The Health Agent
People from the asphalt, from outside, think that everything that is bad comes from here in the favela. There are thieves, drug addicts, criminals, there is everything here. But people forget that inside the favela good citizens exist too, people who are honest and who are fighting for life.
Introduction: Andréia works as a community health agent, or “CHA,” at São Miguel Arcanjo Health Center, one of 139 such facilities that offer basic health services free of charge to needy communities throughout greater Belo Horizonte. São Miguel Arcanjo Health Center serves 9,000 impoverished individuals in Vila Fatima, a hillside neighborhood in the favela of Serra. Here, larger-than-average families crowd into tiny brick houses, or “barracos.” These households, sometimes merely one-room living spaces, from a distance seem to pile on top of one another and in some instances lack basic amenities such as water and electricity. The scene contrasts sharply with that of immediately neighboring Mangabeiras, an upper-class community where expansive, modern homes line the hillside. The CHA, who must be a member of the community served, in effect acts as a facilitator between the population and the health center, whose professionals often come from signiicantly different social and economic backgrounds. Andréia regularly makes house visits, builds trusting relationships, orientates, educates and provides health guidance to some 700 individuals in her assigned area. Living all of her life in the favela, she often can bridge communication and cultural gaps between patients and physicians, nurses and other health center attendants.
Belo Horizonte, Brazil, 2006
Andréia’s Mother
My mother is from Berilo. When she was a child, she lived in a boarding school (1). It is an institution where kids stay, studying, but the parents aren’t nearby. They left her there because they didn’t have the financial means to take care of her. My mother came to Belo Horizonte as a teenager. She was eighteen. She came alone. To live in the countryside, it’s more difficult to work and study, so people come to the big city to try their luck, really, to obtain something better. When my mother met my father, she already was four months pregnant by another boyfriend, but this boyfriend of hers didn’t stay with her. She was twenty years old, alone, unemployed, so she went to live with my father. They didn’t marry. Later, with my father, five more appeared: all girls. We are six. My older brother would be 32, but he already passed away. He was killed five years ago. I am 30, I have a sister who is 27… it’s a little staircase: 22, 24, 26, 27, and 30.
The Favela of Serra
View from Favela Serra
This here is a favela, the favela of Serra. It’s a favela made up of six communities. Look, I work here in Vila Fatima but I live in Vila Cafezal. The other vilas? It is Vila Conceição, Vila Marcola, Aparecida and Novo São Lucas (2). I came here when I was five years old. Before, I lived in another neighborhood, Nova Esperança, some forty minutes from here by bus. When we came to live here, my mother already had four children. Just two more were born here. When we started to live here, we lived some four years paying rent. It’s a difficult situation. During this time my father left home, went away, so my mother remained alone with her kids, paying rent. After a certain time, we went to live at my grandmother’s house, which today is ours.
Difficulties after Father Leaves
When my youngest sister was four months old, my father left. My parents’ relationship wasn’t working out anymore. I think the situation was getting bad between the two of them. They no longer had that affinity, affection. My mother did not have a fixed job, she worked as a “diarista” two days per week, understand (3)? It provided less than a minimum salary. In reality, we survived with help. We had many institutions that helped, neighbors helped us. We lived like this. It was very difficult, very complicated. My father always was an electrician, but we didn’t get anything from him. He started to live in another neighborhood, so we had very little contact with him.
I was closer to my father, had a greater connection with my dad, so it was tough. I was seven years old when he left. Later, I tried to go to his house. He also came, but it was more we would go to his house than he would seek us out. At a certain point we really resolved not to call on him any more since he wasn’t contacting us. As children, maybe we felt a greater need to have our parents, right? But as we grew up and matured, we saw the reality of things, we saw how much we suffered… we were not going to continue constantly behind someone who didn’t contact us. My father has passed away now. It’s two years since he died. In reality, like, I won’t say that I didn’t feel the death of my father, no. I felt it. But it wasn’t that feeling, no. If I am not mistaken, my father had hypertension. He was an alcoholic. So then, it was a heart attack that took him… because he was an alcoholic, had hypertension, smoked.
Some situations are a little sad. I lived five years in Fatima and some twenty years in Cafezal… I remember when we were very little. I was seven years old, my brother was eight, we lived here in Vila Fatima and there wasn’t any water from Copasa (4). So we stayed outside the entire day fetching water, filling drums of water, and through this effort we managed to get food. We sold the water to other neighbors so that we could buy some bread, buy food for home. We helped with our own sustenance. I think that all of this made us grow up real fast because we saw my mother’s suffering. I had a four month old sister, little. I had another: two years old. So then, like, everyone was small. We saw what was happening and grew up fast. I started to work, we worked selling water, understand? But by the time I turned twelve, I already started working for real in the house of a family as a nanny. It was a difficult phase because I was studying. I stopped my studies because we had to choose. I saw my family’s needs. I preferred to stop studying and work to try to help. I stopped studying in sixth grade, but I returned later. I didn’t give up, no.
