August 2, 2013: "Don't cry because it is over, smile because it happened." -Dr. Suess

I arrived home safely! Three months have passed and I have been to Brazil and back. Thank you to everyone who has supported me before, during, and after my trip! I am so grateful for all of your help and encouragement. Thank you especially to everyone who followed this blog, the Sisters of St. Joseph of Rochester and Professora Vera, the Bueno Family and the Barra Family, and Lee and Sally Posey (the benefactors of my scholarship)! Though I will not be continuing this blog, it has fulfilled its purpose of being an account of the things that I experienced and learned. It will be such a useful tool for me to keep my memories alive and my experience fresh in my mind, as I return to Alma College for my sophomore year in a few weeks. I will be able to use it as a resource as I make decisions about ways in which to share my experience with the Alma College community and build on the knowledge that I gained in Brazil. 

August 1, 2013: CABO and a MUITO GRANDE OBRIGADA POR TUDO PARA TODO MUNDO!

Ninety days later and time is up. Thank you to everyone for everything. I have been to so many places, learned so many things, made so many new friends and shared some more laughs with some old ones. My three months in Goiania was both short and long, but what is most important is what is in the middle and what will remain with me.

Saber Viver (To know how to live)

Não sei… Se a vida é curta (I don't know... If life is short)
Ou longa demais pra nós, (Or very long for us)
Mas sei que nada do que vivemos (But I know that nothing that we live)
Tem sentido, se não tocamos o coração das pessoas. (has feeling, if we do not touch peoples' hearts.)

Muitas vezes basta ser: (Many times it may simply be:)
Colo que acolhe, (An embrace that accepts)
Braço que envolve, (Arms that surround)
Palavra que conforta, (Words that comfort)
Silêncio que respeita, (Silence that respects)
Alegria que contagia, (Happiness that is contagious)
Lágrima que corre, (Tears that are flowing)
Olhar que acaricia, (A caressing look)
Desejo que sacia, (A wish that is satisfied)
Amor que promove. (Love that promotes)

 

E isso não é coisa de outro mundo, (And this is not a thing of another world)
É o que dá sentido à vida. (It is what gives meaning to life.)
É o que faz com que ela (It is what makes it)
Não seja nem curta, (neither short)
Nem longa demais, (nor very long)
Mas que seja intensa, (But intense)
Verdadeira, pura… Enquanto durar. (true, pure...while it lasts.)

Feliz aquele que transfere o que sabe e aprende o que ensina. (Happy the one who shares what he knows and learns what he teaches.)

Cora Coralina

July 31, 2013: Day 89 of 90--My heart is beating faster and getting smaller.

As my time comes to an end, just like during the end of Model UN, this morning I had to reset my alarm for a little bit later when it beeped at 6:00 AM. After finally rolling out and getting ready, Sister Joana and I left the house around 7:00 to attend a class that she was giving about political ethics for social service workers at PUC, the Catholic university. She spoke to a group of around fifty people about what CRESS, the regional social service council, is and the principles upon which it operates. 

In the afternoon, I was able to spend some time saying goodbye to the Gomes family (the friends with whom I went to the farm that was near Buriti Alegre). I also was able to have dinner with Sister Joana, Professora Vera, and Dr. Elias Rassi, who was previously Secretary of Health of the city of Goiania and a friend of my mother.  He organized my time at Maternidade Nascer Cidadao and helped me to find my host family. The last time we met was on my second day in Goiania and so I think Dr. Rassi was a little shocked with the amount of conversation we were able to have, now that there is a lot less of a language barrier between us. I was happy to explain for him many of the experiences I have had and some of the things I have learned about health care in Brazil. More importantly, I was happy to thank him for welcoming me to Brazil and for working so hard to organize a large portion of my experience. 

The title of this post, "My heart is beating faster and getting smaller," comes from Sister Joana and Professora Vera because they both asked me today if my impending departure was having physical repercussions in my body. I was not really sure what they meant when they asked me if my heart beat was speeding up and if my heart was shriveling, but I think they mean to say they will miss me too. And honestly, I am very happy to be coming home, but the friends I have made on this trip and the work I have done will always be a part of my life now.

July 30, 2013: Tropical Disease Hospital of Goiania

Sister Joana and I were able to do a little shopping this morning as we both needed to buy some gifts, though mine will be traveling much farther! We went to Setor Central and walked around part of “downtown” Goiania to find what we needed.

