Brazil: Work with street people and the excluded

  • International staff: 16
  • National staff: 83 Eighty percent of Brazil's 165 million people live in or near a city. This intense urbanization, coupled with the vast economic divide between rich and poor, puts great pressure on the health of those on the cities' economic margins. MSF's work in Brazil is focused on the excluded urban areas of Rio de Janeiro and, at the other extreme, in isolated indigenous communities in the Brazilian Amazon. One of MSF's newest programs involves street dwellers in Rio de Janeiro. Although the presence of people living in the street is not a new phenomenon in Rio, it is a growing one. To better understand what living on the street can mean, MSF invited a number of homeless people to a three-day meeting last April. They presented their stories, questions and grievances to representatives of different government services involved with street people, including police, health and social workers and people in the housing department. The meeting gave important clues about how a homeless program could be designed. Medical assistance will be the starting point for the development of a broader social reintegration program. MSF plans to host seminars for local residents, entrepreneurs, sports and religious associations, restaurants, and schools, with the aim of creating a network of support for MSF work and for the street people themselves. Working with people on Rio's margins MSF also works in the northern Rio district of Costa Barros, an area with a total population of about 45,000 people and a long history of poverty, violence and insecurity. The project began in September 1998. The first phase, which ran through September 1999, focused on restarting the activities of the local health center. The emphasis has now turned to education and outreach, with special attention to prevention and health promotion services rather than just medical assistance. In June 2000, MSF phased out its support for another community development project. Local organizations received training on setting up and running associations to support a health center and other local needs. The result was the creation of an NGO devoted to accompanying AIDS patients, as well as several community associations. Participants continue to receive support from local funds. MSF also helped create "Médicos Solidários" (Doctors in Solidarity), a network of 85 physicians who offer about 200 free consultations per month to the poor in Rio. Working within the local AIDS control program, MSF has a project focusing on raising awareness of sexually transmitted diseases and increasing access to condoms. About 20 community organizations have been trained in the development and management of AIDS-related projects. Indigenous health Far from the urban poverty of Rio, MSF works with indigenous people in Brazil's Amazon state, home to about 58% of the country's indigenous population. Isolation and relatively recent contact with disease-bearing people from the outside have resulted in a unique set of health problems: acute respiratory and diarrheal infections, tuberculosis, malaria, and high mother and child mortality rates. Based in Manaus, MSF works in Atalaia do Norte (in Javari Valley District) and in Tefe (in Medio SolimÃ?µes District), in collaboration with Brazilian Ministry of Health and local organizations. During five- to seven-day visits to each community, MSF trains indigenous health workers to identify and treat key diseases affecting indigenous communities. MSF has also trained staff of the Ministry of Health and the Indian National Foundation in preventive healthcare techniques for indigenous people. In October 1999, the government created Special Indigenous Healthcare Districts (SIHD), a system geared in theory to the culture and specific needs of the indigenous population. One of MSF's priorities is to support the values and philosophy of the original indigenous health care district concept, whose implementation has unfortunately often resulted in a replica of the regular national health care system. As a way to raise awareness throughout Brazil of its indigenous peoples, MSF is sponsoring "Indians 2000," an exhibition of 26 photographs by SebastiÃ?£o Salgado, nine panels by artist Claudio Andrade, and texts by poet Thiago de Mello (poster left). In Rio, MSF is also trying to sensitize the broader Brazilian public - with newsletters, seminars and other communication activities - to some of the problems and issues encountered in its programs. MSF has been working in Brazil since 1991.