October 26 - November 12

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.

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:

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.

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.

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.