Dr. Bonaventura Braz de Queiroz

My afternoon consisted of a visit to the Tropical Disease Hospital of Goiania, my last hospital visit of time here, and a social service meeting at CRESS with Sister Joana and Professora Vera. The Tropical Disease Hospital, though it was a little sad, was very interesting and I had a really great tour guide. He was a security technician, who is in charge of reporting all accidents in the hospital and orienting all visitors, staff, and service personnel about proper sanitation/personal protection and prevention of the spread of diseases there. He was really knowledgeable about the ways of the hospital and it made me feel a little safer from germs as we marched up and down the halls in our white lab coats. I visited the adult and pediatric Intensive Care Units, which have nine and four beds respectively for the whole city of Goiania, state of Goias, and all those who come from out of state (as a reminder, this hospital is the only hospital for tropical diseases in Goias and is a reference hospital for other states). We passed through the halls of the inpatient section of the hospital as well as the emergency section and the urgent care section. I was able to meet and talk with a top-notch infectologist, named Dr. Bonaventura Braz de Queiroz, who now works in the urgent care but who previously worked as the director of the hospital for twelve years. To be attended at the hospital in the emergency room, you must either be taken there from a Cais, the type of emergency center I visited on Friday, or you must have HIV. To be attended at the hospital in the urgent care, you must be referred by a family health center such as a Cais or a PSF, you may not directly seek treatment at the urgent care without a referral. 

At the Tropical Disease Hospital, I finally, after three full months of working with countless doctors and nurses and social service assistants, learned that SUS, Brazil’s public health care system, is part of Brazil’s constitution that was written in 1988 when the country returned to having a president after a time of military rule. It is a right, something that if the United States’ founding fathers included in the United States’ constitution would have been dubbed “inalienable,” and is guaranteed to be free for all citizens of Brazil. When I commented that health care in the United States is not a part of the constitution, I was met with puzzled stares and one person even said, “Well then you need a new constitution!” The question of responsibility for one’s health care yet again arose.

Once we left the Tropical Disease Hospital and after attending a long social services meeting at CRESS, Sister Joana dropped me off at the Bueno’s house for a final party with the family. Thaynara and Karen’s mother Tiana made lasagna and my favorite saffron chicken for dinner and almost the whole family came over! I will miss them dearly and cannot thank them enough for welcoming me and helping me on this journey. I am so glad, I learned Portuguese, if for no other reason than because I am able now to talk to Tiana and Carlos Roberto. It was so difficult to communicate with them when I first arrived in their house and at times I felt so rude to not be able to talk with them. Now though, everything is almost normal and hopefully I was able to fill them in a little bit last night with all the things I was unable to say previously.

July 29, 2013: Vila Mutirao and the women's group

Three and a half days to go was a little bit of a startling realization this morning when I woke up today. I have had such a great experience here and in some ways it has sped by and in some ways it has felt like a long time! However, there is still work to do. This morning, I went to Vila Mutirao once again to attend home visits with Equipe 49, the health care team whose meeting I attended on Friday. There were two visits scheduled for 10:00 AM. Since I arrived a little early, I once again was able to help Nurse Maria Irnete in the Sala de Vacina until it was time to leave. The first address to which we traveled was the address given by one of the patients we discussed on Friday. She is a patient of particular interest for Equipe 49 as she has a high risk pregnancy. The address, however, did not prove to be where the patient lives.  Whether or not the patient did not know her correct address or purposely gave an incorrect one remains to be seen, but either way, the Equipe will need to again evaluate a method of providing accompaniment for this patient. The next address where we went was of a patient around thirty years old with schizophrenia. He lives with his mother and needed his prescriptions to be renewed. The doctor of Equipe 49 is currently a newly formed doctor who just graduated last year in May. She seemed to be very attentive though and worked with patience and thoroughness. After examining the patient and determining that he is in good general physical health, she renewed his prescriptions and ordered regular blood work that he needs to have annually. This is always difficult for him as he does not usually leave his house, due to a fear of crowds, but the doctor hopes his mother will be able to convince him to go for the tests and after for a consultation in the PSF to discuss the results. 

When I left Vila Mutirao and returned home, Professora Vera and I ate lunch together before Thaynara and Karen picked me up to spend the afternoon with the Buenos. We did some errands, ate acai, and just caught up since I have not been able to spend time with them since the Independence Day celebration we had on July 3. Later in the evening, I returned and went with Sister Joana and her friend Creusa to the weekly women’s group therapy session that they lead. They have led this group in the neighborhood for ten years and were excited to welcome me there and explain their mission. Tonight, since July is a holiday month, there were only three “regulars” in attendance, but each shared part of their story with me, telling how they joined the group and through what difficulties it has helped them. For each of these women, the women’s group has meant an incredible amount. They have grown in community with each other and have learned to express themselves in a positive way. They have all become more productive members of society and have continued throughout the existence of the group to serve their community, attend the group themselves, and invite new members. The discussion of the night also centered around the ten year anniversary celebration that the group will be having in a few weekends.

