June 30, 2013: Down on the Farm

Professora Vera's family was very welcoming!

 Professora Vera asked me if I would like to attend mass with her and her family today at a farm where her brother Joaquim is currently living. It is a farm for people recovering from drug and alcohol abuse that is run by a Catholic charity. It is private but functions on donations and patients there pay according to the means of their family, which results in a large range of payments per month. The patients here have a strict schedule, structured to give them the best recovery possible. For the first six months of residency on the farm, the patients are not allowed to leave the property except for doctors appointments for which they are accompanied by a staff member. The final three months of their stay (the patients generally stay for nine months) the patients are allowed to visit their family's house on Sundays but have a curfew that must be respected. It was really great for me to learn about the availability of this type of treatment. I really enjoyed getting to know Professora Vera's family as well and seeing so many new things on the farm! However, in case you thought it was a good idea, it really is a TERRIBLE idea to step on a fire ant hill! Thirty-three bites later I would suggest watching where you step!

Fire ants are not so friendly...I won't post a picture of the bites, but believe me they were painful!

This is a part of the farm, but really I just love this picture :)

It really was a hike up the hill to the chapel!

I got to meet Professora Vera's mother. She is a very sweet woman who loves Our Lady of Fatima. This statue of Our Lady of Fatima is one in the chapel at the farm where her son is staying.

Professora Vera and I were not expecting the small oranges we picked to be so sour, but it was pretty funny to see each others faces!

Joaquim showed me sugar cane that the people grow on the farm.

He chopped down some for me with a machete and the peeled it so that I could taste it raw. It is like wood with a sugary milk inside! Strange, but delicious.

This city, Neropolis, was on the way to the farm. We stopped to see the great monument of Our Lady at the entrance of the city.

June 29, 2013: Arria do Cerrado, 80 Years of Goiania

Happy Birthday Socorro!!!

After finishing the gardening today, which included encountering an enormous, practically-tarantula spider, the nuns and I went to one final Festa Junina at the nuns' friends' house to celebrate another birthday, that of Socorro, a dear friend of theirs. It was great and we all had a wonderful time talking and reminiscing. I learned a lot about the nuns and about Socorro! After the party, Socorro, Sister Jeane and I went to the 80th birthday party of the city of Goiania that has been occurring this week. The party is called Arria do Cerrado. We watched some traditional dancing of Brazil that happens at Festa Juninas and then we watched a concert of an African-Brazilian singer from the Northeast of Brazil. He sang a lot of songs about race and racial equality along with many songs about Africa. One song was a tribute to Nelson Mandela. This is a prevalent theme for this singer because the history of his birthplace in the Northeast is embedded with the African slave trade to Brazil. Again, we did not return until nearly 1:00 AM! I think these nuns are younger than I am sometimes!

Socorro and I at the concert

Sister Jeane and I at the concert

We really had a great view of the stage! I look a little pink after working in the gardens today...

The lighting was pretty cool for this concert.

June 28, 2013: A spring garden and some gardening

The PSF in Jardim Primavera

In the neighborhood called Jardim Primavera (Spring Garden), there is another PSF. Today I went some colleagues of Professora Vera to this PSF to administer a similar meeting to the one I attended on Tuesday. The people who work there were meeting to discuss the pros and cons of their operation as well as their plans for the future to address the challenges they find most pressing. The meeting on Tuesday was very calm: everyone participated and the meeting ran smoothly. In this meeting, the people were much more aggressive and the social workers who were running it had a much more difficult time keeping order. For me it was interesting to see the difference in the dynamic. I learned afterwards that the PSF in Jardim Primavera is newer and so is still learning how to function. When it was all said and done however, it seemed that both PSFs I have visited face similar problems that will only be resolved by a change in the system (something someone at both meetings pointed out).

Sister Joana and I enjoyed ice cream for lunch today after the PSF meeting.

