IHP Health and Community: Globalization, Culture, and Care (Spring 2)

Spring 2011 Letters

Brazil Letter Home

Written by Trustees Fellow Siobhan Brewer with help from HC students Amanda Dowden, Susan Johnson, Natalie Terens and Mindy Lee

We arrived in Sao Paulo, Brazil, greeted by the warm summer sun, the smell of pao de queijo and kisses on the cheek from our country coordinator, Glenda De la Fuente, and facilitator, Francesca Cirelli. Excited to leave the winter behind (and soak up some vitamin D), we were eager to jump right into the country program and learn all about the beautiful country of Brazil. Over the next month we would come to understand how Brazil’s unique political history, diverse blend of cultures, seemingly infinite natural resources, and quickly expanding economic development all contribute to the present public health issues people face within the country. We spent many hours navigating the large city of Sao Paulo, visiting hospitals and clinics, NGOs and government departments, and contrasting neighborhood communities, and spent a week in the rural city of Iturverva. And because hard work must be rewarded, we were even able to soak up the culture of Brazil by indulging in Churrascurias, futbol and samba dancing.

Sao Paulo would prove to be a different experience than what we expected to get in Brazil. Home to 19 million people, Sao Paulo is the largest city in Latin America. Although beautiful and rich with history, the city is full of blatant disparities. High rise apartments stretch to the sky while homeless camps are set up down below, underneath highway overpasses, or along streets. Congested roads produce a thick layer of air pollution that nestles on top of the city. The coming together of European, African, Indigenous and Japanese communities has created a unique cultural identity; however racism, discrimination and inequalities still persist. Wealth congregates in the down town, while the periphery is hugged by favelas, or poor informal settlements.  Some people suffer from malnourishment while others from obesity related illnesses. And, while the country is developing quickly, the population is now facing the “double burden” of infectious, or communicable, and chronic, or non-communicable, diseases.
We started the trip by learning about the history of Brazil in conjunction with the present changes that are taking place within the country. Once ruled by a military dictatorship, currently Brazil is embracing their first female President, who represents the Workers Party, or the people’s party. The government of the last decade or so has placed a large emphasis on developing the country’s economy while addressing some of the historical social problems that have long plagued the people. In Brazil, there is a strong sense of community and this is reflected not just through cultural celebrations, like Carnival, but in the way the country is addressing these developing health issues. We quickly learned that Brazil provides universal public health care guaranteed to everyone regardless of citizenship, protected by the revised 1988 constitution. This sentiment resonates with many of us on this program.  While reflecting on her experience in Brazil, Amanda Dowden, student from Brown University, said, “It is hard for me to summarize what I learned over this past month in five sentences. But the thing that stood out to me most is the Brazilian Constitution. Coming from the US where only those who could afford health care receive it, I was amazed and inspired to see that the Constitution guarantees health care for all, even though Brazil is a country with extreme wealth disparities.”

SUS, as the universal health system is called, set the context for understanding how the government and the people are approaching political, social and economic issues within the country. While comparing Brazil to the US, Tufts University student Susan Johnson expressed, “Brazil’s constitutional right to health has challenged my perceptions of health care. The government has a responsibility to provide health and this forms an ideology, which is the basis for SUS. Health care in the US, then, cannot function in the same way because health is not viewed in the same way. SUS and the Brazilian health care system is a uniquely Brazilian system and learning about it has allowed me to more fully analyze the US system.” Although not without its challenges and flaws, the system is attempting to address public health issues by combining medical access with a strong emphasis on prevention and family planning. Over the next few weeks we were lucky enough to explore many facets of SUS and to see much of the work in action.

