leslie Boyer at the Viper Institute, who had a personal story to tell about Where There Is No Doctor. David relates her research into the courageous efforts of Father Emmett McLoughlin who smuggled scorpion antivenom into the US to save children’s lives. The Newsletter concludes with David’s plan to meet with Dr. Boyer at ARSOBO, a PROJIMO Duranguito-inspired wheelchair workshop, the topic of the next Newsletter.

David first learned of Tonio, diagnosed with Duchene’s Muscular Dystrophy, several months ago from his close friend, Polo Ribota, who since childhood has been deeply involved in our community-based rehabilitation efforts. Upon meeting the boy, it became clear that his physical disability was a driver for emotional problems, as the boy was extremely withdrawn with anyone but his grandparents, and only privately. Witnessing the boy’s difficulty moving around the house, David advised his grandparents to install ramps, which they did. A Child-to-Child workshop was undertaken at Tonio’s school which aimed not only to install facilities for disabled children to move around, but also to encourage social inclusion, to bring Tonio out of his shell.

This year’s-end newsletter tells the story of a farm boy in México —Miguel Angel Alvarez—who, more than three decades ago, was helped by the local village health program (Piaxtla) in the Sierra Madre to continue his schooling. Along the way, he became a village health worker, then a doctor, and finally a gifted eye surgeon and professor of ophthalmology. But the best news is he never forgot his roots. He continues to reach out to disadvantaged people in need. Recently we sought his help for a blind child whom other specialists had essentially given up on.

In April of 2014, I, David Werner, was asked to visit Chile and Argentina, the two countries that flank the imposing Cordillera de los Andes in South America’s southern cone. The corresponding groups that invited me—of occupational therapists and of community doctors –represent the more radical, social-change-seeking arm of their respective professions, much in the way that the “Theology of Liberation” is the socially progressive arm of the Catholic Church. In sum, within their professions they are the mavericks who stand up for the rights of marginalized people.

In February 2014, David was invited to Burkina Faso, West Africa, by the Dutch NGO, Light for the World–the Netherlands. He exchanged experiences in Community Based Rehabilitation (CBR) and facilitated workshops, using the Child-to-Child approach, to promote “educational inclusion.” The objective was to explore ways to make schooling more accessible, friendlier, and more helpful to children with disabilities—while at the same time making public education more relevant and empowering for all children. The Newsletter concludes with a substantial two-part photo essay of David’s visit and workshop.

In this Newsletter, David tells the story of Matías Cepeda Monsalvo, a boy born with incapacitating spastic cerebral palsy so severe that he could not communicate. His life changed when he was introduced to facilitated communication, which enabled him not only to communicate his wants and needs to his family, but to become a published author. “[E]veryone present marveled at how a person so young, who spent his first 12 years without a voice, had gathered such profound understanding of humanity and the world surrounding him.”

In the second of our cost-saving, but also more flexible online-only Newsletters, HealthWrights presents the inspiring story of Miguel Angel, a disabled child, and his rehabilitation at the PROJIMO Duranguito wheelchair workshop. Dedicated to designing and building wheelchairs to meet the individual needs of disabled children, the activists at PROJIMO Duranguito evaluate each child individually, and build up to 300 custom-made wheelchairs and other assistive devices per year. In the case of Miguel Angel, however, the they have taken on responsibility for this child's full range of rehab needs -- both physical and social. For although the boy has a difficult background and an especially challenging disability, he has big dreams and lots of potential.

In this Newsletter, David attends the 40^th anniversary of the Gonoshasthaya Kendra (The People’s Health Center) or “GK” in Bangladesh. David reviews various developments in health mostly positive—improvements in conditions for women, the drop in infant mortality rates, etc.—some mixed—such as the ‘victory’ of Big Pharma anti-diarrheal treatments—and some negative—such as pollution and the return of rickets. Various ongoing and impending challenges to health in Bangladesh are outlined.

In this Newsletter, David relates his experiences last November (2011) in East Timor, a country ravaged by conflict, a visit generously sponsored by SHARE Japan (founded by Dr. Toru Honda). David relates the decades-long struggle for independence from the US-backed Indonesian occupation, before offering his observations about the present day rural health situation in the country. David visits the rural health outposts called SiSCa (Servisu Integradu do Saúde Comunitária) locations at the sub-district level where pregnant women and mothers are summonsed once a month for pre-natal screening, growth monitoring of infants, vaccination, and health education. The Newsletter closes with suggestions to promote sustainable health for all in East Timor.

This Newsletter outlines the life and struggle of quadraplegic disability activist Rigo Delgado who is now creating exciting and innovative programs in Mexico. David examines the role of PROJIMO in rehabilitating and training Rigo, and a conflict that led him to enroll at the Autonomous University of Sinaloa under the guidance and support of Professor Mario Carrranza. Rigo has gone on to be instrumental in promoting Child-to-Child; included here is the story of Jaime, a bullied disabled boy who Rigo helped regain confidence. Finally, David outlines Rigo’s broader work including national events, and closes with a request for financial help, to enable Rigo to continue his important and innovative activism work. The Newsletter concludes with the announcement of a new publication Cerebral Palsy by David Werner and Bruce Hobson.

In this Newsletter, David visits Casa Hogar—Hijos de la Luna” (Home Shelter—Children of the Moon), a shelter for the children of sex-workers in Mexico, run by María del Socorro Ramirez Gonzalez, a.k.a. Doña Coco. Concluding his visit, David observes the principles of Child-to-Child in action, as children help other children, including Luis who has autism. David muses about the human condition and reminiscenes about his visit to a Nai Talim (New Education) school for Dalit (formerly “untouchable”) children. The Newsletter closes with a call to help HealthWrights.

