Saturday, December 1 2007
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Key 1
The Student Experience - Collaborative Course on Infectious Diseases, January 2008This report was written by Amelia Rock, Master of Science Candidate in the Department of Population and International Health at the Harvard School of Public Health, following her participation in the January 2008 Collaborative Course on Infectious Diseases. To download a pdf version of the full report, please see the attachment at the bottom of this page.
The Experience: Week One - Metropolitan São Paulo
Key 1
The Student Experience
Visit to Barra Funda
Primary Health Clinic and Surrounding Communities
On Wednesday, we
visit the Barra Funda Primary Health Clinic, a philanthropically-funded
institution that belongs to Santa Casa and is the workplace of two course
participants, Louise and Danielle. In its beginning years during 1968-1980, the
clinic, where Santa Casa medical students train, mainly served the nearby
favela and now serves a diverse population of 15,000 people, including the
homeless, undocumented immigrants, and sex workers.
We split up into
four groups and are led by community health agents and other staff involved in
community outreach to some of the local communities that Barra Funda
serves. My group goes with Carmen, a
Bolivian community health agent, and a nurse, Gisele, to meet members of a
community of Bolivian immigrants who live and work in textile sweatshops. There are about 70 of these sweatshops in the
area, and it is impossible for Barra Funda to provide outreach and care for all
of them. Maria Amélia comes with our
group and helps with translation.
Carmen explains to
us that this community is hard to reach and it is difficult to gain access to
their workplace because they live and work in
Carmen has made
arrangements with the people who live there for us to visit, but when we first
arrive and ring the doorbell at the front gate, a boy, who looks to be around
14, appears and tells us through the gate bars that only he is home. Eventually a woman comes out, negotiations
occur between her and Carmen, and we are allowed inside the house.
We meet Isabel and
Luisa, who look to be somewhere in their 30s and 40s respectively. There are a couple other people around in the
background, including the boy who came to the gate, but they don’t talk with
us. We stand in a space of two adjoined rooms with several sewing machines and
ask Isabel and Luisa questions. They
tell us that two families live and work in this two story house, and there is
one family per room and work room. The
rent is paid by an overseer or “supervisor” who is a legally resident Bolivian
and works for a company that is supposedly run by Brazilians, Koreans, or Jews.
The children go to school one half of the time and sew the other.
Bolivian immigrant
community members
The women tell
us that they work from
I ask Maria Amélia
to ask Isabel and Luisa what they did in
We then realize
that not all of the students have been introduced and we go around saying our
names. When Leonardo (a.k.a. Leo), the physician and professor says his name,
Luisa grins and says “Leonardo di Caprio?” Everyone in the room laughs. The women then ask us why we wanted to know
about them. While they had answered our
questions easily and immediately, we all find ourselves momentarily stumped, I
think feeling slightly off kilter from being in the presence of these women and
their hardships, and on some level trying to reconcile with our relative
position of comfort and ease in life. We look at each other until someone
speaks up; Adeline says that as doctors and public health professionals, we are
interested in learning about the most vulnerable populations and the
communities who are least likely to come forward to seek health care.
When we leave, we
say “muito obrigada” a thousand times, and tell them it was an honor meeting
them. “Bye Leonardo!’ Luisa giggles and
waves through the gate.
At the second
residence and sweatshop, we are guided by Cecilia and her very small and
adorable daughter who looks to be about 4.
We also meet another young woman.
They tell us that they enjoy the physical therapy that they do with the
Barra Funda workers and that when they do the exercises, working is easier, but
that they only do it when the workers come because otherwise they
“forget.” We spend some time with these
women, chatting and looking at the purses Cecilia makes and sells on the side—a
couple of us buy them. Gisele leads a
session of the physical therapy, including stretches, twists, and massages, and
we all participate.
All of the groups
reconnoiter at Barra Funda and share our different experiences. Ana Luiza’s group stayed at the primary
health care unit and was given an extensive tour of its primary health model,
including its different offices, exam and treatment rooms, and pharmacy. The group observed patients receiving TB DOTS
(Directly
Observed Treatment, Short-course), learned a great detail about the clinic’s surveillance and patient
follow up activities, and was very impressed with the clinic’s highly
pro-active approach to surveillance and patient follow up. It not only receives cases and reports them,
but also goes into the communities to find other cases. There are many deaths among women of
childbearing age in the surrounding communities, and the clinic investigates
deaths that are coded in a way that suggests possible maternal mortality. The
clinic also conducts searches for patients who—for example—miss appointments
for TB treatment or prenatal care.
Amie’s group spilt
up into sub-groups and accompanied community health workers to find and talk to
homeless people in different locations—many of whom have TB—to check in with
them or remind them of upcoming appointments. At Barra Funda, only people who
have been homeless themselves are recruited as homeless outreach workers. One sub-group visited a homeless shelter run
by Franciscan monks. Another sub-group
met a couple and their children who live under a bridge, in a remarkable
infrastructure they have built with boards. Another
group visited a TB patient who missed his DOTS treatment and works informally
for a van company, guarding their parking lot, in exchange for food. This man had a problem that seemed to be
common: interaction between his TB drugs and alcoholism. The last group checked in with four men living
in a tent.
Josy tells us
about her group’s visit, which was led by Louise and Danielle, to check in with
residents of a public housing project that was formerly a slum, and retains
many slum characteristics such as lack of sanitation, running water, electricity.
The group is extremely impressed with the rapport between Louise and Danielle
and the patients, and the true, deep respect and love they showed. Louise says that they have known and worked
with some of the people for five years.
For many of the
students in our course, both HSPH and Brazilian, the visit to Barra Funda was a
favorite activity in
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