Young boys at play in Serra
It was like this: I think I had a lost childhood. I played, but I don’t think I had much freedom to play. I didn’t have toys, those children things, that children should have. The only thing that I remember is that I wanted to have a bicycle, which I never had. You know, it was only that. I remember that I wasn’t the type to dream of material assets, no. But I remember that I was crazy to have a bicycle. Crazy! I had to start working at an early age. I want to say, I had to take on responsibilities. I grew up more quickly. Even with all of the difficulties, I don’t complain about my childhood, no. Today I can look back and say, “It was worth it.”
Think if I used my childhood suffering as an excuse and said, “I am going to find another way for me to survive.” I might have looked for easier ways to survive. I could have entered into the world of crime, drugs. Would this have been worth it? Who would I be today if I had become revolted by life and had practiced other acts? Today I might not even be alive. It could have been… I don’t know, a totally troubled life. These life experiences are worth it. Suffering strengthens us, as long as a person has a good conscience, an open mind and really knows what she wants. I said, “No, I am going to find something better.” We also have to try to create a different life. You can’t think that suffering is an excuse to deviate from your path, no.
Work as a Baby-sitter and Maid
I worked in another neighborhood in a family’s home. It was in the neighborhood of Lourdes (5). I stayed there one year. It was one minimum salary. I brought everything home, gave it to my mother to help with the family budget. For me, myself, nothing was leftover. I brought it all home. It gives you a certain feeling of revolt, right? Because imagine… I was twelve years old, a child, looking after other children. I thought to myself, like, maybe they were exploiting me. I thought, like, if these people had consciences, maybe they would have tried to help me in another way, not putting me to work. So it’s such that I saw the size of inequality first hand. I thought, heck, I should be studying, I should be playing. I felt revolted because they were children my age who didn’t have to worry about work. They had everything: it was school, country club, everything that was good. And me working. My mother thought I shouldn’t be working and asked me to stop. So I stopped and returned to school. But two years later I found another job, once again in a family’s home. In this home it was good, but I felt a lot of discrimination there. The woman was a person who paid everything correctly and on time, but she was a person who distrusted us a lot. I don’t know, I think she distrusted us too much. She didn’t leave out anything of value, money, things like this. So I said, “I don’t need a situation like this, no.” I left that job.
Work at a Butcher’s Shop
Then I went to work at a cash register at a butcher’s shop, where they sell meat. I liked it a lot. I worked there five years straight. I got a lot of experience with that job. I didn’t have any experience as a cashier, but they gave me an opportunity, they believed in me. You enter a job in which you don’t have experience and meet people that give you an opportunity… I really found support there. Until today I am friends with the staff, I am still friends with everyone. It was very good to work at the cash register, but it was very tiring. I worked from seven thirty in the morning until eight at night. I only had one day off per week. So I stopped studying again.
Honest Citizens
I think our country is very unequal in terms of salary. And also there is the issue of racial prejudice. It’s a lot of stuff. People from the asphalt, from outside, think that everything that is bad comes from here in the favela (6). There are thieves, drug addicts, criminals, there is everything here. But people, like, forget that inside the vila good citizens exist too, people who are honest and who are fighting for life. But they forget about this. They see it is a favela, so end of story: there is nothing good here. One time I was trying to find a job and when I mentioned the neighborhood where I lived, the person immediately passed me up. There was an available space, but when I said that I lived in Cafezal, end of story.
Community Health Agent (CHA)
When I left the butcher’s shop, I was unemployed. I already was tired and I wanted to have some time to study. So I had to leave because I didn’t have any time. Then, through a community association, I was called on to consult a local health commission. When I started to go to the health center and participate in those meetings, a competitive exam was launched for some new jobs at the community health center. So, I had an interview, filled out the application for agent, took a test and was selected. I was twenty five years old. Now it’s going to be six years as a Community Health Agent.
São Miguel Arcanjo Health Center
This is São Miguel Arcanjo Health Center. Our region is Vila Fatima. It starts at our health center and goes until a street called Nossa Senhora de Fatima, there at the very beginning. I think we have around seven to nine thousand people served by this health center. This we see by way of records. I know well that many people here come and go. Also, many houses already have been demolished. But in our region we have as many as nine thousand people. This center here will be two years old. Before there was just one health center, Cafezal Health Center, which attended both Vila Fatima and Vila Cafezal. I started working at Cafezal.
Eyes on the Community
Here we have three family health teams. Each team attends a certain number of people. I work on the Red team. Our team has two nursing assistants, a nurse, a doctor and four agents. Agents are divided by micro-areas. My region is micro-area 15. Look, I have around 170 families. So then, it’s around 700 people. The health agent is a very important link between the community and the health center. I think of my job as a facilitator because, working in the field, we end up truly knowing each family. We go from house to house. So, you really know the people. We make a better approach. In the past, people didn’t come to the center because they thought they would be poorly received. So, like, after they created the CHA, we started to converse with people, discover many cases and managed to bring many families here. So then, the CHA really is a facilitator.
