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 Brazil illegally and are fearful of being caught. Many Bolivians come to Brazil in search of better and free healthcare and more employment opportunities. As Barra Funda and Carmen in particular have developed a positive and trusting relationship with this community, we have the opportunity to meet some community members, learn about their experiences, and the kind of work Barra Funda does with them.

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.

The women tell us that they work from 8 am to 10 pm everyday, doing basic sewing of previously cut fabrics, with a one-hour lunch break. Noone is regulating these 14 hours, but they do what they have to in order to make enough money. They suffer from what we would call repetitive stress injury, and one type of work that Barra Funda does with them is physical therapy. When we ask where their pain is located, their hands immediately go to their shoulders and the space below their necks. We all wince and nod, empathizing—to an insignificant degree, of course— with this problem, as can anyone who has sat hunched over a computer writing a final paper for 8 hours. The workers also suffer from eyestrain and stress to their ankles from pumping the sewing machine pedal. When this community first settled in Brazil, no one was vaccinated, and none of the women had ever had Pap tests. At that time, health workers went to their workplace to give them vaccinations, and the women received Pap tests at the clinic.

I ask Maria Amélia to ask Isabel and Luisa what they did in Bolivia. They worked much less there—a comparatively humane eight hours per day. Isabel tells us that she sold fruits and vegetables on the street. For Luisa, this is a painful question to answer, and she seems nearly to approach tears as she responds: she was in her second year of law school. She has neither the documentation nor the money to continue school here, but hopes to do so in the future.

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 São Paulo.

 

Bolivian immigrant community members and Mary Wilson

Next Page
Back to index
Previous Page