To keep up with the garden theme, this afternoon I worked weeding the sisters' gardens, a task I plan to finish tomorrow. I think it is one way I can give a little bit back to the sisters who have so generously welcomed me into their home and their lives, showing me everything they do. I think the way they have been teaching me about their service in their community and the way that everyone in the community loves them shows just how much they serve and give of themselves. Though some might consider them nontraditional, I think that it is more important to see the good that they do for others and the way they serve God through serving others.

After dinner, Sister Maria Jose and I went to the church where she works for mass and after we attended a surprise birthday party at one of the parishioner's houses. It was really a great party, with practically a whole other dinner and cake! However, in true Brazilian fashion, many people did not arrive at the party on time and so the food was not served until nearly 11:00 PM. While we were waiting for the food and even again after we ate, Maria Jose and others at the party tried to teach me this Brazilian card game. It is SO strange and to me it seemed like there was no pattern. There was however a lot of screaming, eyebrow raising when certain cards were dealt, and trying to pretend you had a card you really did not have. Believe me, I was confused and needless to say, I did not learn how to play. It was hilarious to watch the others though. And, leaving the party at 1:00 AM was certainly something I never expected would happen!

June 27, 2013: Home visits and Hospital Materno Infantil

After participating in the PSF meeting on Tuesday, I was able to return today to see a little bit of how the PSF functions. It really was a great experience and I saw a lot of new things. It was a very interesting way to experience the public health system, especially after hearing all the downsides to how the PSF functions on Tuesday. Today was the "see-it-in-action day," if you will.

I arrived at 7:30 AM and was given a chair because I had to wait for the doctor to arrive before we could see the three patients who had appointments scheduled for the morning. All three were already waiting. Finally, around 8:30, the doctor arrived, ninety minutes late (she was supposed to be there at 7). She was young, probably twenty something, and she just graduated from medical school six months ago. She has not done her residency yet and does not know in what she wants to specialize. Crazy! Once she finished explaining for me how we would meet with the patients, we quickly saw each of them, spending maybe ten minutes with each. The doctor explained for me how these three patients were a good representation of what she does on a normal day because they were middle aged and combating hypertension and/or diabetes. The only other majority group that was not represented was the pregnant women, of which there were plenty waiting in the waiting area to be seen by the doctors and nurses of the other two equipes (health care teams, see June 25).

When we finished with our three patients, the doctor, two nurses, and I waited for a car from the city of Goiania's department of transportation to take us to the homes of patients who need home care. There were four homes to which we went today to take care of patients for whom it is difficult to come to the PSF. For the first house, we were about one hour late since our driver did not arrive on time. Therefore, when we arrived, the patient was not even home. Apparently they went somewhere and decided to not wait until the doctor arrived. We arrived at the second and the driver waited for us in the car. Our patient at the second house was an elderly woman with hypertension, diabetes, and obesity for whom the doctor merely described some previous test results. Also, since Goiania is entering a dry period which has very low humidity and nearly zero precipitation, the doctor stressed the things that the patient needed to do to prevent a cold which could turn into pneumonia or the flu. The theme of this visit, PREVENTION, was really a key for the whole process of the PSF, including the time in the clinic and the home visits. Due to the fact that the doctor is inexperienced and the way the public health system operates here, the PSFs are mainly for prevention. If patients have an ailment, they are directed to the appropriate doctor who will accept public health care patients. The rest of the houses we visited were much the same, entering to find the patient well and just with a few questions about basic preventative measures to take for the season or looking forward to the results of recent tests. But, the last house we visited had a patient much younger than the others. This house had a girl who was about four years old who was born with her heart outside of her chest. I think her ribs did not form completely so that her heart was inside them, but rather her heart is protruding out from her body, but is covered with skin. You can see it beating heartily through her shirt. This patient too did not need a lot of care. She was recovering from a cold and was taking antibiotics according to her parents who clearly were worried about her. However, the doctor said that she was recovering very well and if she continued to stay hydrated and to rest, she would certainly return to normal. From this description, I am sure that the home visits do not sound all that interesting. And really, they are very basic. What was important for me to learn from them was that there are many factors, including living conditions, that impact the health of a patient. It was important for me to learn the type of people the PSF serves. It is much easier to learn about a person in his or her environment, rather than in a doctor's office. I think that is part of the reason I was given the opportunity to come to Brazil and learn about the reality here from those that are living it every day, rather than just being given a text book.

