:: Projimo ::
October 26 - November 12
"No hay bien sin pero ni mal sin gracia."
Only after weeks of digesting our visit and researching PROJIMO did I begin writing. Illustrating my experience while trying to tell their story - their story, their dynamically colorful, painful, victorious history - became a complicated task. As I researched I realize it is not black and white but full of color and texture. Spreading their story is, however, important to me. Explaining how their dreams actualized, illustrating how struggles turned into successes, outlining how the struggles relentlessly continue, telling their story teaches and encourages all of us to search for our own passions and fight like hell to achieve them . . . and hopefully we also can achieve a place of joy, comfort, safety and love for those around us.
(There's nothing good without a drawback
nor bad without some saving grace.)
--an old Spanish saying
HISTORY OF PROJIMO
PROJIMO is an acronym for the Program of Rehabilitation Organized by Disabled Youth of Western Mexico. The history of PROJIMO starts with the Ajoya clinic in a rural area of Sinaloa state. The Ajoya clinic was a vision of David Werner. Sometime before the year 1965 David, a field biologist, was hiking in the western Sierra Madre Mountains, where drug-lords murder each other for control of the region's marijuana crops and simple rural people live in dilapidated villages. David came across a group of people carrying a man down from the mountains who was suffering from a terrible neck injury. After a brief series of questions David concluded that this man will inevitably be paralyzed for life due to the lack of basic medical support where as if this man was injured in a developed western country his fate would be entirely different. David was and is not a doctor, but his background in biology enabled him to see the desperate needs. His insightful heart helped to facilitate solutions and his motivation brought health care to poor rural communities. These endeavors led him to found Healthwrights and write many papers and books including Where There Are No Doctors.
The process of how primary health care came to the impoverished, rural areas of the Sinaloa state may have started with Werner's advocacy but it was the village people who birthed and mothered the process. Western doctors, engineers, scientists and allied health professionals donated their time to educate the village people, rather than just provide services. Donations, monetary and medical supplies, were also given, but it was the villagers who implemented the programs. The following excerpts borrowed from the Healthwrights web page illustrate their story better than I.
Village Health Care to the Struggle for Land and Social Justice: An Example from Mexico
When the program started in 1965, the "diseases of poverty" dominated the health scene. One in three children died before reaching the age of five, primarily of diarrhea and infectious disease combined with chronic undernutrition. Seven in ten women were anemic, and one in ten died during or after childbirth.
Primary Heather Care and the Temptation for Excellencewriten by David Werner
For better and for worse, the Ajoya Clinic has come a long way since 1965, when it began as a few boxes of medicines and bandages on the front porch of the casa of blind Ramon, and its staff was no more than an ex-schoolteacher trying hard to play medic, assisted by a handful of over-eager village children. Then, to be sure, we had a strong sense of community -- sometimes too strong -- for we shared the open porch with dogs, chickens, pigs, cockroaches, a pile of pumpkins, a corn crib, a small table at which we ate in shifts; and five cots which at night were unfolded to sleep eight of the household and myself.
...Over the years we have poured cement floors in the patient wards, fixed up an X-ray darkroom (which is not quite dark), built a workshop, put in a septic system, a flush toilet (which doesn't always flush) and a cold shower. Last year we finished construction of an almost modern operating room complete with scrub room, fitfully running water, filtered air system and surgical lights powered by our increasingly cantankerous 5 kw generator. . . Many people have helped donate or scrounge supplies for it, so that we now have a fair range of equipment including two fine microscopes, scales, a macro and a micro centrifuge, and a simple but ingenious incubator for culturing bacteria. (This last item consists of a styrofoam box through which runs an exhaust pipe from our small propane refrigerator. The pipe has a thermostatic shutter valve, so that a constant temperature can be maintained in the box.) . . .Our village apprentices, have gained more experience, our American volunteers are better trained, our range of equipment is more extensive and our laboratory facilities are enormously improved. In short, one might say we practice 'better' medicine. But, is it really better medicine?...
Piaxtla, a villager-run health care program, was the first project that evolved from the Ajoya clinic. After people received the first line of medical treatment the clinic provided general rehab care. The need for sustainable rehab care programs became apparent, thus disabled villagers banded together to create PROJIMO in 1982. Demonstrating immense determination and passion, they once again rose of above poverty and the lack of resources.
PROJIMO's primary goals is to provide high quality services at a low cost. Services include family counseling and training, therapy, work and skills training, brace and prosthetic fabrication, wheelchair making, and constructing wooden toys and positioning aides. They contributed greatly to the evolution of Community Based Rehabilitation programs (CBR) and has inspired the books Disabled Village Children and Nothing About Us Without Us. In doing so PROJIMO developed progressive philosophies that other rehab communities adopted:
Community Control The community was not to be run by outsiders.
De-Professionalization The original PROJIMO team had an average education of 3 years of primary school, however, they have mastered many 'professional' skills. Therapists, prosthetists, and other rehabilitation professionals are invited for short visits to teach rather than to practice their skills. "The PROJIMO team believes that only by simplifying rehabilitation knowledge and skills to make them widely available in the community, can the millions of underserved disabled children in the world receive the basic assistance they need." [Disabled Village Children by David Werner]
Equality between the service providers and receivers is another philosophy of PROJIMO Visiting disabled people and their families are invited to contribute to the project in whichever way they can.
