In sum, community participation was central from the inception of this project and throughout the four phases. Participants were involved in trainee selection, curriculum development and modification and negotiation of clinical practicum and evaluation. Their contributions significantly influenced the content and process of the workshops on a daily basis. For the in situ training the indigenous trainers used a similar process of participation and planning, and adapted the workshops specifically to the island culture. Evaluation methods were similarly adapted to the specific communities. High success rate of returns resulted from the evaluators' careful sensitivity to the culture and the adaptation of the Western research process. The team involvement in the participant's transformation and self-reliance created a productive mutual experience.