Team Brazil Letter Home
After many weeks of learning and exploring in the US, India, and South Africa, we arrived in Brazil and began the final leg of our semester. Our final transition, our final country team, and our final homestay family came with equal excitement and anticipation. Upon arrival in São Paulo, we hit the ground running and jumped right into the program and began learning about the life, culture, and health system in Brazil. From guest lectures and panels to site visits and rural stays, we had an incredible learning experience that was a perfect end to a semester of adventure.
São Paulo itself is a whirlwind of a mega city – with 20 million people in the greater metropolitan area, it is the largest city in the Americas. Our homestays were scattered around the central area, and we took buses, the metro, and walked to class and weekend activities, navigating the maze of streets like true Paulistas. São Paulo is a hotspot, where we constantly found ourselves stumbling upon events, from political protests to samba performances to free circus performances in the square.
Some favorite weekend destinations were the Municipal Market (the most amazing selection of fresh fruits from Brazil’s Amazon region and beyond – and enough free samples to make the world’s best fruit salad), Liberdade (a Japanese neighborhood with street food fairs on weekends – São Paolo is home to the largest Japanese population outside of Japan!), and Ibirrapuera Park (a gorgeous, expansive, and relaxing green space in an often exhausting mega city).
When we arrived in Brazil, we were very impressed with their healthcare system. While in India and South Africa, we felt that there were pretty drastic differences between the health policy and the implementation of policies in reality, Brazil’s system seemed to work quite well in practice.
One particularly impressive part of the SUS is that is has a monitoring system of health councils. Individuals are voted onto these councils by their different communities, and then monitor the implementation of the healthcare system and hold the government accountable to delivering adequate services and addressing each community’s needs. There are three layers: the Municipal, State and National Councils. Everyone we talked to appeared to be very happy with this health council system because it gave the people a voice instead of allowing the health system to be dominated by medical professionals.
The guiding principals of the SUS are decentralization, participation, and pluralization of providers. The system also prioritizes access – anyone in Brazil, from immigrants to the homeless to tourists like us, can access public health care in Brazil by registering for a free SUS card. The SUS is a combination of public and private care facilities, but unlike other countries we visited, some of the public hospitals and clinics are just as good, if not better than the private facilities. Sometimes, like in the case of Santa Casa hospital, where we had our classes, the public and private were in the same hospital complex. There are also many specialties that focus on specific at-risk populations so that everybody’s health is covered. One example of the beauty of the SUS system is that all of the medication is given for free so people who need certain medications can get them, including ARVs, which is a big problem in other countries. Oftentimes pharmacies are connected to the hospitals and people can go to these pharmacies with their SUS cards and receive the medication they need.
During a visit to UBS Republica, a clinic in São Paulo, when we walked around with some of the nurses, one man came up to us and proudly showed us his SUS card. He was very proud to be registered under the system and be able to receive the medicine he needed, which demonstrates how well the SUS system works in São Paulo. UBS Republica also had teams that worked specifically with the homeless population. We talked to social workers, health agents, doctors and nurses who worked in teams of twelve. They talked about slowly establishing a relationship with their patients and then helping them “reenter” society. They used their networks with other agencies to help patients in other areas other than health, depending on people’s needs like food, jobs, and shelters. It was very inspiring to hear from them and listen to how they focus on primary care and holistic, long-term treatment. However, they also talked about how hard their job was. They all started their work with a very hopeful attitude and believed that they could make a difference, but they soon start to get frustrated. Some of the people they work with move and so they lose contact, others do not want to go in for treatment or don’t want to change. They learned that they couldn’t force people to change and reenter society if they do not want to.
In our first week, our learning cycle focused on maternal and child health. We learned about birthing practices in Brazil, including the extremely high rate of Cesarean sections in Brazilian hospitals. At the end of the week, we visited different maternity hospitals where we learned about the work being done to lower the C-section rate. We also heard about the many different services being provided to Brazilian mothers throughout their birthing experiences. The highlight of our week, though, was speaking to a panel of mothers who had given birth in Brazil and getting to hear about their personal experiences with the health system. Denise, Sarah, and Deborah are now all activists working to promote women’s safety and agency in deciding how to give birth and in decisions throughout the entire birthing process. Hearing their stories and all that they were willing to share was incredibly inspiring, and it was amazing to hear about the action that they had decided to take after their own experiences in order to better the treatment of future mothers.
The next week, for our rural stay, our group had the opportunity to live at Coopera Floresta, a blissful oasis in the mountains of Brazil. Among other things, Coopera Floresta was a farm filled with various herbs, vegetables and lots of baby chicks. It was physically stunning, bursting with trees, rivers, and even a natural swimming pool in which our group was able to swim and relax. While on the farm we learned about food justice and ate what was arguably the best food of the trip. We indulged on local vegetables, homemade bread, and fresh juice. During our stay we had the amazing opportunity of learning from Pedro, the farmer on the land. On our first afternoon at the farm, Pedro told us that although many people would describe him as poor, he believed that he was incredibly rich because he was living in a beautiful place and doing what makes him happy. Those words stuck with us for the duration of the trip, and will stay with many of us forever.
During our final week in São Paulo, we went on a site visit to Butantã Institute, where we learned about the research and production of vaccines in Brazil. Butantã is surrounded by a large amount of green space, so it was very enjoyable spending the day there amidst the hustle and busle of the city. The Institute was started with a focus on treating venomous animal bites and tropical diseases. We were able to visit three museums about the History of the Institute, Microbiology, and Biology, which featured some of the poisonous snakes, spiders, and bugs. We also had a lecture on the Institute’s current projects, including the production of the majority of Brazil’s vaccinations and the development of a dengue fever vaccine. Hearing about the work being done there was so interesting and inspiring.
As our time in São Paulo came to a close we wanted to spend time thanking the people who made it as truly special as it was. On our last Friday in São Paulo we had a homestay family dinner that was hosted at the home of one of our homestay families. Being that Thanksgiving was the day before, some of us brought Thanksgiving dishes like pies, green beans and stuffing to share with our families. We had a lot of fun meeting each other’s families and we each got a chance to share some of the most special moments. On Tuesday we had a presentation for guest lecturers, homestay families and our staff to share with them each of our biggest takeaways from Brazil. A lot of us spoke about the birthing panel, the site visit to Butantan Institute and our rural stay at Coopera Floresta. We really enjoyed these moments of reciprocity that were built into our program in Brazil.
The five weeks we spent in Brazil were filled with hours of learning and laughing, and were a perfect way to end an incredible semester. Brazil gave us a completely new perspective on public health in action and challenged us academically and personally in a number of ways. We are all extremely grateful to the country team, traveling faculty, and all of the other people that made our experience here possible. The things we learned and the relationships we formed will continue to be with us for years to come.