Brazil 1998

International staff: 5 National staff 17 MALARIA & MALNUTRITION POSE THREAT Land reforms in favour of mining and lumber interests, and a policy to resettle people from the overpopulated Northeast, have had a disastrous effect on Amerindian groups and small farmers. As settlers have pushed the indigenous people off their lands, they have been forced into great poverty. There have also been large displacements of dispossessed peasants to the periphery of big cities, swelling the already huge numbers living rough or in favelas (slums). MSF works on behalf of both Amerindians in rural northern areas and marginalised groups in Rio de Janeiro. Risk of extermination As a result of their past isolation from common diseases and a failure to implement the national health system on their behalf, the Amerindian population of northern Brazil is at very high risk from, for example, malaria and the effects of malnutrition. Indeed, large numbers have already died among a group that is already comparatively small (0.2% of the total population). MSF works on behalf of the Yanomamo and Javari groups in Roraima and Javaria states to reduce the five main causes of mortality, increase immunisation coverage, improve the distribution system for essential drugs and medical material, train community health workers and microscopists and establish a health monitoring system. MSF promotes inter-institutional working groups and indigenous organisations with a view to the eventual hand-over of these activities to the Brazilian authorities and local NGOs. The total number of beneficiaries from this project is less than that of most MSF projects, but as no other organisation is working with this threatened group advocacy is an important element. Rio de Janeiro The favelas are rife with gangs of drug traffickers and the inevitable consequences that have led to an official policy of violent police raids. MSF tries to counter these problems of urban violence and social exclusion by an approach that aims both to improve health and to act as an interlocutor between the public authorities and the excluded. A pilot project on STD/AIDS prevention brings MSF into partnership with public authorities and local community groups in 15 favelas. The project provides a "condom bank", information/education and a link-up with the public health system treatment available for STD/AIDS. In Vigario Geral favela (pop. 12,000), MSF has set up a health post providing primary medico-psycho-social care for children and adolescents, and a health co-operative for adults. In order to reach a level at which this can become autonomous, MSF is running a community management training programme for 17 participants from five favelas. MSF also continues to provide access to health care through five projects for street children. In Costa Barros favela, MSF runs a social integration programme for 1,000 re-housed families previously living under bridges and in transit shelters. Using a health-oriented approach, MSF encourages them to formulate and seek solutions to their problems.