In the evening, I was given a tour of another maternity hospital here called Hospital Materno Infantil. It is much bigger than Maternidade Nascer Cidadao, having both a section for women and a section for children, and is quite different. I did not know that Maternidade Nascer Cidadao was the only hospital in Goiania that was designed for Humanized births. This means that births there are generally more natural, without drugs or very much other medical intervention, and woman have more choice during the birthing process as far as how they labor and in what position they will give birth. When I worked there I attributed this fact to the fact that the hospital is in a poor neighborhood and did not really have a choice but to operate in this manner. However, as the nurse who gave me the tour assured me, the births in Materno Infantil were much more civilized and people generally tried to have cesarean sections. The word civilized I would say is an interesting choice on her part...

During my tour there I was able to speak with one doctor about her opinion on President Dilma's plan to bring foreign doctors to Brazil to fill the deficit of medical professionals that Brazil is facing. The doctor made a very good point that whether or not the doctor is Brazilian, the first thing that needs to occur is to better the system, then Brazil can be concerned with the doctors. I think her point was that many places in Brazil lack doctors due to conditions in which the doctor would be required to work, not due to the fact that there are not enough people who want to be doctors. Interesting. I was also during this visit asked if I was one of "Dilma's people"!! There was a nurse who was very surprised to hear me speak in English with the doctor and even more she could not believe that President Dilma had acted so quickly. I was quick to assure her that I am far from being a doctor!

June 26, 2013: Music to my ears

This evening, Sister Joana and I went on a little adventure! One of my friends here, Leonardo, is in a choir and he was having a performance that he invited me and the nuns to watch. The church where the performance was to take place, however, was on the other side of town. After Google Maps failed to be able to give us directions to the church, one of the other nuns helped us as best she could and we set out to search and at least find the neighborhood, then we would ask someone for help if necessary. I'm glad that we left one hour early, as it took us a little while to find the church, but we made it on time for the mass that was just before the concert. Once the choir began, it was lovely to listen to their sacred music, which included one Gregorian chant, Vivaldi, Panis Angelicum, Ave Maria, and many others. It really was an excellent concert, and the choir was accompanied by a keyboardist, a flutist, and a violinist.

June 25, 2013: Programa da Saude da Familia (PSF)

What in the world does the word "equipe" mean?? This is the thought I was having for almost three hours this afternoon. I wracked my brain, I tried to ask for an explanation, I consulted a ten year old, really, it seemed like I did everything. The problem was that this word, equipe, was integral to understanding the discussion I was observing. I was attending a meeting of a PSF, a public health care clinic or unity responsible for public health care in a community called Jardim Curitiba in Goiania. There are many PSFs in Goiania, in Brazil for that matter, as they are all part of Brazil's Ministry of Health's public health care plan. They are free for those who are treated and since they were instituted in Brazil, they have largely faced the problem of a lack of doctors and other health care providers and an overwhelming amount of patients. At bottom, it is a simple problem of supply and demand that is exacerbated by corruption in the government and a lack of money. Put that way, it sounds like almost every other problem that society faces.

This purpose of this meeting of health care officials that administer this particular PSF was to discuss the biggest problems facing the staff on a daily basis and to discuss the example of another PSF in a different state of Brazil that recently was reformed and is now functioning in a more successful way. The word equipe first came up when the staff was discussing the challenges in the PSF. There were three equipes in one PSF and the equipes were not equal. Finally, at the end of the meeting, I finally was able to understand one person's explanation: an equipe is like a team (in fact I think that is the direct translation) that functions as one health care unit responsible for the care of a sector of the population. One equipe consists of a head nurse that is the supervisor and, under the supervisor, there is a doctor and other nurses. Generally, they have about ten people, but one equipe in the PSF I went to today has only four people. That being said, that equipe, which only has four health care providers, is responsible for nearly one thousand five hundred families (!!!!!!). That means there are four medical workers for what is probably more than six thousand people (1500 x 4 people per family). Whether or not you fully understand the concept of an equipe (I am sure I do not), that ratio is outrageous! Is it possible for a doctor to do a proper or thorough job with six thousand patients and only three nurses?

