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.

July 25, 2013: Week Twelve

Today was a busy start to my final week in Brazil. Sister Joana, Professora Vera and I began the day bright and early by driving to the other side of the city for a tour of the Hospital of Alternative Medicine, which, since it was about twelve degrees Celsius this morning, was freezing cold. There we learned about the services provided by the hospital and how the hospital functions. It is a state hospital and has its own garden from which many of the medicines prescribed there are made. It has acupuncture, yoga, psychiatry, and general health services. Patients are either referred to the hospital from the local health clinics or they can come directly to the hospital. However, if patients come directly to the hospital, they are seen only as openings are available in the schedule. In other words, if a patient is referred to the hospital by a clinic, they are guaranteed to be seen at their appointment time. It was interesting to experience, though briefly, the difference in the atmosphere at this hospital in contrast to the others I have visited. It was much more relaxed, but I think that it was in part due to the fact that this hospital is more of a clinic, as patients do not stay in the hospital, they are just seen for consults. It is interesting to note also that all the doctors that work there specialize in holistic medicine rather than something more specific such as cardiology.

After lunch, I spent some time in another PSF (family health clinic) called Villa Mutirao. There I observed a class given by a doctor for patients with hypertension and diabetes about proper diet. Each month, the eqipes (health care teams) of this PSF have a class for twenty to thirty of their patients after which they do brief check ups and renew prescriptions as well as schedule consults if necessary. The doctor of this equipe was very nice and seemed to be very observant of her patients. She gave the class in an accessible way and tried to be encouraging rather than blame the patients for having poor diets. I was also able to observe one consult with this doctor after the class. She explained for me about observing both the patient's physical state and his or her demeanor as well during the consult, which was something obvious, but that I had never been told before. 

Tonight back at Jesus de Nazareth, we changed topics and began to discuss family. Tonight's speakers were a OBGYN and women's health specialist, Dr. Luis Henrique, from Rio de Janeiro who now lives and works here in a PSF the sisters' neighborhood and his wife, Christina. They have two young daughters, eight years old and eleven years old. They began slowly, telling about how they met and decided to get married, but a hush fell over the church when they began to describe their family's struggle when Christina was diagnosed with breast cancer during her second pregnancy. It was incredible to hear of their journey and see the way they respected each other throughout everything. The example of this family and the faith that they maintained and on which they relied during their times of uncertainty are inspiring. I am a little sad that I will not be able to spend more time learning about the work of Dr. Luis Henrique also! He spoke a little bit about how he has worked in a PSF, an hospital, and as a breast care specialist. He also has worked in administration, though he returned to direct patient care when he realized that he missed interacting with patients directly.

Dr. Luis Henrique and his wife Christina, a breast cancer survivor

The captivated audience...including me in the front left of the photo

Professora Vera, thanking Dr. Luis Henrique and Christina for speaking

Sister Anita, me, Dr. Luis Henrique, Professora Vera, Sister Joana, Christina and their two daughters at the end of the evening

July 24, 2013: Home Visits with Servico Social

Aside from perfecting my own skills at baking pao de quiejo today, I spent the day doing a lot of translation.

The sisters have asked me to write a piece describing my experience in Brazil for their website. I of course obliged and when I told Sister Joana that I was finishing with it, she said, "Ok, now translate it into Portuguese for the Portuguese website." AHHH!!! Well, I did it. I translated the English version as best as I could, so Sister Joana and I spent part of the day correcting it. Let's just say that it was a lot of work! I learned a lot though, especially about accents and spelling. We also had a few good laughs at words that I thought were words but that I actually made up and times that my translation did not mean exactly what I was hoping. For example, when I tried to say that my time in Brazil has been fruitful, I said something closer to time in Brazil is like a fruit!

My second opportunity for translation today occurred when Anita and I went with Professora Vera, who not only teaches Social Services but also is a Social Service worker for the city of Goiania, to make some home visits. (This is yet another time that the government has instituted the model of the Pastoral da Crianca.) A driver from the city took Vera, Anita, and me to the three houses that Vera needed to visit. At the first and the third house, no one was home. In the second house, however, where a man requesting the government health plan pay for transportation for him to and from dialysis three times per week resides, we were able to see an example of what Vera teaches in the classroom. I was the translator for Sister Anita, who is doing a great job learning Portuguese but still has a little trouble understanding. The man whom we were to visit was not home, but his daughter-in-law, in whose house he resides, was available to explain the situation for us. The point of the visit was for the Social Service department to gather information to justify the person's request for public assistance. We discussed the man's condition as well as his routine, family situation, and his finances. Since I only have been on one such visit, I think it would not be wise for me to say whether or not I think he will be eligible for assistance from the government, but it did seem like Vera was optimistic.