Self-government through group process PROJIMO has developed different systems to try to avoid the 'boss-servant' or hierarchical relationships. At one point in PROJIMO's history the group elected a different program 'coordinator' (not the boss or the leader) every month. Currently there are specific defined roles of those who work at PROJIMO, but everyone is involved in decision-making, planning and organizing.
Modest Earnings Wages should be they same as that of the farming and laboring families their serve.
Unity with all who are marginalized "The PROJIMO team views its role not only as one of helping disabled children and their family gain power, but as part of the larger struggle for social change and liberation of all who are 'on the bottom'." Thus the group has participated in movements to change the social structure and governmental policies.
Grassroots multiplying effect The PROJIMO approach has spread in various ways: encouraged local business and schools to install ramps and wheelchair friendly bathrooms; inspired families of disabled children in neighboring towns to form their own special education programs and playgrounds, invited people from other rehabilitation communities to take back ideas back with them; helped write manuals and books on rehab care in rural areas.
Over the past 20 years PROJIMO has greatly contributed to the quality of rehab care in Sinaloa's rural areas and has served as a progressive and compassionate example for rehab communities around the world. Not to mention the enriched lives of those who live and work in the rehab community. Many people were suicidal or without family before they came to PROJIMO.
Individuals, children and adults, arrived at PROJIMO to receive rehab care and support from others with disabilities; to learn how to walk or learn a trade or be fitted for a prosthetic limb. At any given time there were 16- 20 people living at the project. Many times those individuals moved to Ajoya and became active members in the community. "PROJIMO is like a big family, mainly of young people, growing up together. . . benefiting from rehabilitation, learning to work, and learning to relate to each other." [Disabled Village Children by David Werner]
The family developed ways to live as a community while providing valuable services to people with disabilities. PROJIMO gathered great momentum and support. PROJIMO had the only playground in town, thus the villagers were attracted to the project and willingly volunteered. And the wheelchair and wood shop not only produced therapeutic equipment, but repaired bicycles and made home furniture for the pueblo. The self-worth and self-empowerment of those who worked in the project also soared.
In the early 1990's, the lives of those living in Ajoya were threatened by the local drug-lords. Roberto, who still lives in Ajoya, explained that kidnapping and deaths occurred more and more frequently. As a child, Roberto moved to the Ajoya clinic to learn how to care for his juvenile arthritis and soon became a passionate member. He explained that the violent drug-lords began a turf war, shooting each other and kidnapping people from rich families for high ransoms. Things began to get worse in the 90's; innocent people were killed and poor families became even poorer by being forced to gather ransom money.
In the 1990s, however, Ajoya began to pass through increasingly difficult times. The economic crisis in Mexico - and the widening gap between rich and poor that resulted from the North American Free Trade Agreement (NAFTA) and the "global casino" of speculative investing - has led to a tidal wave of joblessness, falling wages, crime and violence throughout the country. As we have described in Newsletter #29, the village of Ajoya, a strategically-located exchange point for illegal drugs grown in the mountains, has suffered more than its share of robberies, assaults, and kidnappings. As a response to so much crime and violence, many families have fled the village. In the last 4 years the population has dropped from 1000 to 450.
As the result of the violence in Ajoya, in 1999 PROJIMO split into two sub-programs. The PROJIMO Rehabilitation Program left Ajoya and moved to the safer, more accessible town of Coyotitan on the main west-coast highway (67 km. north of Mazatlan). For two more years the PROJIMO Skills Training and Work Program kept its base in the troubled village of Ajoya. Its goal was to provide socially constructive alternatives to both disabled persons and to village youth who, for lack of job opportunities or hopes of a viable future, were too often lured into drugs, crime and violence. For a time things seemed to be improving, but in the Spring of 2002, this program also moved to a safer location. Now the new PROJIMO Work Program is located in the small, very tranquil village of Duranguito, about 20 km. east of Coyotitan, near the coastal town of Dimas. [borrowed from the Healthwrights web page ]
The relocations of the PROJIMO and the Skills Training and Work Program appeared to dampen the energy level, the involvement of the community and the cohesiveness of the project. Unfortunately, the rehab project in Coyotitan and the Work Program in Duranguito does not frequently collaborate these days. Each program, however, continues to do provide valuable services. The Work Program in Duranguito is essentially a specialized wheelchair workshop. Recently they sent 30 customized wheelchairs to another state, which is a extraordinary service.
PROJIMO, currently headed by Mary Picos and Conchita Lara, offers the same low cost services to more costal towns and is more accessible by those in Mazatalan or Culiacan, the capitol of Sinaloa. Individuals from different states, large cities or tiny rural pueblos come to live at PROJIMO to receive rehab care and contribute to the community. The 25 member team, which changes with the seasons, manages a wheelchair workshop, a brace shop, a prosthesis shop, a toy and therapeutic furniture shop and a therapy program. The team operates on $30,000 per year which comes from foreign companies; they receive no money from the Mexican government. In a year, however, they will be losing their funding sources and are looking for Mexican and Foreign grants. David Werner continues to visit and serves as a consultant but spends most of his time traveling, speaking at courses and working with Healthwrights. PROJIMO continues to improve the lives of people with disabilities and to network with other rehab communities throughout the world.
