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Laura Libman is doing her best to wake up, standing in the dusty street lined with low-slung, windowless, adobe dwellings, a cup of steaming coffee gripped in both hands. As the sun creeps over the Altos de Jalisco, the foothills in the far northeastern corner of this central Mexican state, the sleepy pueblo of La Granja is waking up to an important event.
Today, 13 excited village women will receive graduation certificates pronouncing them promotoras, official health workers in the small community about five hours from Guadalajara. The women give credit for their accomplishment to Libman and the Tia Foundation, the Arizona-based nonprofit organization she founded to bring health care training to rural Mexico.
With her brains and education, Libman could easily be the CEO of a major corporation, ensconced in a plush, high-rise office, wearing heels and an Armani suit. Instead, the 2005 Thunderbird graduate has spent the night on a mat on the floor of a bare room in the home of Don José and Doña Maria de Jesús Marín. This house boasts a cement floor and bathroom with hot running water, both luxuries in this town — where most of the simple houses have only dirt floors and no running water, animals roam freely in and out, and children play in the streets.
Libman wears jeans, tennis shoes and a well-worn cotton blouse with colorful Mexican embroidery. “I wish I blended in better,” she says, apropos of nothing, in a throaty voice that she attributes to too many cigarettes and too many nights with too little sleep. With her fair skin, green eyes and long hair as crinkled and chocolate-red as an ancho chile, she is decidedly the only gringa in this remote village of some 800 people.
At 44, Libman has taken on a monumental task, turning her back on more lucrative jobs to “go out and do something to help somebody else.”
Libman is the daughter of a successful American businessman, and her mother is Mexican. She grew up spending summers with her cousins on the family ranch near Guadalajara, sometimes also attending school there. So she feels a special connection with Mexico. She started college early, but got married young, had two children and didn’t finish her undergraduate degree until the kids were in high school.
She returned to school at 40 and graduated as valedictorian from Arizona State University West in Phoenix with a bachelor of arts in English. Even before she finished the degree, she developed a successful career as a contractor in global project management, knowledge engineering and marketing.
But she wanted something different out of life.
When a friend suggested she attend Thunderbird School of Global Management in Glendale, she said, “Why would I want to go to an MBA school? I thought I was done climbing corporate ladders.”
Taking the plunge
The friend, who happened to be head of Thunderbird’s Career Management, told her she should think about going into international development. When the School offered her a generous scholarship, she took the plunge.
“I went there having no idea what I was going to do when I graduated, and really, to be honest, scared to death,” she says. “I was 40 years old, a single mom, juggling a part-time job, kids and a house, and I wondered if I was smart enough to do this. Then, a month before graduation, I had all these job offers. But it was all the same thing I had done before. I thought, ‘I didn’t go back to school to do what I was doing before.’”
About that time, she attended a fund-raising event for the Center for Humanitarian Outreach and Inter-Cultural Exchange (CHOICE), an organization that focuses on sustainable village development in poor rural areas in more than six countries. The CEO told her he didn’t have enough money to hire her, but the center had an operation in Mexico, and the one area where the staff couldn’t seem to put the pieces together was health care. “It would be cool if you could do that,” he told her.
“I had learned about similar models in class at Thunderbird about barefoot doctors and community health workers,” Libman says. “I wanted to find a use for those models for creating independence and teaching people to take care of themselves. So I began to research the best way to put together a program that would work in Mexico.”
The turning point came shortly before her graduation, when she met with a man who would become an anonymous donor. He offered her the seed capital to get her program started, so she jumped in with both feet. First she spent a month in the field, hiking and driving from village to village in the state of Guanajuato, Mexico, talking to people from CHOICE and trying to figure out how to make the plan work.
“It ended up that a lot of the ideas I had were good, but not broad enough,” she says. “You have to walk that narrow line between being too broad and not being able to do anything very well.”
A valuable partnership
Thinking she had no contacts with the medical community in Mexico, Libman next pondered how to deliver the training. At a cousin’s wedding in Guadalajara, her relatives laughed at her.
“Don’t you remember Tío Luis, your uncle who at one time was dean of the medical school at the University of Guadalajara?” they asked.
Luis Garibay actually had started the Community Health Program for Universidad Autónoma de Guadalajara nearly 35 years ago. The program runs 40 to 50 clinics for the poor all over the state of Jalisco, sending in brigades of medical students to do field work mandatory to earning their degree. The weeklong blocks of field work include vaccination campaigns, treating patients and providing health education classes for the schools, as well as for adults. It would be a natural extension for the students to also take on the task of training Libman’s promotoras.
So she approached Dr. Francisco Rico, director of the student brigades, to help with her project. A big, burly man, Rico is a no-nonsense, shoot-from-the-hip kind of guy who has no problem approaching government officials in the municipalidades (like a county seat in the U.S.) in jeans and rumpled Polo shirt to request help with expenses.
