IHP Health and Community: Globalization, Culture, and Care (Spring 2)
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Brazil Spring 2012 Letter Home
After a ten hour flight, we arrived in the bustling city of Sao Paulo, Brazil. Tired and groggy from travel, we were greeted in the airport with hugs and kisses by unfamiliar people who bizarrely knew our names. Little did we know that these strangers, Country Coordinator, Glenda, and Facilitator, Caio, would soon become our family.
We received an initial physical orientation on our first night with a group excursion down Paulista Avenue, one of the most famous streets in the city, to explore new restaurants, foods and fresh fruit juices.
The next morning, we embarked on another group trek, this time to Santa Casa, a medical school and our academic home in Sao Paulo. We grew accustomed to our classroom on the eighth floor and to the beautiful view of palm trees, blue skies and the grandiose architecture of Santa Casa Hospital. We were welcomed to Santa Casa by the president of the school, as well as Dr. Maria Milian, and two medical students Guillerme and Joao Victor, who made several appearances, translating for us during site visits and organizing parties so we could meet other medical students. We learned about the history of Santa Casa, a public hospital built in 1885 during the Sanitorio movement in Brazil. During our first day in Santa Casa, we continued to learn this country’s history with an unforgettable lecture by Leandro Moura, a historian who captivated us with engaging tales of Brazil’s political and social history.
The academic portion of the day concluded and it was time to meet our Brazilian host families. Our nerves eased as we were greeted with warm smiles and big hugs. Many of us had uncertainties about our first homestay experience, but soon found ourselves looking forward to the end of the day, so we could return home to our new families, eat delicious meals and spend hours laughing and telling stories. Through them, we had an insider perspective of the Brazilian reality and spent our free time accompanying them to the beach, markets, bars, graffiti walls and concerts in the park. Having a homestay beautifully enhanced our time in Brazil and provided a comfortable place to go at the end of a long day.
On Neighborhood Day, we divided into five groups and ventured off to explore distinct areas of the city. One group went to Cantinho de Ceu, located on a polluted reservoir that divided the town. Healthcare was also divided in this area, as one side of town had a health clinic and the other side of town was seen as too corrupt to have a government health clinic. Heliopolis, the largest favela in Sao Paulo, came into existence by resisting police repression and refusing to leave. An organization there fights for social rights and health services for the community through non-violent means. Another memorable moment from the visit to Heliopolis came when the community radio station invited students to speak and they were able to thank the community for sharing their lives and welcoming us into their reality. In Bom Retiro, a group met Jorge, a person of almost mythical proportions for many of the students. Jorge is a community health worker who inspired us with his tireless dedication and these words: “I became a community health worker not for myself, but for my community. Whatever you do in life, do it for your community, not for the good of yourself.”
Women’s Health and HIV/AIDs were important themes during our time here in Brazil and exploration of these topics helped us to conceptualize the differences between Brazil and the US in terms of health policy.
After various lectures, hospital and NGO visits, it became apparent that women’s health is something that is changing, both in policy matters and in the social climate around those policies. In Brazil, a country with a 90% C-section rate, a culture around the acceptability of C-Sections as a first-choice method of delivery has emerged, although a swing in the opposite direction is now taking place. Abortion is illegal, and in a country with a progressive health policy, it was surprising to find that many people we interacted with were staunchly anti-abortion. Even current President Dilma, a feminist who was previously pro-choice, had to give up her position on abortion to be politically viable.
We visited several NGOs focusing on women’s health. The women’s police station, the first of its kind in the world, was started by a group of women who wanted better services for victims of violence. Because of this grassroots action, there are now twenty-five women’s police stations with trained psychologists and social workers. Another NGO, Instituto Patricia Galvao, a feminist media advocacy agency, makes an impact by polling the public and changing the culture of violence against women through media outreach. The Institute shared commercials they created, which aired on national television during Carnaval, to raise awareness of domestic violence and shape public opinion.
Many of us were impressed by the depth and scope of the HIV/AIDS health policy in Brazil and also by some of the idiosyncrasies. Brazil is the largest Catholic country in the world and the government is the largest condom buyer. We learned about how Brazil uses its burgeoning economic clout to pressure drug companies to allow Brazilian pharmaceutical companies to produce generic drugs, driving down costs and making life-saving anti-retrovirals available to the population. Brazil was even sued by the US through the World Trade Organization because it used backwards engineering to manufacture generics. (The case was later dropped after international pressure from HIV/AIDS groups and civil society.)
At Pela Vida, an organization that works with the transvestite and transsexual population, students were moved by the effect violence and transphobia has on the lives of the people they spoke with. When questioned as to what their biggest health concern is, the members of Pela Vida responded that it is violence and discrimination, a sad reality not dissimilar from the situation in the United States. Another group visited GIV, a community center for people living with HIV. This NGO organizes events for the community, such as Friday night dance class, and provides a range of services from counseling to two meals per day. For the forty people a month who utilize these services, GIV is a place that feels like home and to be on the board of directors, you must be HIV positive. Other students visited a harm reduction program that engages in different tactics to impact the health of people who use drugs. One program worked with crack addicts to invent a better crack pipe that won’t burn people’s lips and lead to infection. They also provide various services for the community, such as computer literacy courses. Another group of students visited the HIV News Agency, started by a woman named Rosa Lee. The agency, which includes activists and advocates, creates HIV/AIDS narratives through interviews and shares them with journalists, media outlets and other NGOs, as well as publishes them on their website. The organization created a database of important articles and information about HIV/AIDS from sources like the New York Times that they translated into Portuguese. Their main goal is to make HIV/AIDS an important topic in the media and to ensure it is not viewed as an issue of the past.
