Trial, Error, Negotiation, and Qualified Success: The INI's Public Health Programs in the Chiapas Highlands, 1951–61

This paper considers the first decade of INI health programs at its pilot Coordinating Center in highland Chiapas (1951-61).
Arguably, no task was more difficult for the INI than the introduction of Western medicine and modern hygiene practices to the
Tzeltal and Tzotzil Maya, who associated illness with sin, moral lapses, or metaphysical aggression. Western medicine
represented a direct challenge to the traditional, magic-religious worldview of the highland Maya and threatened to undermine
traditional hierarchies. These were outcomes that the INI openly sought. However, the INI also wanted to tread lightly, to avoid
direct confrontations with traditional healers; in no other aspect of its development programs was negotiation more necessary.
After a rough start, the INI shifted to preventative medicine and became quite adept at finessing its programs with elders,
traditional healers, and the Tzeltal and Tzotzil population at large. It used bilingual puppet shows to educate about vaccination
campaigns, it reconfigured its clinics to allow relatives to stay with the sick, and some doctors worked side by side with traditional
healers. In spite of the many factors that conspired against the Coordinating Center’s health campaigns, the INI’s approach to
health care was moderately successful and produced lower infant mortality rates, fewer deaths by preventable diseases, and a
greater life expectancy. And because the INI used its pilot Coordinating Center in Chiapas to test its development plans, the
lessons learned among the Tzeltal and Tzotzil informed subsequent programs elsewhere in Mexico.