Now, back to the discussion of the meeting... The main point the staff brought up were that they have trouble prioritizing which patients they should see and in what order. It is impossible to see everyone who comes to the PSF because there are so many  people and the facility is so crowded, but the workers generally do their best. The other problem they have is how to communicate with the patients and change their thought process. Many patients arrive at the PSF early in the morning, before the doctors and nurses even arrive. Some even sleep in the street outside, just to be sure that they will be seen and attended to. This however is not necessary or helpful to the patients. Though I am unsure of the system used to decide the order in which patients are seen, it was made clear that this would not be helpful for them and really made things more difficult for the staff. Aside from these challenges, I learned many general challenges/facts today about Brazil's health care system and the attitude of many of the health care providers, especially some doctors. Until recently, the public medical school here in Goiania, UFG where Thaynara and Karen study, was the only one. The one in which I observed, PUC, the private Catholic school, was non-existent until about five years ago. There are also many differences in the ways that students are taught at these two schools, a fact which requires more investigation. Also, it was very interesting to learn that President Dilma's comment in her speech the other day regarding her plan to bring foreign doctors to Brazil to fill the need here really was more of a threat! Many doctors here only want to work in cities, in large hospitals and do not want to serve areas that are already under served. There is a difference in salary, in quality of living and working environments and many other obvious differences. It is a troubling question for the public health care system here, how to attract doctors to places that are under served and in less wealthy areas (really I suppose this is a universal problem). Whether or not President Dilma is correct that the solution is foreign doctors, there is a consensus that something has to be done. I think for many here, who live and work in the area, and who have seen both the public and the private systems, changing the reality will begin only with greater communication and recognition of the universality of health.

The meeting commenced with a speech about inclusion in the workplace.

There was also a musical demonstration during the meeting...though I am not sure why....

June 24, 2013: Happy Birthday Sister Jeane and Back to the Children's Library!!!

HAPPY BIRTHDAY SISTER JEANE! :)

Congratulations on your 70 years! I wish you continued success and a very happy year!

As for the library, I think pictures, and a side note that the children and I created the drawings in the background (things like festas juninas, trees, flowers, fires, and chickens) will suffice for this post.

June 23, 2013: The parish of Jesus of Nazareth

Sunday, a day of rest and recovery from the pilgrimage yesterday, was much needed today. After sleeping in and a nice lunch here at the nuns' home, I went with Sister Joana to the parish she serves. It is in a nearby neighborhood and it is called the Church of Jesus of Nazareth. The church is small but beautiful, with colorful stained glass windows and wooden pews. There is a small adjacent building for parish gatherings and, behind the church there is an even smaller building that was made of mud bricks by members of the community about forty years ago that served as the original church. Today, I think it serves as a reminder for this rather poor parish just what they can accomplish when they work together and to be thankful for the improvements with which they have been blessed since then. Next to this building, there is the skeleton of a larger structure that is going to be the new parish hall. It is being constructed solely from the goodwill of the parishioners who usually work on it on Sundays, the only day they are not working to make a living for their families.

Before mass, Sister Joana and I attended an administrative meeting with the leaders of the youth group and the people who plan the extra activities of the parish. We discussed the budget, the Festa Junina that the parish held a few weeks ago, the upcoming day of service that the parish will be having, and the parochial mass that will be held in July. It was good for me to learn just how active the whole of the parish is, working together and also working with other small parishes in the area to praise God and serve others.

