I went back to my students at Pacific High School and shared these experiences. We started talking about putting together some useful medical information and supplies and going back to the mountains to distribute medical kits and teach some basic medical skills.

So we made up some little kits in old coffee cans and went down to Mexico. We made about a hundred-mile loop through the mountains, passing out the kits and talking with people about health problems.

After we got back, I decided to go back down for a year to help the people there obtain the medical skills and supplies they needed.

And you ended up staying ever since.

Just about, though the program is now completely run by the community, and I'm just an advisor,

When was that first visit?

That was in 1964.

When you went down there to live, how did you get started ?

I started out making the mistake I think all experts tend to make, that is, trying to provide care instead of helping people care for themselves. Luckily, there was much more than I could do by myself, so I started recruiting the children who had begun to hang around out of curiosity, getting them to do things like washing wounds, suturing cuts, giving instructions. This group of kids, thirteen, fourteen, fifteen years old, became paramedical workers right from the beginning.

Then we went through a phase where we depended on young American students—many of them Stanford pre-meds—to come down and spend blocks of time helping out. We'd organized an unofficial course at Stanford to train these volunteers. The course was run by the young volunteers with local doctors as resource people.

It was very interesting to compare the graduates of this three-month, very practical course with some of the new medical school graduates who also came down to volunteer. The pre-med students were better in every respect, including the strictly clinical areas. They had learned to focus on the problems of greatest need, while the med school graduates would want to do an extensively detailed medical work-up with a complicated differential diagnosis. They'd feel frustrated because we didn't have the technology to do all the lab tests and diagnostic procedures.

How did the villagers respond?

That was very interesting. We realized that the better our volunteers got—and by that time we were really getting the cream of the crop of Stanford students, really dedicated and committed people—the more they tended to undermine the capacity of the villagers to assume responsibility for their own care.

When the paramedical village workers, many of them teenagers, had to compete with the volunteers, we could see a real falling-off of interest.

So we went into another phase in which we decided that no outsider should provide any direct service at all. They should be there as educators. Their goal should be to leave behind their knowledge and skills with the villagers. This didn't come until eight years after the program had begun. We learned pretty slowly.

So there have been several phases of the project....

Yes. The first was me working with the young people from the villages. I think that was a good start.

The second was using the American pre-meds, which I see now as an unfortunate back-sliding toward the kind of dependency that professionals always seem to produce.

The third phase was limiting the outside experts to teaching functions, so that the outsiders were really coming in on the villagers' terms.