This newsletter reflects on the 2nd Continental Congress on Community Based Rehabilitation held in Oaxaca, Mexico, and celebrates the potentially liberating changes that are under way in the concept and practice of CBR. The Congress also provided feedback on programs in different countries where David Werner has facilitated evaluations and workshops in recent years. This includes good news from a boy in Ecuador about his progress after a workshop there last May.

In October, 2009, I was invited to Japan for a speaking tour linked to launching the Japanese translation of my book, Where There Is No Doctor. At first glimpse, it may seem incongruous that this healthcare handbook—written for marginalized people living in underserved areas of poor countries—be translated into Japanese. After all, modern Japan is reputed to have one of the highest standards of living in the world. It has among the best health statistics in terms of low child and maternal mortality rates and long life expectancy. It also has one of the highest ratios of doctors per capita. Why should there be a need for this village healthcare handbook in Japanese?

In February 2009, David Werner facilitated two workshops on innovative technology for and with disabled children and their families—and with mediators from Stichting Liliane Fonds (SLF), a charitable organization in Holland that helps disabled children in difficult circumstances. David was accompanied by his long-time friend Allison Akana, who filmed the workshop in Lima.

Marcelo Acevedo was one of the founders and core members of PROJIMO and touched and changed so many people's lives. As a disabled person who reached out with his hands and heart to do his very best to help other people, on equal terms, Marcelo was a personification of the highest ideals of the program. In May 2008, Marcelo fell ill and rapidly succumbed to brain cancer. This Newsletter remembers him.

In Colombia in February 2008, I (David Werner) led two hands-on workshops with Stichting Liliane Fonds on creating and modifying assistive equipment for children. The primary purpose of these workshops was to expand the skills of Liliane mediators who work in the area. This Newsletter highlights what was learned through these workshops. We also pay tribute to Marcelo Acevedo, who for many years was a key member of the PROJIMO team, who died in May of this year.

In November 2007 David visited Health in Harmony, in Indonesian Borneo, a pioneering program founded by Kinari Webb striving to address the health needs of the local villagers and the environmental protection of endangered tropical forests. This Newsletter explores the link between health and the environment, HIH’s relationship to the community, and closes with a heartwarming encounter with Ocu (pictured here in the yellow cap) who benefited from no-cost custom cardboard show inserts designed by David.

In March 2007 in Morelia, Mexico, David Werner led workshop on ‘ways to make education more inclusive, relevant, and fun,’ helping train educators to adapt the Child-to-Child methodology locally and across the state. This newsletter describes the workshop, its evaluation by those who participated in it, and prospects for implementing these ideas on a larger scale. We also include an update on PROJIMO.

For three weeks in February and March 2007 David Werner visited South Africa at the invitation of the Western Cape Association for Persons with Disability (WC-APD). During his 3-week visit he facilitated a series of seminars and work-shops on Community Based Rehabilitation, first in the city of Cape Town, then in outlying areas in the Western Cape Province. David had an opportunity to visit the homes of some of the people with disabilities assisted by APD, and witnessed the grinding poverty and powerlessness that still oppress the majority of South Africans, despite the celebrated liberation from the apartheid regime that was achieved, by the democratic elections in 1994. Here David describes the continuing socioeconomic polarization in South Africa, and the challenges it creates for those striving for rights and opportunities of people with disabilities.

In this issue we look at an effort by the state of Michoacan, Mexico, and the Teachers Union to achieve educational reform, which has triggered a heated debate about whether or not to include disabled children in regular schools. Meanwhile, a Community Based Rehabilitation program near Patzcuaro is quietly integrating children into village schools. Next we visit a remarkable “Museo de la Basura” (Museum of Garbage) in Morelia, where an innovative school teacher makes educational toys and ingenious teaching aids by recycling refuse. We also get our first glimpse of Jason Weston’s forthcoming book, Choosing our Future.

This issue presents the text of an address given by David Werner to the New York State Occupational Therapy Association. This year’s NYSOTA Conference was especially important because it was led by a group of socially progressive therapists who challenge their peers to go beyond the conventional focus on disabled individuals and answer in a holistic way to needs of all who are marginalized in a globalized paradigm of “occupational apartheid”. We also provide a brief update on the two PROJIMO community-based programs in Mexico, and look at the way they have evolved over the last 25 years. We then explore the implications of the Military Commissions Act and how it might serve as an opportunity for change. Finally we extend our readers a Season’s Greeting—and thank you for your continued support.

In this newsletter we look at a Community Based Rehabilitation initiative in Honduras. We explore the underlying causes of disability, worsening poverty, environmental demise, and social upheaval that can be traced to the war of the ‘Contras’ in Nicaragua in the 1980s. We also look at the plight of impoverished Hondurans who left their country in search of jobs in the south-eastern USA, only to be caught in the nightmare of Hurricane Katrina.

In this newsletter we travel to India, where David Werner facilitated 3 hands-on workshops in Community Based Rehabilitation (CBR) and assistive technology for mediators of Liliane Fonds. Strengths and weaknesses of different models of CBR are discussed, as observed in the collaborating programs. Examples are given of how innovative low-cost assistive devices can be developed by working together with the disabled young people and their families.