Just before mass, Sister Joana introduced me to the priest. He was very surprised that my name is Katherine. Though not a common name here, there are other people who are called Katherine, but I suppose I should explain exactly why he was surprised--

Last year, one of the Sisters here passed away. She was one of the original sisters from Rochester, New York, who was instrumental in establishing the nuns' community here. She served the parish of Jesus of Nazareth for many, many years and was dearly loved. There is a picture of her in the rear of the sanctuary above the last pew, where she sat during every mass. This sister's name was none other than Katherine. So, whenever someone who knew her is introduced to me, and since I am staying in her former home, usually there is a moment of surprise, and then many say, "Oh Sister Katherine has returned!". I really did think that this was just a nice coincidence, our names being the same, until the other day when I learned that not only do we have the same first names, but we also have the same middle names, Marie!!

Therefore, the priest's surprise was justified. When he began the mass, after the initial blessing, he proceeded to introduce me to the congregation of about sixty people, which then proceeded to SING to me! Oh goodness did I turn bright red! It was so unexpected and so kind of them to welcome me so wholeheartedly.

After mass, I attended the youth group. of about fifteen students ranging from twelve to twenty-three years old. We began with a prayer, followed by some singing and dancing. One of the young men in the group plays guitar so he led the singing and then made up these incredibly hilarious dance moves for us to do. There was more laughing than dancing, but the awkwardness of the situation made us all a little more comfortable afterwards. The discussion for the night centered around service and whether or not one should do service inside or outside one's own community. It was interesting for me since I am about 4600 miles away. But, I think the consensus was that both are important, a conclusion with which I was very happy to agree.

June 22, 2012: Trindade a pé! (Trindade on foot!)

Starting with the sunrise :) (though it was behind us...)

20 kilometers = 12.4 miles. 

That is how far it is from Goiania to a small city called Trindade. This morning, leaving the house at 5:30 AM, I made a pilgrimage with some of Sister Joana's family to Trindade. We started walking in the dark at 5:46 AM and we arrived in Trindade four hours and eighteen minutes later at 10:04 AM. It was really a nice walk, even though it was far. We were not alone on this journey; there were other people walking as well. Young and old alike were making there way to Trindade a pé (on foot) to celebrate the miracle that is said to have occurred there two hundred years ago when a medal was found with an image of the Incarnation surrounded by the Trinity. This is actually how the city got its name, Trindade, which is just Trinity in Portuguese. The pilgrimage here is popular and so there is a trail between Goiania and Trindade just for that purpose. It was being updated while we walked actually so sometimes we had to pass by workers pouring concrete, smoothing asphalt, and planting grass in the red earth that is characteristic of the state of Goias. The scenery is mostly rolling hills with some trees and farms in between but also small dilapidated houses and places filled with old cars and tractor parts. There were several billboards as the road next to which we walked has a fair amount of traffic. One even was advertising Dow Seeds. What a coincidence for me, being a Michigan resident and living so close to Midland. Along the trail there are six stops where large mosaics are situated depicting the stations of the cross (two stations per stop). They are really beautiful and remind the pilgrims what exactly they are celebrating on the walk. When you reach the city of Trindade, there is a large gate in the shape of a cross at the edge of the city through which you pass with a statue of the image found on the medal. Then, it is QUITE the uphill hike to the Basilica of the Divine Eternal Father where there is mass for the pilgrims every hour. I think it was about a mile uphill, which was definitely the hardest part of the long journey. Until then, the walk was rather leisurely, but we were all very thankful to reach the Basilica!

The medal said to have been found in Trindade

Mass at the Basilica was lovely. There was an old priest who I suspect was not Brazilian because he had an interesting accent and rolled all of his "r"s. I bet he was a native Spanish speaker since Portuguese tends to not roll the "r" like Spanish requires. He spoke slowly though, a thing which I much appreciated since it allowed me to understand a lot. The Gospel he read was from Matthew 6. He gave a homily about worrying centered around the verse Matthew 6:38,
"Do not worry about tomorrow: tomorrow will take care of itself. Each day has enough trouble of its own."

