Welcome to Doctors for Global Health (DGH). Since 1992 our partners and volunteers have been working with communities in Morazán, a department of El Salvador, helping to promote human dignity and guided by the principle that health and education are basic Human Rights, not just commodities to be enjoyed by those lucky enough to have been born into relative wealth or peace.

You have probably been involved with, or already heard something about, our health-building. Based on community involvement, international accompaniment, Community Oriented Primary Care and keeping "the eyes of the world on El Salvador," our work would not be possible without you. We now include within our focus other communities-in the United States and Chiapas, Mexico-and feel that there is a strong, yet largely unappreciated, interrelation between the Health and Human Rights of all communities around the world. Therefore, we need to know your ideas and would like to find out how the reality in which you live and work mirrors or differs from our own.

This report is a call to observation, to reflection and to action, especially at the level of your own community and in the context of the reality of those persons and groups throughout the world who have difficulty making their voices heard. You need not necessarily take action with Doctors for Global Health, for there are other groups with similar principles. More importantly, we want to awaken you to the fact that your ideas, talents and resources can benefit many people in ways you may never have thought possible. Of course, you don't have to be a doctor to help - our view of health is an integral approach, adapted from the World Health Organization of the United Nations, "A state of physical, mental, social" and Human Rights well-being. About half of the Volunteers with DGH are not physicians nor health care professionals. Within this group are artists, lawyers, teachers, students, engineers and persons from all walks of life who find other human beings and the environment we live in important enough to "add their light to the sum of light."

"Every human being merits some basic Human Rights," said the United Nations General Assembly in 1948 in its Universal Declaration of Human Rights. Among the rights mentioned were education and health. Yet most people in the world do not enjoy even the minimum of education and good health. It is easy for those of us lucky enough to live in security to forget about these people or pretend that they are the cause of their own problems. It is more convenient to ignore this majority of the world's population, because the explanations for their misery are complex and discomforting, and the way to make a positive and lasting difference in their lives is unclear, to say the least. Alas, in the name of making a difference or doing good, much harm has been done.

But some ways of working to make a difference seem to function. Considerable experience has shown that community-based approaches, which have a clear goal of enhancing the ability of the persons in a community to make their own decisions and control their own destiny, have a much better chance of making a positive and lasting difference than projects whose goal it is to enhance goodwill toward its provider (for instance, the United States government).

Speaking of a lasting difference, there is the question of sustainability. For a project to be sustainable, it must be embraced by the community where it is working. However, even if that happens, the community must have the economic and administrative stability and ability to keep up their dreams. One does not have to be a scholar of history to note that the natural riches of the "developing" world have been stripped and ravaged by companies based in the "developed" world, often leaving environmental and social disasters. Even now, more money flows from the "developing" world towards the "developed" world each year than vice-versa, in the repayment of World Bank and International Monetary Fund loans. Such loans were often made to dictators who pocketed the money and are now absent from their posts. In the name of loan repayment, the World Bank has demanded "structural adjustment" programs in much of the "developing" world, causing profound social distress among the poorest persons in these countries and relieving the governments of these countries of the obligation to provide health and education services.

In the context of the plunder of many countries' natural resources and of "structural adjustment" programs, "sustainability" takes on a new meaning. It means being able to accompany the community, as much as possible from within the community and country, but even as partner communities from within the community and country, but even as partner communities from afar, in the promotion of human dignity.

Which brings us back to Doctors for Global Health. We are dedicated to observation, education, evaluation and action-all done in coordination with the community involved and in the context of the interconnectedness of the world. In 1959 the United Nations proclaimed in the Declaration on the Rights of the Child (expanded in 1989 to the Convention on the Rights of the Child, awaiting ratification) that all children-the hope of our future-have the right to an education, to health, to a peaceful environment and to a childhood itself. It seems normal. And it makes the awful reality of the world today, seen through the lens of the unfulfilled promise of the Rights of the Child, worthy of making us wake-up and take action.

If you can be part of the work of DGH, please let us know. Send a letter to teach us something or to show us you care. Send an application to be a volunteer in your community or abroad. Send a contribution to make our work possible. Or all three. We need your support and your ideas. Read, learn and share your reactions with us.

This report, a voice of Doctors for Global Health, contains many elements. The major focus is on El Salvador and the work of the Salvadoran foundation, Medicos por El Derecho a La Salud (MDS-Doctors for the Right to Health, was DGH's partner organization in El Salvador between 1995 and 2004), which works with international Volunteers recruited by its partners DGH and Medicos del Mundo-El Salvador, a mission of Médecins du Monde-France (MDM-Physicians of the World-France). Because this is the first official report of Doctors for Global Health, we present a brief History of DGH-our family tree and reason for being (page 2).

You'll also get a sense of what the core of our work in El Salvador consists of by reading, Where the Peace is New (page 8). The title comes from the fact that our project first began right after the peace accords were signed and the communities were just starting to rebuild their lives. And Bridging the Gaps (page 6) describes the incredible work the communities put in to building a bridge across a river that caused many deaths over the years.

Stories about projects in Chiapas (page 10) and in the U.S. (page 4), present examples of DGH initiatives outside of El Salvador. In addition, our commitment to being a "student friendly" association seems unique enough to warrant sharing some reflections from our International Student Volunteers (see A Day's Life... sidebars throughout). Of course these reflections also serve to illustrate the soul of our work, the "community within a community" approach.

We hope you find this report informative and look forward to hearing from you soon.

Thank you,

Lanny Smith, MD

President, Doctors for Global Health; Coordinator and Legal Representative, MDM-El Salvador, Mission MDM-France; Research Assistant, Franois-Xavier Bagnoud, Center for Health and Human Rights, Harvard School of Public Health.

Note: In this and all other instances in this report, with the exception of Doctors for Global Health, institutional names are provided for identification purposes only, and do not imply that opinions expressed in this report are condoned or shared by the institutions so named.

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