One thing that troubled me about this process was its inefficiency. Why could the workers not drive their own cars? And, why was it worth it to chance that the residents would not be available when we arrived at their houses? Well, Vera described for the that the people whom they serve primarily often are very anxious to receive the government's assistance as it will alleviate their financial burdens and usually they are not in good health. Therefore, it is better for the Social Service department to risk a visit rather than to make appointments because if the Social Service worker is not able to go to the meeting because a public service car and/or driver is unavailable, the person in need would be under more stress and have more anxiety. What's more is that the people being served do not always have phones and so making an appointment is impractical.

Sister Maureen giving part of the talk for Integration Week.

After a quick dinner, we set out once again for the Church of Jesus de Nazareth for Integration Week festivities. Tonight we discussed the characteristics of living well as a community. We talked about the principles of living well and defined them, including things such as communication, respect for ourselves and for others, and education. We had small group discussions and shared with the larger group as well. At the end of the night, we played a little game. Each person had to bring something with them to trade, such as a homemade craft or any small gift. We each traded for something we thought was valuable and discussed the difference in a thing's monetary value and its value to a person. I took pao de queijo to trade and ended up with a key chain of the Sisters of St. Joseph.

July 23, 2013: Maybe Christmas IS coming!!

This morning in Goiania I was greeted by a fresh, cool mist outside when I woke up. Thinking that as has happened every other day in July, and most of June and May too, it would within the hour be sparkling in the sun and baked away by the dry, persistent heat, I sat through breakfast in the track shorts I wear for sleeping here thinking nothing of it. By the end of breakfast though with my feet in my flip-flops practically freezing, I had a moment of realization, along with confirmation by all four of the sisters in the house, that today was not NORMAL. Winter had finally arrived in Goiania with a significant drop in temperature overnight. Anyway, it was about 61 degrees Fahrenheit today and after temperatures in the mid eighties yesterday, it was cold. Maybe the Christmas cookies I made yesterday (sweating even more because I turned on the oven when it was eighty-something degrees outside) were a little more prophetic than we first thought!

Sister Joana, Sister Anita, and I met with Mara, a volunteer leader of the Pastoral da Crianca

This is the book that the volunteer leaders use to educate themselves on the process of participating in Pastoral da Terra. Sister Joana let me borrow it from her in order to get to know a little more about the NGO before we met with Mara. It was great because then I was able to ask questions about what I had read. This was a very good test of my Portuguese since I had to read in Portuguese and understand! It also helped a lot to read out loud to Sister Joana to work on pronunciation. 

Once we "bundled up" (meaning I wore closed toe shoes, a sweater, and long pants), Sisters Joana and Anita and I spent the morning in the house of a woman who is a volunteer leader for an NGO that began in Brazil thirty years ago called Pastoral da Crianca. The work of this organization, though simple on the surface, is anything but simple. Rather, it is incredible and commendable communitarian work (as the Brazilian government has realized...a point I will address momentarily). I first learned about Pastoral da Crianca when I traveled to Paranaiguara and met Sister Christina, who helped initiate part of the program, especially in her region in the south of Goais (see post July 4, 2013). The volunteer leaders of Pastoral da Crianca are members of the community in which they work and are trained by the organization before they officially commence. The job of the volunteer leader is to provide education and preventative care for pregnant women and children and their families until six years of age without prejudice in up to fifteen families. The leaders do home visits for each of their assigned families with the goal of learning more about the environment in which the mothers and children leave and the familial atmosphere. There is also a Celebration of Life one time per month and group meetings to unite all of the families and to develop a sense of community and understanding. The mission of the Pastoral da Crianca is based on John 10:10, "So that all children may have life in abundance." Under this umbrella, the work of the organization works within communities to develop the community and to make it more productive and self-sufficient, thereby enabling citizens to better their own lives with the resources available in the community. 

When the Brazilian government noticed the success of the Pastoral da Crianca, saving the lives of mothers and children, preventing hunger and malnutrition, and keeping records for reference, it began to plan how it would be able to use the model of the NGO to better health care in Brazil and achieve similar success. Therefore, the idea of the PSF, the type of family health center that I visited at the end of June, was developed. The PSF is somewhat community based in that it is small and within the community that it works, it includes home visits for the same reason as the Pastoral da Crianca, and in theory is an excellent idea. However, it seems that what the PSF is lacking is the same type of motivation to better ones own community since the doctors that work there are not usually from the community. Also, the amount of people who are supposed to be served by each PSF is incredibly high and so cannot be as personal. Ultimately, I think the differences noted in the Pastoral da Crianca and the PSFs ultimately may be an indication of who needs to take charge of initiating the changes necessary in health care.


In the evening we returned to Jesus of Nazareth to continue Integration Week. Tonight we learned about the effects of industrialization on the indigenous populations in Brazil especially in the state of Mato Grosso do Sul. This was discussed in connection with the Wedding at Cana and Jesus asking the Samaritan woman for water at the well in the Gospel of John. The bottom line of the connection ended up being that we are all on a journey--Jesus included when he was on earth--and that without thinking of the ways that our journey intertwines with the journeys of others, we will fall into disrespect for each other and for creation. Also, within the theme with which we began yesterday of "Living well," the speakers stressed that living well must include respecting the way that others also can live well.