One of the stations

This is the descent to Trindade

The gates of the city

The last portion of the ascent to the Basilica

Such a gorgeous view of Trindade and the surrounding landscape from the Basilica

This is the image in the Basilica (no I did not wear long sleeves the whole time we walked but once we arrived the coolness of the Basilica felt cold after being so hot while we walked)

 

June 21, 2013: CRESS

CRESS: Conselho Regional de Servico Social. This afternoon I attended CRESS's annual meeting in which they vote on dues and officers. They review the work which they have done during the year briefly, including finances and then debate who should hold what position in the group. Though I did not understand very much because everyone was speaking SO quickly, it was interesting to see how the group functioned and who participated. The group consisted of social workers from all over the state of Goias who serve their communities through various programs that address human rights, literacy, support, education, and health. This year, in December, CRESS will celebrate its 30th Anniversary! Congratulations and may you continue to serve your communities with vigor and to the best of your ability!

June 20, 2013: The whole of Brazil is protesting! (Except for me. I am staying inside! Don't worry Mom and Dad!)

After being in the archives again today, it was very interesting on the way home to be greeted by blocked off streets and crowds of people waiting on the sidewalks with faces painted and huge posters. Due to hikes in the public bus fares that has taken place recently, people in Brazil have collectively taken to the streets to protest. At first, near the beginning of the week, this was mainly occurring in the largest cities, like Rio de Janeiro and Sau Paulo. But, by the end of the week, the clamor spread throughout the nation and almost every city in Brazil had a large number of protestors, Goiania included. They were of all ages and positions in society, which was very interesting. I am not sure that everyone was on the same page as some of the signs the people were carrying that I saw on TV were a little contradictory, but it is really something that so many people were attracted to the protest. It made me wonder what exactly about the protest attracted so many people? There is not exactly what one would call "social" or "class" solidarity in Brazil. There is actually a pressing and obvious division among that classes that for me is unsettling. Why are university students, the poorest of the poor, the upper class who do not even use the bus system, and even the religious taking to the streets to oppose this act of the government?

The main subjects in the protest were:
1. Public transportation fees
2. The World Cup coming to Brazil in 2014 and the money that is being spent to build several stadiums across the country
3. The Olympics coming to Rio in 2016
4.The lack of funds for education and the public health care system in Brazil (really in the face of the spending for the World Cup and Olympics)

This is when President Dilma met President Obama.

On Saturday (ok that is a few days away but I actually did not write this on Thursday...), the President gave a speech about the protests. She spoke a lot about democracy and how she planned to ensure that all protestors were afforded their rights to protest so long as they were peaceful. She assured the people that not only were funds for education and health care not being spent on the World Cup but that it was important for Brazil, the only country who has participated in every Cup, to be a generous host for the other countries. She included an interesting statement that the authorities would make sure to do their jobs as well and that violence of any kind would not be tolerated and would be punished accordingly. Her concluding remark was (google translate did its best...):

"My dear friends,I want to reiterate that my government is listening to the voices calling for democratic change. I want to tell you that the streets were peacefully: I'm hearing you! And I will not compromise with violence and riot.We will always be at peace with freedom and democracy as we continue to build together this great country of ours."
  
Though not very many Brazilians seem to be in favor of President Dilma, she seemed to be, like President Obama, a captivating speaker. However, since her speech was given on Saturday, many people have continued to protest and the reaction has not been all that favorable. One remark that President Dilma made that really stuck out to me was about health care and her plan to improve the fact that Brazil has a lack of doctors. She said, "I will talk in the coming days, with the heads of other powers to join efforts. I will invite the governors and mayors of major cities of the country to a great deal around the improvement of public services. The focus [in health care] will be . . .immediately bring thousands of doctors from abroad to expand the service's Health System, SUS." Many doctors I have spoken with here do not find this plan very attractive as they do not understand how exactly the President plans to attract these doctors for any sustainable amount of time. Though they could foresee volunteers, they feel that the solution to the lack of doctors here really needs to be more long term to be useful for citizens. 

This type of bus is a public bus that in Goiania has a special lane to drive in since it is so long. It does not drive in the streets with the other cars. But, since the lanes were filled with protestors, the drivers had to navigate the already crowded streets in order to function.

This shows the people in the streets and in the bus lane (the bus lane is the one you can see on the right side of the picture). This was what it looked like around 3:30 PM before the protest officially started at 5:00 PM.