A slum in Brazil sees MSF presence in health and psycho-social support

Marc lio Dias is one of the estimated 800 slums spread throughout Rio, a city where social inequality is huge. The violent evironment and geographic isolation - most of these slums are located on high hills turn these communities into enclaves within the city, where there is hardly any public service available. As a consequence, these populations have very poor access to health care, water and sanitation, education and other basic services.

"We lack everything here", says Margareth Nascimento, while waiting for a consultation for her one-month-old baby Iasmin, who is sick.

Tatiana, who is sitting next to her, agrees with her friend.

"We need people who want to come into this place", she said. "Every time my daughter got sick and I had no money, I just waited until she got better, because it is impossible to go to a public hospital. We wait for too long and at the end we don't get an appointment", she complained.

Tatiana and Margareth live in MarcÃ?­lio Dias, a poor community of 10,000 people on the outskirts of Rio de Janeiro, where MSF has just opened a project. MarcÃ?­lio Dias is one of the estimated 800 slums spread throughout Rio, a city where social inequality is huge.

The violent environment and geographic isolation - most of these slums are located on high hills - turn these communities into 'enclaves' within the city, where there is hardly any public service available. As a consequence, these populations have very poor access to health care, water and sanitation, education and other basic services.

For people living in MarcÃ?­lio Dias, the closest Public Health Center is seven kms away. Access to the facility, however, is hampered by the violent environment, lack of public transportation and a situation of extreme poverty.

"Due to a long waiting line, patients have to reach the health center as early as 3am in order to assure an appointment with a doctor.

However, a kind of curfew often imposed to the population restricts circulation within the community before dawn", said Marta Martinez, MSF project coordinator. Even if they overcome the barriers of physical access, the facility is still overwhelmed. This Public Health Center, which was originally built to target 50,000 people, is now covering 150,000 patients, due to the lack of basic health structures within the surrounding communities.

"As a result, consultations are often fast and superficial, and laboratory tests results may take up to four months to come out", said Martinez.

Before deciding to start the project in Marcilio Dias, MSF assessed several slum areas in Rio de Janeiro.

"The first analysis took into consideration criteria such as public services available to the population and access to the closest health facility", explained Susana de Deus, MSF Head of Mission in Brazil. Once this first screening was completed, MSF met local public authorities regarding government plans for the different areas evaluated.

Due to lack of community organization, geographic isolation and violent environment, Marcilio Dias was excluded from any government priority plan - although it was acknowledged as a community in great need of some kind of intervention.

MSF then carried out a survey in order to gather further information about the local population and identify health and social priorities so as to define a project plan. The survey showed that only 20% of the population is currently employed, leading to a very low family income in the area. Pregnancy among teenagers is also high in the community, as well as intra-familiar violence. Approximately 60% of the households have no water and sanitation structure, which represents a high risk of spreading diseases, especially when it rains.

The high percentage of teenagers (45%) and the lack of education, leisure alternatives and proper health care is also subject of major concern for MSF, as they are exposed to the influence of the drug lords and to the violent consequences of their activities. Regular police operations aimed at containing the action of drug dealers normally end up causing deaths of innocent people who get caught in the middle of cross-fire. Children grow up hearing the sound of bullets, and violence tends to become trivial to the population in MarcÃ?­lio Dias.

MSF project in Marcilio Dias provides primary health care and psychosocial support to the population. Besides medical consultations, MSF team offer vaccination and other preventive activities, such as health education sessions. The medical activities will help to identify the most urgent psychosocial needs, which will be addressed by the team as well.

"We will develop, for example, special activities targeting teenagers, who are permanently at risk due to the overwhelming presence of the drug dealers in the community", said Marta Martinez. "It is common to see young boys carrying guns. Serving the drug 'lords' is an appealing 'job' for them, since they can make more money out of it than their parents make out of their regular jobs."

Many of them are recruited by drug dealers when they are old enough to handle a gun - which can be as early as 13.

MSF first arrived in Rio de Janeiro in 1993, aiming at providing basic health and social care to populations living in contexts of social exclusion in urban and violent areas. Ever since, MSF work in the city has been focused on slums and, more recently, expanded to street populations as well, which represent another area of urban exclusion in Rio.

The main aim of its projects, however, is not only to provide assistance.

Working closely with these populations, which are often forgotten by the government, MSF tries to stimulate community organization and, simultaneously, attract government's attention and commitment to these communities.

"With our projects in Rio, we want to prove that working in such distressed areas is feasible and that it can be done by the government, who is the ultimate responsible for the health of its citizens", said Susana de Deus.