“We have mobile units that go into different villages each month,” Rico says. “It’s part of the students’ curriculum to spend 40 to 80 hours each semester at these small clinics in the field where there is no health care available. I love this program and working with Laura because we are able to help the people that
really need it.”
Two years after connecting with Rico, the Tia Foundation is a working reality.
Teaching them to fish
The fundamental theory behind Tia, which means “aunt” in Spanish, is to teach villagers how to care for themselves rather than being dependent on outsiders. Libman says she learned the philosophy of “teaching them to fish, rather than giving them fish” at Thunderbird. The idea is to teach the people and mentor them as an aunt would, not to come in and boss them like a parent. Using native student doctors builds trust, and purchasing medical supplies locally helps to spur economic development.
“Our whole goal is to make ourselves obsolete,” Libman says, “get in there and give them the essentials and tools, access to the resources, and get out with a minimal impact on their culture.”
The program starts with an initial needs assessment to determine which communities are the best candidates for the program. The second trip involves a community study, going house to house to do a thorough medical survey of the living conditions and medical histories of about 25 percent of the residents. Then the village organizes a meeting and chooses the people to be trained as promotoras.
Each of these individuals must have at least a fourth-grade reading level, be someone the community will respect and have a nurturing personality. The program has never specified women, but all of the candidates have been women, probably because they are the typical caregivers and the anchors of their families.
Finally, the brigade of medical students with their professors comes in to do a week of instruction, lectures and discussions, as well as hands-on training with any local people who are sick or injured. At the end of the week, the workers are presented with their diplomas and their medical kits.
One of the unforeseen byproducts of the program has been female leadership building, as these women who once were voiceless become leaders in their communities.
With her first project in the municipality of Sayula behind her, Libman is concentrating this time on the municipality of Ojuelos, with four villages involved: La Granja, Salitrillo, La Presa and Los Morenitos. La Granja is a five-hour drive from Guadalajara, and the other villages are even farther on bumpy dirt roads.
Only La Granja has a clinic, which serves six to eight communities of 300 to 800 people each. But they are lucky if the medic assigned to their area by the government shows up once a month for one day.
The area used to employ many people in copper, gold and silver mines, but most of the mines have closed. Many of the men have left for work in the United States or larger Mexican cities, so the wives are left to care for the families and try to farm.
A few people raise goats, pigs or chickens, but they cannot afford to eat the meat they raise, needing to sell it to buy more essential items.
“We usually have beans and corn,” a woman in the village says. “But this year the rain was late, and when it came, it was so much that it damaged the corn.”
Angel with no wings
One remarkable woman was instrumental in contacting Rico and bringing the brigade and Tia Foundation to the Ojuelos area. Maurilia Huerta, from the poorest town in the area, La Presa, was born with no legs and underdeveloped arms. Rico fondly refers to her as an “angel with no wings.”
Against all odds, she finished high school, then attended some college, thanks to a scholarship from the wife of the municipal president. She went on to be elected a supervisor in the Ojuelos district representing several communities in the area.
As supervisor, Huerta was shocked to find that the casa de salud (health clinic) in La Granja, like many others in these remote villages, was in disrepair, and that the doctors often would not show up for three months.
“This is not a casa de salud,” she says. “They just painted that on the building and put a couple of old pieces of medical furniture here and left. There is not even medicine or alcohol. We are very grateful to Dr. Rico and Tia for helping us.”
Graduation day
The streets of La Granja bustle on the day of graduation. The student doctors are busily finishing their consultations with patients, while others give last-minute instruction to the graduating promotoras. Libman is darting here and there doing what she can to help, along with her newly hired Mexico project manager, Patricia Garibay, her cousin from Guadalajara. Garibay has been involved with Tia from the start.
“When Laura told me two years ago she was starting this project and had to go to Guanajuato, I just grabbed my car and my kids and went with her,” she says. “Then I started helping her, making phone calls, making appointments, translating, anything I could. Then she asked me to work for her, but I keep telling her, “I would be doing exactly the same even if you weren’t paying me.”
Down the street, Huerta oversees the preparation of food for the fiesta to take place after the graduation. Tia is supplying all the food for the carne asada barbecue, a rare treat for this town. Some of the local women have pitched in to cook tamales, beans and tortillas.
Finally Rico arrives in the university bus with a government official from Ojuelos, and the ceremonies begin. The promotoras are all smiles as each walks up to accept her certificate and medical kit.
Libman is embarrassed by the gush of appreciation they show for her.
“They look at me like I am the one that has given them everything, and I am really nothing,” she says. “I am the orchestra conductor that puts the pieces together and begs for the money to make the programs possible. They are the ones who give up their time and drop everything to go help people.”
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