Compared to the US, Brazil has a much more accessible HIV/AIDS program which is publicly discussed and debated, and in general we found that more people in the healthcare sector seemed to be knowledgeable about the country’s HIV/AIDS policy. Even we benefited from public campaigns and were given packets of condoms at various points, including during Carnaval. It behooves people to be informed, as a Brazilian citizen can sue the government to provide life-saving care and medication. People benefit enormously from public knowledge, open discussion, free medication and care, and although it is not a perfect system, these are the times when Sistema Unico de Saude (or SUS), the public, universal healthcare system, shines.
We visited several hospitals, both public and private, which focus on women’s health. Many of these hospitals also address the social conditions surrounding women’s health, such as violence. The hospitals serve the richest populations to the poorest. Many of us were surprised at the level of access we were granted during our visits. This was explained to us as not being a granting of privileges because we are from the United States, but rather as a reflection of the immense pride people have in their healthcare system. At Perola Byrington, the only public hospital that grants legal abortions, we were amazed to see the work the doctors did, yet we also had an uncomfortable experience touring a forensic lab for sexual assault victims and seeing patients going in and out of this room. At another hospital, Santa Joana, the largest private maternal hospital in Brazil, we witnessed the differences between public and private healthcare. In this hospital, there are luxury treatments, a spotless environment and extensive technology, such as a baby cam wired to mothers’ room, so she can watch her baby when she isn’t in the same room. At Hospital Maternidade do Barros, a public hospital, women receive a high level of attention from providers and students learn about Kangaroo Mothers, a method of increasing maternal-child bonding immediately after birth. During this visit, we toured a room with six women who had just given birth. In Brazil, the public hospitals granted us closer access to patient realities and it seems that in private hospitals, patients pay for the luxury of privacy.
A number of us had experienced SUS for ourselves when we got sick. Some students received care at private hospitals, but felt that the level of care was not necessarily better or worse than at public institutions. Private hospital visits took a lot of time and sometimes students incurred higher costs for treatment. Alex, our translator turned hospital guide, accompanied us on these trips and helped us to navigate the system with care, taking us on follow-up appointments and running us to the pharmacy to pick up prescriptions. We love you Alex!
We are learning that IHP is full of surprises and another time we will never forget is when a day we thought would be filled with class time turned out to be a giant street party and pre-Carnaval Samba rehearsal. We decked ourselves out in hot pink lipstick and waited in anticipation for the drumming and dancing to begin. We were the first group of students, joined by Glenda, Lee, Caio and Janelle, to participate in the rehearsal. Though most of us had never learned this style of dance before, we danced Samba to the music for hours, sweating, laughing, cheering and shouting the only word we knew to the incessantly playing song: LIBERDADE!!!
Outside of the classroom, we filled our free time with Brazilian culture, catching their infectious spirit for enjoying life. A futbol game was our first group excursion and even though getting tickets was a hassle, we were glad we decided to do it. Caio, our amazing facilitator, took us there against his religion, as he is a Palmieras fan, and we were rooting for Corinthians, a rival team. In his own words: “I’ll have to pretend to be happy they’re winning, but inside I’ll be dying.” Thankfully for his sake, it was a tie game.
At Bloco, a pre-Carnaval street party, we danced for hours, chasing the parade through the alleys and desperately trying to hold onto a rope, while men on stilts shimmied all around us. We truly felt swept up in the frenetic pulse of this celebration.
For many of us, the rural visit to Barra do Turvo was a highlight of our Brazilian experience (even for those who were sick for most of it). On the bus, we fell asleep to the towering skyscrapers of Sao Paulo and awoke to see them replaced by misty green mountains and verdant forests. We piled into a small boat in groups of ten and crossed the clay-colored river to begin our amazing experience at CooperaFloresta. We felt at home and welcomed by Pedro, Daniel and all of the students who were there learning about agroforestry techniques. We were fed communal feasts from organic food grown on CooperaFloresta cooperative farms. We hiked, swam in a pool fed by the river, learned about banana zip lines, sang songs late into the night, danced the samba de coco and participated in a free-style Caipoera roda. We also learned that if 10% percent of the Brazilian population practiced agroforestry, the food produced could feed the world. Pedro encouraged us to be citizens of the world and we were beginning to understand our place, as individuals and a group traveling and learning about comparative health.
Democracy is a young political system here and SUS is a young healthcare system, but it has the potential to be strong and expansive with the momentum to grow and change. There are still important access disparities based on class, corruption and discrepancies between urban and rural health, but important lessons and inspiration abounds about how universal healthcare can be implemented in a country as large and diverse as Brazil. With all of the successes and challenges, our exploration of SUS and its impact on health in everyday life, helped us to understand universal healthcare in a more realistic way. In the US, healthcare reform is possible, but it’s going to take incremental steps. Currently, a lot of change-makers in the US are trying to break through the system. In Brazil, civil society engages with the system and all of its imperfections, actively working to make it better. In the US, grassroots activists are exasperated at dealing with the government, while in Brazil, grassroots action turning into official policy is viewed as a success to be celebrated. In all aspects, from healthcare to politics, there has to be a place to meet in the middle. In the US, people are disengaging with the system because the idea of “Washington as usual” is deeply entrenched. It seems that in Brazil, people still believe in their ability to actively shape their futures.
Brazil was a time of happiness, celebration, and inspiration. We met amazing people who showered us with love and who, through the example of their lives, inspired us to work for the good of people and community. As we continue our journey to Vietnam and South Africa, we carry the words of Pedro, a member of CooperaFloresta and citizen of the world, with us:
“May love find fertile ground in your heart to grow and blossom. May happiness be at your side and along your path and may luck be your next door neighbor.”
Duration: Spring, 16 weeks
USA, Argentina, South Africa, Vietnam
Prerequisites: None. Coursework in public health, anthropology, biology, or related field recommended. Learn More...
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