July 22, 2013: Integration Week for the Parish of Jesus of Nazareth

Today I made cookies...Christmas cookies. Maybe I was inspired by the fact that my winter in Brazil, since I am returning to the United States in nine days, is coming to a close. I know that Christmas is in December, but winters in Michigan have always included Christmas and Christmas cookies. Anyway, they were tasty and in between a little reflection on my experience here, I used a drinking glass as a rolling pin and made these lovely treats.

The more important thing I did today was attend the opening of the Integration Week for the parish of Jesus of Nazareth this evening (Sister Joana works in this parish and is heavily involved in organizing the meetings.). Integration Week is an annual event in the parish that is in celebration of the diversity of creation within the parish community, the local community, Brazil, and the world. This year, there is a meeting for prayer, reflection on the Gospel, and education every evening. The education, in connection with the Bible, this year is being presented by people in the parish (including some of the sisters) who participated in a class offered in Goiania every January. Tonight we began with a short history of the class to describe the types of topics that have been studied in the past and to introduce the topic that would be the focus of Integration Week: living well and what that means for people here and people of other cultures as well, with a look at humanity's relationship to the earth. It was very interesting to think about and realize that "integration" means something very global. They way in which this parish is teaching integration is both community focused, so as to recognize the equality of all, but also focused on gaining perspective about how others live and work and play, both with the same goal of gaining understanding for others and helping to change broken relationships. It might at first seem like there is no room for health care here in this discussion. On the contrary, health is integral since it is all-encompassing. Health is physical, mental, social, cultural. It affects work, families, faith, love, understanding, ability. Health is part of humanity. Therefore, living well, the topic that will be covered as the week progresses, will have everything to do with the health of men and women, girls and boys, in this community in which I now have lived and been welcomed for three months, and outside of it, where I live, where my family and friends live, in Alma where I go to college, in London where the royal baby boy was born today, in Rio de Janeiro where Pope Francis is meeting with thousands of youth from all over the world, and in all the places man resides. What is even better is that this topic will be about both health care and history, two of my favorite things!

Sister Anita and I got to meet the speaker after the gathering tonight. The decorations in the background next to the crucifix are representative of leaves and each leaf has a word on it that is part of Integration Week. Some examples of this include to learn, admire, value, take care, protect.

July 21, 2013: Martha made some pao de quiejo for Jesus

Luke 10:38-42

³⁸ Now as they went on their way, he entered a certain village, where a woman named Martha welcomed him into her home. ³⁹ She had a sister named Mary, who sat at the Lord’s feet and listened to what he was saying. ⁴⁰ But Martha was distracted by her many tasks; so she came to him and asked, “Lord, do you not care that my sister has left me to do all the work by myself? Tell her then to help me.” ⁴¹ But the Lord answered her, “Martha, Martha, you are worried and distracted by many things; ⁴² there is need of only one thing. Mary has chosen the better part, which will not be taken away from her.”

Today, bright and early, I visited a Catholic church in Goiania with Professora Vera that is more charismatic than the ones that I have already experienced here. It has many ministries in the community, including a food pantry and a type of health clinic to help people pay medical bills, and though I will not be able to visit them, it was nice to see the site and to get a better idea of the community. The Church of the Holy Family is what the church is called and it is big, but modern, and filled with beautiful stained glass, including one that depicts the Holy Spirit dove surrounded by fiery reds, oranges, and yellows. There were two priests for the mass as well as a band and a choir. It was really interesting to see how lively the people were during mass. That is not to say that there was a lack of reverence among the parishioners, just that there was reverence with a visible excitement to be participating in the mass. This included movements during the songs, the priests encouraging the parishioners to sing louder, and applause after the readings for the word of God. As a Catholic, it was good for me to learn about this part of the church, especially after seeing hints of it in the other parishes that I have visited here. 

I did have a realization during the mass that was quite exciting for me that I thought I would share. During the homily, which included background piano music (why???), the priest spoke about the readings from Genesis, when three men visited Abraham and Sarah and told them that Isaac would be born, and the Gospel reading from Luke when Jesus visits Mary and Martha, Mary dropping everything to be with Jesus. The priest began to describe the encounter between Jesus, Mary, and Martha, telling about Mary sitting with Jesus. He then said, "And there was Martha, standing in the kitchen preparing some

pao de queijo and a little juice for Jesus,
instead of remaining with him in the living room." I am sure the priest was joking and I was so glad that I now understand enough Portuguese to be able to understand the jokes! I laughed so hard! However, if Martha really was making pao de quiejo for Jesus, I am sure he would have been impressed with how delicious it is!

pao de queijo and a little juice for Jesus

I would also like to give my well wishes to Pope Francis and all who travel to Rio de Janiero to celebrate World Youth Day this week, especially those traveling from Goiania. A part of me wishes that I could make that a part of my PGlobal experience here, but I am sure in actuality I will see more (and not to mention be safer) on TV in the nuns' house!