The fourth phase began about three years ago, when the village team in Ajoya decided they wanted to take the whole thing over themselves, including the supervision and training of the village health promoters. So it was decided that there would be no ongoing presence of outside providers.
Including me. They did decide to invite outside professionals in as they needed them, but strictly to teach.
How has your role changed through those four stages?
I was originally a direct provider of services. In the middle stages, 1 was an active teacher. More recently, I've been more of a consultant and advisor. I'm moving in the direction of making myself completely dispensable. Because of my role in the past, it's difficult for me to be there without being an authority figure. I'm now spending about a quarter of my time in the community there, and always at their invitation.
Are the village health workers practitioners or educators?
They're both. Half their training is in communication and education. They don't try to be some big expert. Even if they already know all about a problem a patient has, they're encouraged to look it up in our handbook with the patient, so that a patient gets a sense of what he can do for himself. They try to transmit the idea that this isn't some magical knowledge, and you don't need some special ticket to have access to it. It's something easily understandable; let's find out about it together—that sort of approach.
Do they use medical supplies brought in from outside?
Yes, but less than they used to. Dehydration in children—secondary to diarrhea—is a major problem in rural Mexico. When we started out, we were infusing these kids with intravenous fluids, because that's what they do in hospitals up here. But we realized that this was creating a dependency on skills and materials that required outsiders. Now we almost never use IV treatment, because the long-term survival of these children is ever so much better if the mothers themselves are involved in the rehydration process, using oral mixes they can make themselves from things they already have in their homes. Infant mortality has dropped from 34 percent to about 6 percent since we've been there. I think that's due almost entirely to the fact that mothers now know how to rehydrate their own kids.
You were saying that some of the villagers had learned to do simple eye surgery.
Yes, they remove cataracts. You know, so many medical skills consist of some very simple knowledge combined with dexterity and a lot of practice. Somebody with a limited amount of education can learn a specific skill. Our chief laboratory technician has never been to school a day in her life, but she can do stool analyses, differential diagnoses of different parasites, blood workups, urine analyses, and so on, and report her findings accurately and intelligibly.
The dental workers there can run circles around recent dental school graduates from the States— because they've had more experience. Having a title or a diploma doesn't necessarily make you any good. Some of our village kids have pulled ten thousand teeth, while a new dental school graduate might have had a chance to pull two or three in his four years of dental school.
As far as the skills of primary dentistry are concerned—drilling, filling, and cleaning—the village boy can be trained to a level of skill comparable to an American dentist in a matter of weeks and can provide those. services at about—oh, I'd say about one-fiftieth the cost.