Two of our team members, indigenous bilingual education expert Dr. Carla Paciotto and physician and public health expert Dr. Victoria Lee, jointly led the effort to gather information about health, hygiene and sanitation needs in the settlements, and also to explore opportunities for a literacy program that would eventually integrate these topics within an eco-cultural health framework. Undertaking this task required going from house to house during two field trips beginning in Nobember 2007, to learn from the women about health and sanitation issues and practices. It became evident that most women in the community are well aware of health needs, but that health care and medicines for some ailments are in short supply, particularly since most families reportedly resort to biomedical care more than traditional medicine (except perhaps for the more common ailments). Medical services are not regularly available in the community, and even the clinics in the nearby town of Norogachi suffer from shortages of drugs and personnel. Concerning hygiene and sanitation, it was apparent that ecological latrines would definitely improve sanitation, as several of the existing facilities were little more than privacy shelters with no form of waste collection and safe disposal or composting. Some of the latrines, however, were better built and considered adequate. We discussed ecological latrines with community members and left with them detailed blueprints of some simple models easy to build with local materials, so that people could build their own latrines if desired.

Medical literature surveys conducted by Dr. Lee had indicated that the traditional Rarámuri diet, consisting largely of corn and beans, was responsible for a distinctly low prevalence of chronic diseases such as dyslipidemia and hypertension. This favorable health situation was thought to be at risk of negative change, as Rarámuri diet and nutrition have changed significantly in the past three to four decades, due to the widespread adoption of non-indigenous foods. There were also studies that demonstrated nutritional deficiencies especially in women, specifically with iron. As a consequence, planting iron-rich foods, such as spinach, in home gardens was encouraged. This possibility was discussed with Rarámuri women, leading to the planting of spinach in the gardens. Dr. Lee also interviewed a physician in Norogachi serving four nearby areas, who confirmed that the incidence of chronic diseases (diabetes, heart disease, hypertension) is still relatively low in Rarámuri people. She also learned that malnutrition rates (which had hit high levels in the past decade due to drought and other effects of environmental change on soil fertility and crop abundance) appear to have declined in the past few years, perhaps due to Mexican Federal Government programs aiming to supplement the Raramuri's increasingly meager food supplies. On the other hand, difficulties with medication supply were noted again as a significant barrier to health care delivery.

From both the surveys and the interviews with health practitioners, Dr. Lee concluded that, for the sustainability of this aspect of the project, it would be advisable for us to connect with existing Mexican federal and state government programs that focus on health, nutrition and adult education and have visual, written and verbal materials in Rarámuri. Some of these programs have proven to be effective in improving both health and nutrition, and it may be worthwhile to consider ways to improve their coverage in Rarámuri communities.

With respect to literacy, inquiries with Rarámuri women about their concerns and priorities revealed their interest in learning to read and write their names in Spanish, in order to better navigate the outside world. In November 2007, seven women formed a group that they called "Women Learn" and took part in several sessions co-led by Drs. Paciotto and Lee, in which they learned to recognize and write their names. The literacy training was coupled with demonstrations of hand washing and sanitary handling of food and water. After this experience, the women showed interest in continuing a literacy program. In order to support this effort, we explored possibilities for connecting with existing government-sponsored adult literacy programs that have already been introduced to the area. We found that one of these programs had recruited and trained a bilingual woman from one of the two settlements in which we work to serve as alfabetizadora for the indigenous women of the two settlements. This program also integrates hygiene and health topics in the basic literacy curriculum. The disadvantage of the program  is that it follows a conventional transitional bilingual education approach: that is, one that only uses initial literacy in the indigenous language as a stepping-stone for literacy in Spanish, after which literacy in Rarámuri is no longer maintained. Furthermore, the instruction is only two hours per week, and reportedly there is inadequate attention to the varying needs of individual learners, so the program appeared to have lost momentum owing to insufficient participation.