This double newsletter serves 2 purposes: 1. It describes two recent “do it yourself” workshops on appropriate technology for and with disabled children, which David Werner facilitated with Los Pipitos in Nicaragua. 2. It provides a detailed outline of how such workshops might be conducted, including supplies needed, in hopes that more community-based rehabilitation programs will take initiative to conduct them by themselves. The focus is working in partnership with the family and disabled child. Note: Newsletter #53 and #54 are identical, and form a single “double issue.”

This double newsletter serves 2 purposes: 1. It describes two recent “do it yourself” workshops on appropriate technology for and with disabled children, which David Werner facilitated with Los Pipitos in Nicaragua. 2. It provides a detailed outline of how such workshops might be conducted, including supplies needed, in hopes that more community-based rehabilitation programs will take initiative to conduct them by themselves. The focus is working in partnership with the family and disabled child. Note: Newsletter #53 and #54 are identical, and form a single “double issue.”

The previous Newsletter (July, 2004) looked at the ways Cuba—despite the prolonged US embargo—has succeeded in achieving a level of health equal to that of the United States at 1/20 per capita income, through a model of development that strives to be both equitable and ecologically sustainable. This issue looks at a pioneering effort to meet the needs of Cuba’s disabled people through a community based initiative led by disabled persons’ organizations with multisectoral government support.

Twenty years ago David Werner visited Cuba as part of the California-Cuba Health Brigade. Now, after revisiting Cuba in May 2004 to evaluate a pilot Community Based Rehabilitation project, he provides an update. He laments the hardships caused by the US embargo, yet reflects on how Cuba has risen to the crisis through innovative steps toward equitable and ecologically sustainable development. In our next newsletter we will provide an in-depth discussion of the CBR program David visited. "Cuba" is now a topic in our restructured Politics of Health website (www.politicsofhealth.org), which we review in an insert to this Newsletter. Lastly, we give a brief Update on PROJIMO, in Mexico.

This issue takes us to Bolivia, where David Werner’s scheduled workshop was intercepted by the overthrow of the Bolivian president. The turmoil in Bolivia, due to privatization and macro-economic policies, mirrors a growing trend that threatens health and political stability worldwide. As a response to these and other key political issues, one year ago HealthWrights initiated an interactive web site, the Politics of Health Knowledge Network. In this issue we begin unveiling our forthcoming major site update, designed to initiate exciting possibilities for increasing participation and community building.

This issue takes us to Bogota, Colombia, where two innovative initiatives are being launched to include marginalized persons as key players in community-based programs. Landmine survivors and street youth will learn to provide health and rehabilitation services to disadvantaged communities. Because projects Piaxtla and PROJIMO in Mexico—and the books they have given birth to—have provided a worldwide model for this inclusive and empowering approach, David Werner was invited to Colombia to share experiences and facilitate a hands-on workshop. Here he shares his observations. In addition, an update on the PROJIMO programs features a reunion of disability programs in Mexico, and a new network.

This issue takes us to the state of Andhra Pradesh, India, where early this year David Werner went as a consultant for a statewide Rural Poverty Reduction Program. Although the consultancy concerned the needs of disabled persons, it turned out that the lack of adequate health care at the village level was a substantial contributing cause of poverty. The possibility arose for self-help groups of disabled villagers to play a central role in meeting the health needs of the whole community.

Also, as an insert within this Newsletter, we provide an update on our new Politics of Health Knowledge Network, a joint project of HealthWrights and the International People’s Health Council. See: www.politicsofhealth.org. [Editor’s note: This insert is missing.]

This issue looks at recent events in rural Sinaloa, Mexico, the home of the PROJIMO community-based programs run by disabled persons. First we look at the latest in a series of violent incidents in the area, which have forced first the PROJIMO Rehabilitation Program, and now the PROJIMO Work Program, to move to safer villages. We explore the socioeconomic roots of Mexico’s epidemic of crime and violence. Next we look at the remarkable way the PROJIMO programs—especially the Children's Wheelchair Workshop—are evolving. In Mexico and beyond, there is new and rapidly growing interest in providing disabled kids with wheelchairs and appropriate assistance. Finally, we give an overview of an exciting new resource that HealthWrights is developing with the International People's Health Council, called the Politics of Health Knowledge Network.

In this time of twin terrors dividing the world, this newsletter explores possibilities for positive ways forward. The main article looks at the challenging, rapidly changing health situation in Iran, where the Health Ministry recently invited David Werner as a consultant in "education for health promotion in Iran." Next we look at an ecologically and politically healthy way to resolve a root cause of tension with the Middle East: the US's huge dependency on oil. Finally, returning to Mexico, we include the review of Molly Bang’s inspiring children's story book, Tiger’s Fall, which portrays how an adventurous little girl becomes disabled and then discovers new meaning in life at PROJIMO. An insert in this newsletter explores opportunities for "Seeking Peace" in these troubled times. [Editor’s note: The insert PDF is broken.]

This Newsletter looks at the challenge of working collectively toward a "livable future." At a recent strategic meeting led by the Mulago Foundation, in West Virginia, innovators explored the need for equitable and sustainable change, from the local to global level. The lead article discusses China's effort to reduce tobacco use, and obstacles posed by the World Trade Organization. In the next article, Kevin Starr (of Mulago) describes diverse approaches to building "healthy communities" by bringing health and conservation together. The final article shows how a community-based rehabilitation program can sometimes provide happier solutions than do sophisticated professional services.

This Newsletter is devoted to “PHA2000,” the first international event of the People’s Health Assembly, which took place in Bangladesh in December, 2000. Activists from nearly 100 lands testified to how the health of people and the environment is suffering due to global policies that put corporate profits before basic needs. A People’s Charter for Health (see insert) [Editor’s note: There is no insert.] was endorsed to help mobilize people throughout the world in the struggle toward a fairer, healthier, more sustainable social order.

