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For this reason, many community-based programs
make the development of critical awareness a primary
concern. Through special educational methods and
‘group dialogues’, they try to help people look at their
situation more closely, realize their possibilities for
changing it, and gain the self-confidence to take positive, cooperative action. This
process of building social and self-awareness is the main theme of this chapter.
Social change, through which the poor gain more control over the
conditions that affect their well-being, is the key to “health for all.”
DIFFICULTIES IN WORKING WITH PEOPLE
TO IMPROVE THEIR SITUATION
Often health workers are eager to involve people in community action when they
return to their villages after training. But many quickly grow discouraged.
We recently got a letter from a young man who had trained as a ‘barefoot doctor’
in a community-based program in Nuevo Leon, Mexico. His training, which had a
strong political focus, had inspired him to try to organize people to work toward a
fairer and healthier social order. In his letter to us, the health worker wrote of his
frustration and sense of failure 6 months after returning to his own village:
“The people just don’t seem to care!” he lamented. “I explain to them that
in other communities farm workers have joined together to start
cooperatives, taken action to regain land that is legally theirs, and
replaced corrupt local officials with persons who represent their
interests. But they just shrug their shoulders and admit they are
exploited by the authorities, the shopkeepers, the landholders,
and the money lenders. No one is willing to open his mouth
in a village meeting or raise a finger to do anything about it.
Nobody tries to look ahead; nobody even seems to care that
much. When things are too bad, the men get drunk and beat
their wives or children instead of coming together to solve their
problems. The people in my village are hopeless! I give up!”
He went on to ask if we could suggest a different village where
he could work, where people would be more willing to work toward overcoming
their problems.