Letter Home from Brazil

A Letter Home from the Fall 2014,  IHP Health and Communities Program:

Dear Friends and Family,

The IHP Health and Community Fall 2014 Team comes to Brazil a little changed, a little wiser than before, and with the shared experience of traveling, living, and learning about health in Washington DC, India, and South Africa over the past two and half months. As the program comes to a close, we’d like to share our final experiences, thoughts, and reflections during our wonderful time in Brazil.

Our journey in Brazil could not have begun in a place better than São Paulo, a great place for cultural immersion. The city is packed with incredible art and history museums, plentiful parks, and delicious food amongst many other things. We’ve had the chance to explore Parque Ibiapuera, one of the largest parks in South America, boasting a large jogging and biking track, multiple museums, a music hall and plenty of restaurants and cafes. One of the group’s favorite parts of the park is the Modern Art Museum and the ice cream shop next door—food always keeps an IHP student happy! São Paulo also has incredible street art that many of us have sought out. Some in our group have also sought out places to relax just outside the city such as Ilhabela beach while others chose to hike up Serra da Cantareira, which has most of the most amazing views of São Paulo. We have also had the opportunity to attend the São Paulo v. Palmeiras state championship game and got to experience the excitement of a Brazilian ‘futbol’ game, firsthand.

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One interesting area that many of us have visited is Liberdade, a historically Japanese area that hosts markets on the weekends and is home to many delicious restaurants and cool stores. Did you know that São Paulo has the largest population of Japanese people outside of Japan? Another fun place many of us have visited is the Municipal Market (Mercado Municipal) where we were able to try fruits and vegetables we had never even heard of before and purchase all the pastels, <describe pastel here), one could ever want. Of course, we have also checked out the night scene including participating in Samba lessons!

You must be wondering how the city can get any better and a simple answer to that is: our homestay families. All of our host families are between 30 minutes to an hour away from our school.  People usually take the metro or buses (it gets easier with practice).  They typically greet us with a kiss and hug, which has become a common practice for us all in Brazil.  On the weekends, the families have taken many of us to local antique fairs that sell old music records, jewelry, clothes, and delicious fried pastel.  Our diet consists of lots of rice and beans, pasta, beef, fried chicken, lots of freshly squeezed juices, fresh vegetables, and fruits.

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Before you start thinking that Brazil is all play and no work, we’d like to tell you about our Public Health and Globalization classes taught by two awesome local professors: Dr. Monika Dowbor, and Dr. Marina de Moura. In both our classes, we’ve learned a lot about the history of healthcare in Brazil. Brazil’s revolutionary landmark reform in 1988, declared health as a right of all and a duty of the State. Two decades after the Unified Health System (SUS) was established, more than 80% of the country’s 190 million people rely exclusively on it for their health care coverage.

Furthermore, we learned about the inner workings of SUS, not only in the classroom, but also by visiting Family Health Centers, and seeing participatory organizations such as health councils in action. We’ve learned about the nuances of public and private healthcare, and have also discussed the disadvantages of what is ostensibly, an ideal system. The same system that works to ensure health also has monetary incentives, which has resulted in the medicalization of childbirth. For example, we learned that the rates of C-sections are sky high (ranging from 80-90%) in private hospitals, because C-sections are more time and cost-efficient than natural births.

A big topic we have spent hours exploring and discussing during our time here, is women’s reproductive and health rights in the Brazilian context through lectures and site visits. The issues surrounding birthing and female autonomy has been important to us throughout the IHP journey and we explored this topic outside the classroom in public and private maternity wards. In Brazil, we heard women speak about their experiences giving birth during a birthing panel, which gave us a more complex understanding of social perceptions, stigma and status of C-sections. Some women have had experiences of obstetric violence, which is where physicians force or encourage female patients to have C-sections unnecessarily because it is convenient for the doctor.

One of the greatest strengths of IHP has been hearing and learning from the stories of others. This has provided us with information that allows us to explore possible solutions to some of the health issues we are learning about. For example, hearing one young mother on a birthing panel speak about how educating herself on obstetric violence empowered her to question her physicians, was extremely inspiring. It made many of us think deeper about the remarkable power of education and how more women deserve to be educated and empowered to make decisions for their own body and health. This mother also noted that such a severe culture has been formed around caesarian sections because in many cases women don’t think to question a doctor’s judgement, who are held in high regard in Brazilian society. Listening to these women’s stories, was fascinating and provided us with a local perspective on the increase of forced cesarean sections in Brazil.

In our globalization classes, we have also learned about the environment, vaccines, and biotechnologies of the future. This was supplemented by various guest lecturers, many of whom are leaders and pioneers in their respective fields. Our first guest lecture was from Leandro Moura, who has been studying history for over 40 years. Mr. Moura provided a detailed history of the colonization of Brazil in addition to the militarized and centralized era of government that preceded Brazil’s current democratic status. We were also honored to hear from Dr. Armando de Negri Filho who was also leader of the sanitario movement, a social activism movement led by intellectuals and community members advocating for the basic human rights, particularly health.  We were recieved an epidemiological profile of Brazil as well by Dr. Andrea Fatima Nascimento, which provided us with information about the most significant diseases affecting the Brazilian population.

After all these experiences within the classroom and learning about Brazil in the urban setting of Sao Paulo, we left for our rural visit in Barro Do Turvo. The community is about 5 hours outside of the city of São Paulo. For the first two days of our stay, we stayed in a quaint hotel in the town’s center. We went on visits to the primary health center and went on rounds with community health workers to different houses in the community. Additionally, we had dinner with three Cuban doctors, part of the ‘More Doctors’ program in Brazil, which helps bring doctors to underserved communities where Brazilian doctors are not always willing to work The following day we traveled to a Quilombo, a community descended from escaped slaves in Brazil. The people in this community participate in agroforestry. This is the art of agriculture throughout the forest. They participate in a program of sharing crops within the other local Quilombos as a means to help each other in leading sustainable lives.  It was fascinating to see all the different crops they grow throughout their land including coffee, fruits, yucca, and other plants.

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Our last two days where spent farther into Barra do Turvo’s forest, visiting a sustainable agroforestry cooperative. Pedro, the owner of Cooperafloresta, took us on walks around the property, showing us all the different crops he and his family grow. He emphasized the importance of treating the environment with dignity, and expressed his love for nature, which touched our hearts. We had the chance to eat amazing foods made straight from the local crops… all of us were in heaven! On our final day of the rural stay, a local team of Capoeira dancers came to teach us about their dance. Capoeira is a Brazilian dance mixed with martial arts. We were all sad to leave the beautiful forest and the wonderful people we had met.

Soon we returned to our families in Sao Paulo and finished up our semester with IHP including working on our final research projects with our respective case study groups. Some of these groups have had amazing opportunities to interview indigenous populations, go to food distribution centers and favelas to hear straight from locals about their lives. Having travelled for so long and been part of so many communities we prepare to come back home with minds changed and hearts eager (and maybe with a more nuanced understanding of ‘home’ itself). We hope to share our experiences with you real soon as we come to an end in Brazil. We hope you have enjoyed reading our Letters Home!

Sincerely,

IHP Health and Community Fall 2014

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