Here you will not find a meeting report, but rather a critical look at what we can learn from PHA2000—its strengths and its weaknesses—in hopes of achieving a dynamic way forward and facilitating even better events for global solidarity in the future.

This newsletter looks at the struggles of disadvantaged people in Ecuador. The first article gives an account of a groundbreaking Regional Forum in Cuenca, where over 40 groups from diverse ethnic groups and habitats gave testimony to how the health of both people and the environment is being compromised by high level policies in the global marketplace that put corporate profits before basic needs. The second main article—in the form of a photo documentary—portrays innovative activities in a Regional Training Course for Community Based Rehabilitation (CBR) in Quito during September, 2000.

The main article in this newsletter tells you about a number of remarkable projects on the coast of the state of Oaxaca, Mexico. These projects are of timely importance as possible models for the direction we need to move in if we are to overcome the interrelated social, economic and ecological crises of our times. Yet we would be wise to learn from the weaknesses and blindspots of such pioneering projects as well as from their strengths and visionary spirit.

The Newsletter also includes an update on PROJIMO and shows some of the innovative wheelchairs and other mobility aids that it custom designs for individual disabled children. An update on the People’s Health Assembly includes a PHA Facts Sheet for those who may want to be involved or attend the international event in December. Announcements include a new paper by D.W. on Poverty and Health in the North; a guidebook for care of Landmine Victims, and a new video on PROJIMO.

The main article of this Newsletter looks at the enormous inequalities in Australia, in terms of health and self-determination, and the complex difficulties and challenges faced by the country’s original—or “Aboriginal”—inhabitants. It shows that public welfare assistance, when accompanied by discrimination and inequality can lead to spirit-crushing dependency and disease patterns associated with marginalization and the loss of hope. However, a growing movement among Aboriginal leaders and activists is working toward community control and assertion of equal rights.

Other brief articles here look at an attempt to save Australia’s north-eastern rainforests, and an update on PROJIMO’s new locations and activities.

Finally, there is a progress report on the upcoming “People’s Health Assembly”, with an invitation for people and groups concerned with the health and sustainability of humanity and the planet to participate in some of the preparatory meetings and activities.

This newsletter looks at a number of innovative efforts to make life better for children who have been living in difficult circumstances and who have especially challenging needs. In Nicaragua, we visit the Los Chavalitos farm school for formerly homeless children in the central highlands. We meet with the region-wide Encounter of children and youth engaged in Child-to-Child activities, where kids share experiences following the devastation of Hurricane Mitch. Next we look at a course held to design custom seats that increase disabled children’s comfort and abilities. Finally we announce the PEOPLE’S HEALTH ASSEMBLY —an effort to get at the roots of growing inequality worldwide.

This Newsletter’s lead article looks at PROJIMO’S budding Skills Training and Work Program. It shows how disabled young persons—many of whom have come out of Mexico’s new sub-culture of crime and violence—teach unemployed village youth useful skills ranging from making coffins to building children’s wheelchairs. This lets them earn a living in ways that help disadvantaged people and the endangered environment rather than harm them. One apprentice wheelchair maker is Alejandro, a boy who was shot in the spine by a policeman and is discovering new options. Next is a design for an All Terrain Wheelchair Carriage, sent by a reader of our book, Nothing About Us Without Us.

Then comes a brief report on the recent WHO meeting in Kazakhstan, on the 20th anniversary of the Alma Ata Declaration. The purpose: to analyze why the goal of “Health for All by the Year 2000” remains a distant dream—and where to go from here.

Finally, we describe the “book launchings”of the Japanese translation of Questioning the Solution, our politics-of-health book.

In this newsletter, PROJIMO facilitates representatives from the charity Stichting Lilian Fonds (SLF) in a workshop about community based rehabilitation (CBR), which resulted in help for 11-year-old Eli and three-year-old Daniela, for whom a special chair was made by a disabled woodwoker. The newsletter also contains David Werner's observations about his experience at a symposium in Singapore, "Management of Longterm Disability" as well as an excerpt of a paper given by Kenneth Jue. And you will also find news from the International People's Health Council, and information about a new book "The New World Order: A Challenge to Health for All by the Year 2000."

In this Newsletter, we cover a lot of territory. We begin with David’s visit to the Philippines to facilitate Community-Based Rehabilitation Workshops. Back in Mexico, we introduce Polo Levya, a new PROJIMO wheelchair builder, and relate how the team helped organize village youth to build a ramp for disabled access to village buses. Our attention then turns to recent IPHC news, including interest in our new book Questioning the Solution, written by David Werner and David Sanders, for which we include a review by Rosemary Harbridge. Finally, a warming is issued about an impending international agreement, negotiated in secret called Multilateral Agreement on Investment (MAI). The agreement, if passed, “will give unprecedented powers to global investment bankers, money speculators, and transnational corporations,” thus threatening environmental, consumer health and safety regulations across the globe.

This Newsletter represents a major, if unfortunate, update to the PROJIMO story first outlined in Newsletter 25. In that Newsletter, David outlined how drug violence had changed the face of PROJIMO from child-focused to youth-violence focused:

In the first years of PROJIMO most children brought to the center had disabilities caused by polio or cerebral palsy. […] The growing number of spinal cord injured participants, however, has led to unforeseen changes in the nature and focus of PROJIMO. First, it has meant that the program now serves many more young adults. Second, many are spinal cord injured from bullet wounds. Most are young men (along with a few young women) whose injuries have resulted from involvement with alcohol and use and/or trafficking of drugs.

