So on the basis of that experience, how does the American system of health care look to you?

Disturbing. I think that a lot of our experience in Mexico could be valuable to people working in the States. Medicine here has become a priesthood complete with its whole hierarchy, with an ignorant populace down below on the receiving end. I think it's a real tragedy that American kids go through as many years of schooling as they do and remain so shielded from an area which is of such importance to our own well-being.

Americans just don't know that much about medicine.

No, and it's a shame. So much medical knowledge is so simple to understand. If the things all our health workers in Mexico know were taught in the public schools here—all the stuff which has been the sacrosanct domain of the health professions—it would do an enormous amount to make people more aware of how to deal with their own health needs. It would be a tremendous boon to both prevention and treatment.

How might this come about?

It would take a big conceptual shift, a lot of consciousness-raising. The schools would have to place a lot more emphasis on the workings of the human body in health and disease—and that should include considerations of environment and social and political influences on health.

We need to set up situations in which people can share their experiences and come to recognize their mutual needs. Then they can focus on their power both as individuals and as a community to cope with some of those needs.

Health workers need to evolve in the direction of being better teachers, better communicators and sharers of knowledge and skills. I think a good many doctors go into medicine—or maybe they're influenced in this direction by their training—because they want power and prestige. I think it's going to take a major change in attitude for doctors to become more open about sharing their knowledge and skills.

I am impressed by your community-cantered approach in Mexico, having the communities who need a medical worker decide who's going to get the advanced medical training.

That's how they do it in China, too. Another thing they do there is graduate doctors up from the ranks, so that you start out as a barefoot doctor, then you can become a physician's assistant, and finally a doctor, instead of going right to the top once you've received your M.D.

What's been the effect on the young American premeds who worked in your program? Some of them must be doctors by now.

Yes. There are about twenty of them, most of them still in their training. They're all committed to the kinds of changes we've been talking about. They're all talking about trying to find a way to establish the same kind of special sharing-based relationship with a community that we've had in the Ajoya area.

You know, to me it's a tragedy that people coming out of medical schools and the other healing professions are so often deprived of this real human closeness. It's one thing to have a patient come into a hospital nice to him, and to have him be grateful, but it's quite another to be a real member of the community where you live, to be involved with all the members of family from birth on up.

That doesn't seem to happen with the way medicine is practiced here. The doctor relates to his colleagues, but in many cases there's a great deal of social and psychological distance between doctors and their patients.