July 28, 2013: Sister Maureen's Community

My day began bright and early after staying out late with the sisters last night at the finale of Integration Week in Sister Joana’s community of Jesus de Nazareth by waking up for the Sunday celebration at Sister Maureen’s community Sao Carlos Houben/Nossa Senhora de Santa Eucharista around 7:00 AM. Every other Sunday, Sister Maureen’s community does not have a priest to celebrate mass at their church and therefore has just a celebration of the Eucharist. There are a few community members, as well as Sister Maureen, who are trained to lead the ceremony. Today, Sister Maureen was in charge, and dressed in the green robes of the priest, her leadership made the ceremony feel rather Anglican! It was very evident that her community respects her and her vocation and it was great to see everyone’s enthusiasm for welcoming Sister Anita and I to celebrate with them. At the end of the mass, we were called to the front with the people who were celebrating birthdays and everyone sang for us. 

As soon as the celebration was over and we returned to the house, I prepared for Dr. Mauro to pick me up for a final dinner with the Barra family. We had churrascu and bacalau for dinner while we reminisced about my time in Brazil. With Senhor Barra I watched part of the DVD from Marcelo Barra’s concert on June 12 that I went to see with the family. I even appear a few times in the DVD as the camera man pans the audience! After some sad goodbyes and see you next times, Mauro, Lila, and I went to visit their first grandchild, Alvaro, so that I could meet him before I go home (He was born June 22, just after I attended his baby shower on June 9). Since Alvaro was recovering from his one month shots, we did not stay long, but I am glad to say that he is adorable and healthy. The final stop of the evening was to visit Lila’s goddaughter, Helen, as she too just had a baby three weeks ago and I was hoping to meet him too before I went home. Henrique is doing well also and is so cute with his chubby cheeks.

July 26, 2013: The first of the Model UN benefits--Public Speaking

I returned to Villa Mutirao PSF this morning to observe a little bit more. I spent a couple of hours in the Sala de Vacina, the Vaccination room, and then I sat in on a meeting of Equipe 49. The Sala de Vacina was, though a little sad to see all the crying babies, very interesting. The nurse that was working there was very kind and she explained for me all of the shots she was giving. I helped with the paper work part of the job, documenting all of the shots she gave. It was a little shocking to find out that the PSF did not have the vaccine for DTP, that all of the babies needed. They have not had it for a few months and were not sure if they would have it available by next month. Many of the parents were not too happy about this. When I asked why there was a shortage of DTP, the nurse said that she was not sure, but that she knew that the shortage was not just in the Villa Mutirao PSF, but in the whole region.

The meeting of Equipe 49 was also very interesting. The group was discussing their week and talking specifically about a few patients they have who have problems with drugs and the strategies they will be implementing this week to reach out to them. The whole team was involved, from their doctor, nurses, and social workers, all the way to their receptionist and their dentist! It was really nice to see a team that was functioning so well. There was conversation, exchange of information, and several different strategies proposed to attend the patients, both inside the PSF and when they do home visits. In some situations, it seemed nearly impossible for the team to be able to do anything and this frustration was visible in their faces, but nonetheless, the group persevered and ultimately designed a plan of attack. I am working with them again on Monday and I cannot wait to get started again! One question that has since crossed my mind though is the process of triage that the group uses to decide what patients need to be addressed and in what order. Also, I do not understand how the team can force people to be patients if they do not choose to seek help. I suppose it has to do with the Brazilian government's free public health care plan for all citizens.

Today was also a learning experience for me because I was able to see a Cais. A Cais is similar to a PSF, but it is a bigger type of clinic that is not so community centered and it also has an emergency clinic. If a person has an emergency and has public health care, then they are taken first to a Cais in order to be seen and then sent to a hospital with space for them if necessary. If there are no PSFs in the area, the Cais works in its place. Another difference though between a Cais and a PSF is that there are centers for the combat and control of certain diseases there too, such as TB, Dengue, and Leprosy. One problem that Cais's can have is that with the crowding in hospitals, the emergency centers, which are not designed for keeping patients for longer than twenty-four hours, often become filled with patients waiting for openings in the hospitals, sometimes for as long as months. There is also the ever-present problem here of the shortage of doctors. The Cais that I visited has two days a week that there are not a sufficient number of doctors present: Monday and Friday. It was great to learn about the Cais, even though I will not get to work in one, because it filled in some of the gaps for me in the story of health care here that I have learning piece by piece.

Jesus de Nazareth tonight was a little more involved than the previous nights because today one of the speakers was ME! The sisters asked me to share about my experience here and to talk about communication and its challenges here with the language barrier. I had to speak in Portuguese for the whole thing! This was the first of the many benefits of being a part of Model United Nations at Alma College... I was not even nervous to speak :)

These were the other speakers of the night, Sister Joana's biological sister, Vera, and her husband, Julio.