In this Newsletter, six years later, David Werner spills out all the sad and at times frightening problems facing the Mexican projects in Ajoya: violence, drugs, thuggery, theft, kidnapping, and more aligned to force PROJIMO to transform. The first step will be to move the rehabilitation activities to Coyotitán, 40 miles away from Ajoya. The second will be to refashion PROJIMO in Ajoya as a work-skills training program.

In his “Health, Economics and the Environment” presentation at TOES (The Other Economic Summit), Jason Weston shows that the biggest threat to global ecology, and hence the future health of humanity, comes from an economic system based on growth-at-all-costs. Part of the solution, he suggests, is a sustainable development model based on need rather than greed. Next, we present readers with a few selections from HealthWrights’ new book, Nothing About Us Without Us—Developing Innovative Technologies For, By and With Disabled Persons, by David Werner. Finally, we provide an update on the recent conference in South Africa.

In this Newsletter we describe a brief training course in Community-Based Rehabilitation in Recife, Brazil. Concentrating on practical activities, participants helped improve the situation of disabled children in distressing conditions-in part by arranging for mentally handicapped girls to help care for physically disabled children. Here we also announce two new books developed through HealthWrights. The first is Questioning the Solution: The Politics of Primary Health Care and Child Survival, which is just off the press. Editors note: the announcement of this book is missing from the PDF The second, which will be in print in 1997, is Nothing About Us Without Us: Developing Innovative Technologies For, By, and With Disabled Persons. Sample pages from this forthcoming book are included as a preview.

This Newsletter explores the links between personal and structural violence. We describe a Child-to-Child workshop in South Africa, where school children identified violence as the biggest threat to their health. We look at growing crime and violence world-wide, relating this with a global economic order that widens the gap between rich and poor. Noting the spoils of war and the powerful lobby of the weapons industry, we protest the failure of the US government and its allies to effectively ban landmines. We call for a total ban! Next we look at the shift from dictatorial to economic oppression in Chile, and see how marginalized women there join in struggle for their health and rights.

We also launch our new book Questioning the Solution: The Politics of Primary Health Care and Child Survival. This book explores how the potentially revolutionary concepts of Primary Health Care have been undermined by powerful interest groups. As a case study, the authors use Oral Rehydration Therapy (replacement of fluids lost through diarrhea) to show the pitfalls of promoting technological solutions to resolve ills caused by social and economic injustice. To put the politics of 'death from diarrhea' into a real-life context, the book announcement is accompanied in this Newsletter by 3 true stories, 2 from Mexico and one from rural Kenya.

This Newsletter begins with the remarkable story of young people with cerebral palsy who study Karate in Madras (Chennai), India. We then look briefly at two essential movements by and for disabled persons Independent Living and Community Based Rehabilitation and discuss recent efforts to bring together their best features. We also report on the recent International Forum on Globalization and the implications of economic globalization to grassroots groups who are working for fairer social structures. Finally, we review several new books which may be important reading for those concerned with health and human rights, or in the quest for an approach to sustainable development that is caring and fair.

If there is a common theme running through this Newsletter, it is the ethical imperative of giving people who are at a disadvantage a fair chance. We start with the story of a multiply disabled child in Mexico, and the way village rehabilitation workers at PROJIMO used Child-to-Child methods to help his classmates become more understanding and helpful. Then we look at dire events in Mexico as a whole, and how the North American Free Trade Agreement has contributed to the country’s economic collapse, with devastating effects on the poor. Next we explore the evolving struggles of disabled people for their rights in Russia, where the All Russia Society of the Disabled has translated the handbook developed at PROJIMO: Disabled Village Children. Finally, we visit the World Social Summit in Copenhagen, where debate polarized between greed-based and need-based development. In Russia, in Mexico, and worldwide it is clear that the greed-based paradigm now holds the upper hand. But growing numbers of people from all social strata are beginning to join together to build a society based more on caring and sharing.

This Newsletter takes us to Africa (Sierra Leone and Kenya) where David Werner has recently been consulting with the World Health Organization (WHO) in an initiative to help rural women identify and seek solutions to their biggest health-related problems. Working together with village women, the researchers try to build on their traditional knowledge and survival skills. The goal is to help disadvantaged women gain more control over their health and their lives. The Newsletter continues with news from PROJIMO and Piaxtla, then closes with the struggle against anti-immigrant Proposition 187 (‘Save Our State’), and closes with a discussion about how the ‘structural adjustment programs’ forced by the World Bank upon struggling nations financializes matters of health:

“But on reading further, we discover that under the guise of promoting an equitable, costeffective, decentralized, and country-appropriate health system, the World Bank’s key recommendations spring from the same sort of structural adjustment paradigm that has worsened poverty and further jeopardized the health of the world’s neediest people.”

In this remarkable Newsletter, David offers an extensive analysis of the politics of health in Ajoya of the Sierra Madre that links the village to the globe. He details failed Mexican land reforms that have left the bulk of the population poor, and offers a short history of political struggle in the Sierra Madre. David levels criticism of NAFTA and “free trade”, and positions the Chiapas uprising as a response to globalized capital, calling for a “grassroots united front for world health.” Thus the ideological transformation of the Piaxtla Project is complete: from CURATIVE to PREVENTATIVE to ORGANIZED ACTION in which “the struggle for land as a strategy for health.” Also included in this issue is information about the International People’s Health Council, the politics of family planning, and updates on PROJIMO, including exciting developments in their work with Child-to-Child.