After being provided with a basic understanding of SUS and Brazil's epidemiological profile, we dove deeper into specific public health issues beginning with gender inequity. Guest lecturer, Dr. Tania Di Gaicomo do Lago, explained how women’s health issues are linked to historical gender roles and power dynamics as well as inequalities such as economic earnings and power. These inequalities have had a direct affect on women’s health from maternal care, to domestic and sexual violence, to reproductive rights and justice. However, Brazil is taking large strides to provide a multitude of services to support women. We were able to visit several of these such as hospitals providing specific care for pre and post-natal care; the only abortion clinic for women in Latin America, which provides psychological and mental health support as well as medical access; a women’s police station; and the Secretariat Department for addressing women’s issues. We were very inspired to see firsthand the various levels, from national policies to state government departments to municipal clinics and community organizations, all working together to provide services and access to women.
This multi-angle approach for helping women is also seen in how Brazil responds to the HIV/AIDS epidemic. Through SUS there are clinics specializing in services for patients living with HIV/AIDS. These clinics allow patients to get tested, receive care, and access anti-viral medicines free of cost and without stigma or judgment. But SUS is not only about providing access to services in order to address patients already living with the disease. There is also a large emphasis on education and prevention. Breno Aguiar of the municipal health department explained how Brazil’s community specific prevention techniques provide AIDS education and resources that take into consideration the community, and their situation, vulnerabilities, and needs. Similar to Metro Teen Aids in DC, this program uses peer educators who come directly from the communities. Because of this, peer educators are able to access vulnerable communities more readily and pass along knowledge and safety kits. Along with medical services and prevention education, we were able to visit NGOs working to provide additional support to vulnerable communities, such as the Diversity Reference Center that works to provide work skills, and legal and psychological support to sex workers and the GLBT community, a Newspaper agency that focuses specifically on AIDS related news, and a orphanage for children living with AIDS/HIV.
Through these two examples we were able to understand fully the complex approach the government is using to address public health issues within the country.
Collective Responsibility
Throughout our time in Brazil, we were overwhelmed by the strong cultural sense of community. Many Brazilians believe in the notion of taking care of and looking out for one another. We observed firsthand how this sentiment is being reinforced through government policies, doctors, community leaders, and even our homestay families. Reflecting on this, George Washington student Natalie Terens says, “I was incredibly inspired by the moral grounds upon which the universal heath care system in Brazil was founded upon. Despite its flaws and complexities, I believe it has great potential for success. This system is feasible in Brazil because of the sense of community and responsibility that these people embody. My host family expressed that they had no problem with paying for universal health care in addition to their own private insurance.”
Beyond those with means helping out those without, we saw how disenfranchised communities are coming together to demand more healthy, safe and just lives for their people. During our neighborhood visit, students had the opportunity to visit several favelas that are struggling to bring infrastructure, education and opportunity to their community. One favela, Heighliopolis, has been a leading example in the power of people to organize around common beliefs for a better life. Believing that education is necessary in order to fight for people’s rights, this favela built a school system 16 years ago that now is the foundation of the community and created a grassroots non-profit organization, UNAS, that has worked on over 200 projects. UNAS provides afterschool programs for young teenagers, a community newspaper, a library with free computer center, community radio, daycare, and several skills-based learning opportunities. Additionally, the community was able to raise enough money to send two students to medical school in Cuba. Through SUS, the favela has a clinic/hospital for the community and surrounding neighborhoods and family health teams, which consist of a doctor, nurse, assistant nurse and two social workers, who go directly to family’s homes to offer services and health care. This favela truly illustrated the power of people in bringing about positive social change for their community.

During our rural stay in Ituverva, we were inspired once again by the power of community during a visit to a settlement of the Landless Rural Workers Movement, or MST. MST fights to reclaim and redistribute land that is not being used for agricultural purposes. In Brazil, 1.6% of the population own nearly half of the land, and much of that land is left unused or misused. This movement, protected by a clause in the constitution that land must fulfill its social functions, organizes and empowers poor and homeless rural workers to create settlements by claiming land that is not being used properly. On this visit, we witnessed the product of this effort, a thriving sustainable community able to provide food, health services and education to their people.

Summing up what she learned from our time in Brazil, Williams College student Mindy Lee says, “My experiences in Brazil have demonstrated the use of community power in advocating for marginalized populations, both in urban and rural populations. In São Paulo, UNAS was spearheading projects from sending kids to Cuban Medical Schools to obtaining basic plumbing to improve their living conditions. Similarly, MST in Ituverava fought for their Constitutional rights to obtain basic sustainable living. These two visits in radically different areas have both been successful against the odds. I was just amazed to see how much progress some communities have managed to make despite limited access to avenues of advocacy or legal methodology. Their stories also served as a cultural contrast to the mentality in the United States. Here in Brazil, I have listened to so many speakers who emphasize uplifting communities and trying to help society. In the United States, it seems that our love for individual “freedom” and “rights” hinders progress in societal freedom and rights. Most people in Brazil consider health to be a right while in the States it is a privilege. Brazil has introduced me to an entirely different framework of thinking about policy and public health that was previously never in my radar.”

After a long four weeks, we headed off to Vietnam, full of inspiration and eager to continue learning. 

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Credits: 16

Duration: Spring, 16 weeks

Program Sites:
USA, Argentina, South Africa, Vietnam

Prerequisites: None. Coursework in public health, anthropology, biology, or related field recommended. Learn More...

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