A MINORITY IN THE FAMILY
Elephante squatted 4 meters from the Cabana, which was situated next to the entrance of the project and in front of the coordinators' houses. Under the shade of the cabana, a palm branch roof on stilts with two hammocks and two benched made by splinting the trunk of a palm tree, Spanish lessons are taught and Cocas are bought. Hence the cabana attracts much lounging and conversing. Living so close to the hub, the pulse of the community, we easily connection with the community- not to mention that our home on wheels inspired many questions. A steady stream of visitors gathered outside our front door; Jose Luis being the youngest and most frequent, followed by Marcellito, Emily, Pedro, Nadia and Blanca.
The cabana and Elephante made a wonderful home; we were quite sufficient. And because of that we didn't have to pay for our keep, however, Conchita and her family opened their home to us for cooking and bathing. We also invited people over for candle-lit meals that were cooked on our coleman camp stove. Twice we tried to cook for them, but, well… finally decided to leave the cooking to the locals; they are much better at it.
We worked but there were also terrific socialization opportunities: a lot of hammock conversations and a couple road trips. Whether it was a walk to the tienda for ice cream or a trip to the river, it was always a community effort, a family outing. We had scrumptious meals at various homes. Halloween included decorating kid's faces and shouted "¡Queremos Halloween!" ("We want Halloween!"). On Dia de Los Muertos we visited their ancestors at the cemetery and went to the local rodeo. We partoock in the ceviche fest, cleaned the camerons, danced, and sang karaoke.
Being involved, working and living with community as a minority, was quite an experience. Not only were we gringos, but we were able-bodied - without a wheelchair or forearm crutches. Not that we felt any discrimination, we actually felt like family. All 12 of us piling into Elephante to visit the old abandoned Ajoya clinic felt like the family was going on vacation - in the rearview mirror: aunts, cousins, brothers, children - smiling faces, barf bags, and wheelchairs swaying to music and bouncing with the road.
WORK AND IMPRESSIONS
Josh quickly determined the specifics of his service and a way to get Spanish lesson. The new PROJIMO Web Site needed finishing and Rigo, the Spanish teacher, wanted to learn HTML. By teaching Rigo how to create web pages PROJIMO would have an important skill to help them communicate their cause to the world and Josh definitely needed Spanish help.
It took me, Rosita, as the locals called me, a good week to determine how the therapy system worked ('system' being a loose term). No documentation. Clients appeared ad-hoc. No schedule book. There was some consistency: Dora came daily at 6:15am but didn't expect to be seen by a therapist daily and Jorge usually came twice a day. Sometimes I was by myself for hours. Other times the room was so crowded that people left with a smile or gave each other therapy in the playground. Without documentation and little communication with the other PROJIMO members, it always came as shock when someone came in with new PROJIMO braces or wheelchairs.
In Disabled Village Children the rural rehab manual inspired by PROJIMO I came across the following: " We [PROJIMO]. . . are in no position to speak with authority about 'organization and management'. Sometimes we wonder if our achievements are due more to our disorganization." I realized that this community has not only survived but thrived on whimsical attention to detail while honoring the nature of chaos; going with the flow so to not get stuck in a rut. Reading about their history and philosophies, encouraged me to shed my western approach and entertained the potential of chaotic successes.
While I was there, three foreign therapists were visiting and David Werner was also visiting. Inga, from Holland, previously worked in PROJIMO and now works for Volunteer Services Overseas (VSO); she helped fill the gaps. The extranjero group reviewed the intended therapy system of a CBR: Local therapist do not need a formal education, just the heart, the mental capacity and the motivation to learn. Formally educated therapists who are volunteers, the extranjeros (foreigners), teach and consult. The local therapists deliver the services, so that the clients relate to and trust the local therapist. This helps ensure that the therapy program continues after the volunteers leave. PROJIMO has been having a difficult time keeping a local therapist making the therapy program inconsistently and unmanaged.
When an extanjero leaves, they are asked to write down their suggestions and observations. David Werner, being a long time friend of PROJIMO and an expert on CBRs, helped facilitate a meeting. The PROJIMO team understood the 'falta' in the therapy program - they helped write the CBR's model of the therapy system. I felt naive, offering suggestions with such limited experience. The coordinators, however, appeared to be interested in objective perspectives. Operating outside the box is one of their philosophies.
During those three weeks, I positively impacted a few people's lives, by teaching clients different therapy protocols and building therapy equipment, scooter boards. At the local school I consulted with the teacher and parents of a boy with Autism. And I emailed therapeutic companies looking for donations -PROJIMO will have a computerized exercise program. I know this sound like a cliché, but the truth remains: I did learn much more than I was able to teach and give.