A trip to the slums of Nairobi confirms the fact that the struggle for health is a struggle for basic human rights and that the work of a few members of the community can far outshine the inappropriate gifting from NGOs. As elsewhere, women and children bear the greatest burden of political negligence and abuse. John Fago of New Legs for Nomads visits Cambodia to teach and learn from local prosthetic technicians, and advocates for disabled people to contribute to the discussion of their own health and autonomy. As John states so clearly, “Life is not a business. Rehabilitation should be pursued in the context of a creative community. It should be fun, and it should make this a better world.”

In this Newsletter, we look at the North American Free Trade Agreement (NAFTA), which is currently awaiting approval by the US Congress. We begin by exploring, in particular, the disastrous consequences which NAFTA promises for Mexican campesinos—including our friends at Project Piaxtla—through the dramatic changes in Mexican laws which have been made to accommodate the agreement. We then take a broader look at NAFTA—-which like most of the economic policies of the Reagan-Bush era—will largely benefit the wealthy at the expense of the poor. Finally, in this issue of our newsletter we Include a report from photographer and prosthetist John Fago, on the situation of disabled people in Cuba—a country which has long suffered the wrath of US foreign policy.

In this newsletter we take a look at some of the changes that have occurred in Nicaragua since President Violeta Chamorro took place in April 1990. We focus in particular on developments in the health care system and on other trends affecting people's health. Also, we are including for the first time a "Letters to the Editor" section to give our readers a chance to respond to our ideas and to share their own thoughts and experiences. We encourage you to write and let us know what's on your mind. We would especially like to hear from community health workers in poor countries.

In this Newsletter we highlight the challenges of maintaining PROJIMO in the shadow of Mexico’s intensifying drug-related violence. Started as a program for disabled village children, PROJIMO has gradually evolved, in response to a growing need, into a haven for physically and socially damaged young adults, many with spinal cord injuries resulting from the expanding subculture of alcohol, drugs, and violence. The PROJIMO team is trying to cope with the program's new role and to explore ways that PROJIMO can simultaneously serve vulnerable children and troubled young adults. We also provide an update on the ongoing struggle for equality within PROJIMO itself, which in many ways parallels the struggle of the project's disabled members for equal treatment by society at large.

This newsletter is the second half of a two-part report by David Werner on a journey he made to the Middle East in November 1990, on the eve of the Gulf war. The report explores economic, social, and political factors—both national and international—which affect people's current health status in this turbulent region. In Newsletter #23 we focused on the situation in the West Bank and Gaza. In this newsletter we turn our attention to Egypt. The intensification of hardships caused by the Persian Gulf crisis fanned the flames of popular unrest in Egypt (and in other Arab countries allied to the US). Events were moving swiftly toward some form of revolt when Washington launched its preemptive war. But the end of the war did not bring peace to the Middle East. Indeed, the growing gap between rich and poor, coupled with widespread poverty, poor health, and denial of basic rights, may yet lead to a broad-based uprising demanding fairer social structures. The Newsletter closes with a short note celebrating the 70^th birthday of Trudy Bock, a loyal ally who has played an important role in the Mexican projects, including producing the Newsletters.

We believe that this is one of our most timely and important newsletters. When David Werner visited the Middle East several months ago, he had no idea the region was poised on the brink of a major conflagration. David's impressions cast grave doubt on the Bush Administration's hasty resort to war.[SUMMARY BREAK]In this issue we explore the impact on people's health of institutionalized human rights violations in Israel's Occupied Territories. We find that these violations are linked to global power structures, to the powerful economic interests that undermine democratic processes in the US, and to the present war in the Persian Gulf. We argue that the same standard must be applied to Israeli behavior in the areas it is occupying as to Iraqi conduct towards Kuwait. And we end with an urgent call for action. The next issue will focus on developments affecting health in Egypt, and will examine the reasons why the White House feared that delaying the Gulf war would have destabilized US allies in the Middle East.

This omnibus Newsletter tells the story of Conchita, a disabled woman who transformed from a shut-in who had given up on life, to an independent leader and worker at PROJIMO. The author reports on his visit to war devastated Angola, another country of people held in hellish desperation by US policies and intervention; TOES, The Other Economic Summit held simultaneously during the G7 Summit, energy policies and their effect on world poverty and lack of health. Excerpts from an interview with Medea Benjamin on “The Third World in Crisis” during a time of changes in the Eastern Bloc that ultimately led to the collapse of the Soviet Union.

This Newsletter begins with a report from the Philippines from Susan Klein, author of an upcoming manual on midwifery for the Hesperian Foundation. Challenged to make practical the revisions to the manuscript, her ally Sylvia arranges Susan to be invited to Manila by Gabriela, a 50,000-member progressive women’s organization, to teach a course on basic midwifery for midwives and health workers from poor urban and rural areas. She begins by receiving a two-week orientation to the health situation in the Philippines, including sex work in Olongopo. Later he teaches for a month with BUNSO, an organization that promotes breastfeeding, during which time she field-tests the manuscript. Next in the Newsletter is an essay by Steve Babb about the election loss of the Sandanista, raising questions about the health gains for the poor in Nicaragua. Closing this issue is an update from David on the violence and human rights abuses in the Sierra Madre resulting from the ‘War on Drugs’.

