Consider this proposal to address firefighting disparities:

“The problem of fires in resource poor areas is growing. Even though we’ve had the tools to control fire for years—namely water, buckets, and hoses—thousands of people and millions of valuables continue to burn each year. Unfortunately, the employment of professional fire fighters in rural areas has not proven to be sustainable. Since we know that resource poor communities are primarily affected, we believe we should use mostly local, culturally appropriate methods to address this issue. Therefore, we propose the creation of a cadre of fire health workers. With only 5 days of training on essential fire topics, such as flammable materials and effective stamping out methods, they will be a cost effective work force ready to take the problem of fire into their own hands. Although fire protection suits and salaries are beyond the reach of local budgets, luckily, water and pails are readily available in most communities. Fire health workers will be on call 24 hours a day, 7 days a week, to attend to either small fires (i.e. grease fires in local kitchens) or larger fires (i.e. forest fires). We believe that fire health workers will give up part of their livelihood to volunteer their time, as they understand the severity of this issue and its effect on their safety. This way, we will have an equitable distribution of services across all areas and populations.” more…

There is no magic formula for how to work with communities in a way that perfectly balances power sharing with meaningful change.[1]  Many of the experiences that I have had in the Partners In Health supported projects in Mesoamerica have been incredible reminders of just how complicated this work can be.  Nevertheless, like the practice of medicine, there is both a science and art to the vocation.  Inspired by my readings and experiences, I offer a few key considerations, certainly not exhaustive, for those who may find themselves in the tumult of community participation:[2] more…

Community participation has had many forms. One of the easiest to recognise is how communities have been involved in the provision of health care. Examples run the spectrum from representation on hospital advisory boards to community activity at all levels, including the direct provision of care.[1]     

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I. The power to move mountains?

The commotion pealed like thunder in the distance.  It was unmistakable.  We turned the corner of the mountain dirt road and came upon over 40 farmers heaving in unison on four ropes that dropped off the side of the cliff’s edge.  The roads in this part of the Sierra Madre Mountains in southern Mexico are nothing more than an acute angle shaved into the crumbling earth.  They hold up well in the dry season, allowing the farmers access to the local city where they can sell their coffee harvest; but now it was the rainy season, and some unfortunate driver had come too close to the edge and slipped off the overhang.  Mud does not support sloppy driving. more…