In a world in which the poor and marginalized are increasingly exploited, human kindness and cruelty are perhaps the main determinants of health. This Newsletter begins with a true story about a unique friendship between two disabled young people at Project PROJIMO, as told by Oliver Bock, a California orthotist (brace-maker) who has made several trips to the program to share his skills with village rehabilitation workers. Elsewhere in this Newsletter, we look at some of the man-made, structural causes of poor health, especially the so-called "War on Drugs," which is often in practice a war against the poor. We also include brief updates on the activities of the México programs and the Hesperian Foundation.

This Newsletter marks an important shift in David Werner’s approach, from a focus on local health matters to a broader, global perspective on health. He notes:

“In the world today, it has become clear that isolated struggles for health and equality, even in a remote village or slum, are inseparable from the global struggle for a more just world economic and social order.”

In this Newsletter, David provides his extensive observations on the political and health consequences of Apartheid in South Africa, the white supremacist regime that lasted from the 1950s to the early 1990s. David marks the parallels between the destabilization efforts of the SA regime in Mozambique to similar efforts by the US in South America. He then goes on to describe in detail the dismal conditions of poverty and lack of health infrastructure for poor Black communities living in slums. David then reports on the the letter writing campaign against the US War on Drugs, provides a couple short notes on tobacco policy, and a poem by a 12-year-old South African boy. The Newsletter concludes with a review of Disabled Village Children.

In this remarkable essay, the effects of the growing drug trade on the campesinos in the Sierra Madre make the previous years of malnutrition, infectious disease, violence, natural catastrophe, medical neglect/abuse and governmental corruption seem almost bucolic. A stunning explanation of the development of the drug trade and why at all costs it must be preserved is presented, starting with a simple campesino farmer on his milpa and leading to the CIA and the world banking industry. The author suggests the solution.

In this newsletter, which announces our new book, Disabled Village Children, we include the first part of a children's story by Molly Bang. Molly, a prize-winning author and illustrator of many children's books, visited PROJIMO in December, 1986. She made friends and had long talks with many of the disabled persons there, including both providers and receivers of the rehabilitation services.

The story of Lupe gives a revealing personal picture of PROJIMO, the community based rehabilitation program run by disabled villagers in western Mexico. We feel that Lupe's story will help you understand both the roots of our new book, Disabled Village Children, and the kind of “people-centered” program it advocates and is designed to serve. For a review of Molly Bang’s story, click here.

The Newsletter closes with news about the fight against diarrhea in Mozambique, and an important Project Piaxtla update: the return of Miguel Angel as a fully trained doctor.

This Newsletter opens with Bruce Curtis’s experience with the psychological side of disability: unspoken feelings of humiliation and otherness that can lead the disabled to hide away, or refuse necessary procedures because they will be viewed as different. In the next section, the philosophy and developments at the emerging PROIMO project are detailed. The Newsletter closes with news from the Hesperian Foundation and information about its self-publishing efforts. Is this Newsletter complete?

The newsletter opens with updates on Project Piaxtla. Detailed are the drama involving a government health clinic in Ajoya, the broadening use of Where There Is No Doctor by the Mexican Health Ministry, and an update on the Piaxtla corn bank.

The main topic of this newsletter, however, is PROJIMO, and it provides a good introduction to the project as it was first taking shape in 1983. The mission, staff, rehabilitation activities and technologies are all outlined. The rehabilitation story of Teresa illustrates the work of PROJIMO. The newsletter closes with updates about the Hesperian Foundation’s publications, and discussion of the early drafts of Disabled Village Children. NOTE: THIS NEWSLETTER CONVERSION IS INCOMPLETE. MORE IMAGES NEED TO BE INSERTED.

Alcohol is a major cause of death, illness, physical abuse, poverty and malnutrition. Women organize to oppose a saloon being built in Ajoya, promoted by the district president. They enact educational plays, in the form of Teatro Campisino, to bring light to their plight and put pressure on the promoters of the saloon. Gross abuses ensue, but the women and villagers win with the help of pressure arising from national attention through newspaper articles. A new book is announced: Helping Health Workers Learn, meant as a companion to Where There Is No Doctor (now in 17 translations). Help is requested to restore the Piaxtla corn bank after Hurricane Norma, and the evolution of the Hesperian Foundation into a health materials publisher is detailed.

In a major update, David describes the ways Project Piaxtla is gradually becoming a self-sufficient program. No longer reliant on drop in American volunteers, Piaxtla is villager run, and increasingly economically self-sufficient, too. The Hesperian Foundation is also establishing its unique position, with Where There Is No Doctor internationalizing the scope of its efforts. David outlines its prosective publications. David then describes their joint effort in promoting Child-to-Child initiatives. Concluding the Newsletter is an invitation for the reader to help out, and a short Hesperian Foundation publication list. Missing images, concluding slogans cut due to missing images.

In this short Newsletter, David describes a trip he and the Piaxtla team made to various places in the Americas to visit and think about community-based rural health programs. The team is troubled to find, in addition to programs that promote self-reliance of communities, others that “us[e] disease as a resource to control people.” Then David provides updates about the revision and translation of Donde No Hay Doctor (Where There Is No Doctor), and concludes the Newsletter with his thoughts about his evolving role in promoting health in the context of rural health care.

Before handing off this Newsletter to Project Piaxtla volunteer Victor Miller, David briefly discusses the changing role of American volunteers with the Project, and gives thanks for financial help offered by readers. In his contribution, Miller provides striking, if brief, vignettes of his life and experiences setting up health outposts, including the Pueblo Viego Clinic. He describes the place, the building, Teresa—a Donde No Hay Doctor “doctora”— the challenges of negotating the cultural differences of the consultas, a somewhat comical vaccination run, and finally a portrait of the campesinos struggling against indifferent nature.

In this remarkable Newsletter, David observes the gradual mission-creep of the Ajoya Clinic from prevention to cure with advanced technologies and medicines that promise ‘excellence’ in care. In conversation with Dr. Mark Lallemont, the importance of simplicity, kindness, and returning to the basics of primary healthcare is registered. But David advances another idea: adapting the Ajoya Clinic to the purpose of training practical health care workers capable of managing local primary health across the local region—the germ of David’s Helping Health Workers Learn.)

Concluding the Newsletter is the heart-wrenching story of María, whose final moments at the Ajoya Clinic were dramatically marked by a collision between medical ‘excellence’ (including device-driven diagnostic confusion) and expert-led indifference, causing the Piaxtla team to momentarily abandon one of its key principles: “The value of human kindness is unquestionable. Let this, then, be our first goal.” David lays bare the case, in all its complexity and self-implication.

After 15 months, the Newsletter returns with an extended digression into the life and work of Piaxtla’s prized mule, Heraclia who will “stoically trudge up a steep winding trail into the high Sierra Madre without perspiring or even breaking hard, leaving far behind the other mules...” Hericlia sometimes serves as an emergency vehicle, or, in her previous life, as a courier for illicit wine fuelling traditional masculine drinking dances where guns come out, misfires are commonplace, and scores are settled with bloody violence. David recounts the consequences of these events, and explains his own drug- and alcohol-free—but not puritanical—approach to life. He then recounts the time when a difficult birth led to the death of one twin baby boy, in spite of David’s stubborn efforts. Finally, eschewing the typical fanfare of the publication of an important and critical book, David modestly describes the local reception of his masterpiece of self-help Donde No Hay Doctor (Where There Is No Doctor), and gives thanks to those ‘midwives’ who helped birth it.

Dr. Kent Benedict, a pediatrician from California, takes over the Newsletter after two and a half years of essential work with Project Piaxtla in Ajoya, El Zapilote, and Joquixtita. David Werner explains:

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.

This would, of course, turn into the pathbreaking book Where There Is No Doctor Missing images.

In this newsletter, the author contemplates the impact of the Piaxtla Project, the joys and tragedies in the lives of the people he has come to live with and love, and the impact of the project on the lives of the volunteers and donors. He begins forming a village health care handbook, “The Practice of Medicine Without Medicine,” eventually to become the influential work: “Where There is no Doctor.”

This newsletter discusses the quandary of deciding when to risk sending a patient to the hospital in the city vs trying to treat in the village. The selection process is not so clear cut as one might think. Also, several villagers receive surgery and care in the U.S. through help from volunteers and donations, new village health posts open, villagers are trained to extract, drill, fill teeth and make dentures. The generosity of volunteers accomplishes miracles.

In this Newsletter David tells the touching story of Manuel, whose heart condition was practically untreatable due to cost, until he met Dr. Sissman from Stanford, who offered to treat the boy for free. We get an update on Project Piaxtla’s medical personnel, and their responsibilities and efforts. David details the new and well-stocked dental clinic, and describes the “Operation Fill and Drill” dental drive with the help of visiting dentists. Then various ecological problems are explored, focusing on the loss of pine forests, the (mis-)treatment of animals, and an unexpected side-effect of the UNESCO anti-malaria program involving the (now banned) chemical DDT. Finally, the Newsletter includes some updates on the students Piaxtla is sponsoring, and closes with an update on the cooperative corn bank, and thanks those who bought David’s bird drawings, which resulted in much needed eye surgery.

This Newsletter opens with David’s experience with a hurricane that wrecked the locals’ crops, then moves on to describe in detail the difficulties and misadventures of establishing the pure water system in Ajoya—which was finally successful. David updates us on the new Project Piaxtla staff, and details the construction of the Project’s new dispensary: El Zopilote. The reader is updated on the educational situation in the Sierra Madre, including the return home of Martín and Miguel, and the stability of teachers in Jocuixtita. Finally, the Newsletter closes with some encouraging medical improvements, like the apparent elimination of nutritional diseases, and improvements in dental health, and some remaining challenges, like infectious hepatitis and routine drunken violence.

This Newsletter is missing from the collection. If you have this Newsletter, please send an email to info@healthwrights.org.

In this Newsletter, David explores the political conditions which result in unjust distribution of land, wealth, and consequently the health of the campesinos. “Hunger for the right kind of food is the most widespread physical hardship in the barrancas,” he writes, and although he holds out hope, he notes how difficult change really is. He therefore initiates under the Piaxtla banner a corn bank that helps mediate the market between growing and planting seasons, when the poor farmers are most vulnerable to exploitation by the wealthy land owners. Finally, the Newsletter provides updates on developments at Project Piaxtla: reconstructive surgery by Stanford volunteers, an update on the pure water system in Ajoya, updates on the Piaxtla medical dispensaries and lab, and life updates on students Martín Reyes and Miguel Mánjarrez, presently studying in California.

In this Newsletter, David Werner describes his experiences and provides updates on his nascent projects in the Sierra Madre. He outlines the visits by eye-doctor Dr. Brock and pediatrician Dr. Prince, and the results of their efforts, as well as a visit by Pacific Highschool students. The Newsletter provides an update on Martín Reyes Mercado, David’s basic dental training by dentist Chuck Renn, details on a prospective birth control program, more information on sourcing medical supplies, and David’s plans for the fall.