The day-to-day is this: we deliver exams… we have to monitor children to know if their vaccinations are up-to-date, to know if their mothers are breast feeding, if preventative exams are up-to-date, if diabetics and people with high blood pressure are taking their medication. We always have to be there. To be there giving orientation too, right? We have this obligation to keep visiting the families, orientating them. The CHA goes into every house, so the CHA knows the problems of all the families. We always are seeing where there is greater necessity for a doctor, a nurse, someone to assist. In my area, there are needy people who have more challenging situations. Our lives are identical to theirs. They are things that maybe I already passed. In reality, who truly knows the community is us. Understand? The doctor learns about some case if the agent goes there and brings it to him. He then goes to the house to visit, but the doctor only will visit that family that really has a greater need: the bedridden, the deficient… On domestic visits, the CHA accompanies the nurse or doctor, but as an agent I can’t do their work.
Challenges in the Community
There are people who you give medication to and they don’t know how to read. Here we use little pill boxes. So what do we do? If the medication is to be taken in the morning, we design a little sun that indicates it is for the morning. If it is at lunch time, we design a little plate. So the pill boxes have to be marked up. You have to do this with some people, you have to mark their medication, otherwise they will take it all wrong.
In my own area, I was touched by a family of a fourteen year old adolescent. Her father an alcoholic, her mother an alcoholic, a little one-and-a-half year old brother and she, at the age of fourteen, pregnant, you know? Here in the vila there are many alcoholics. For me they don’t have any expectations at all. For me, a child, a fourteen year old adolescent, who doesn’t study, doesn’t work, witnessing the situation of her parents and pregnant… so then, what kind of expectations does she have for life? It’s complicated. Here in the vila we see many teenagers around this age pregnant. Many of these girls start to date a boy of the same age, a teenager also. What I mean to say, neither of the two can handle that responsibility so it ends up their parents must assume it.
I really like all of my community, but there was one who was difficult. At the beginning, when I met this family, she had loads of children and not one was registered and it was that struggle: I would schedule a consultation to bring in the kids and she wouldn’t bring them. But I didn’t give up on her. I insisted, I would go to her house every day, I called her… until one day she said, “Today I will register.” So, she registered the kids, scheduled a consultation, she came to the health center and now when she passes, “Look, I’ll go there to the center.” There are many kids at this health center. Many kids come. There are kids with bronchitis, throat infections, viruses, various things…
Health Center Services
São Miguel Arcanjo Health Center
Here inside there is a general medical clinic, gynecology, psychology, psychiatry, a dentist area, a vaccination area, an area for reading vital signs, bandaging area… for example, if it is a cut that needs stitches, here we just give first aid and then send them to a hospital. People who come to get bandaged here are those who, like, have a leg wound that doesn’t heal anymore, so they have to get it bandaged every day. Or a small cut that needs some care, right?
We have medicine for high blood pressure, for diabetes, we have medicine for pain, anticonvulsive drugs… we have these medicines. They are free. But they typically are short in supply. Medicine is always short, primarily for diabetes and high blood pressure. It’s a difficult situation because, for example, the medication for high blood pressure is something that needs to be taken every day.
Objective of Health Center
Before the community had this center, people had to travel far to find another center or had to look for a hospital. So, in reality, this center fell from the heavens. I think that this center has improved a lot the lives of this population. The health center is here to facilitate the situation a little because it is not urgent care, nor an emergency service. For example, if someone arrives needing more rigorous treatment, the health center doesn’t have the resources. So then, the health center will only give first aid. For a more specific treatment, if a person needs an orthopedist, or some other specialist, he will be sent to another locale.
Hours and Salary
In reality, I don’t work fixed hours. Some days I arrive at 7:30, some days I arrive at eight, nine, ten… in reality, we work a total of eight hours. So if I arrive at eight I would have to work until five. Our salary is R$340 before deductions (7). After deductions—the allowance for INPS that we have to pay—it falls to R$314 per month (8). My money? It goes to pay bills at home. I am a person who really… I feel an obligation to help at home. My mother is not working. She already is 52 years old. In reality, who works is just me and my sister. So then, I buy the things I need, but I don’t forget my obligations at home. If you were to look at it in terms of salary, I wouldn’t be here, no. But I get a return, which is gratification. I work for this side of it really, for humanity: you are helping the next person so then this is very gratifying, understand? You bring a friendly word to someone… arrive at the home of somebody who is there with their head down and you start to chat and the person starts to feel better. This is really gratifying!
Lack of Investment in Infrastructure but a Success
In reality, I think we are short professionals, doctors and infrastructure because it’s not enough to have a doctor without adequate resources. It’s not good, much less so for the patient. At the health center, there are days that it is empty, but because it is in a favela, which has many people, there are days that it is really crowded. My service is in the morning. I arrive here some days and there are forty people waiting. People have to wait. They have to come to the health center with patience, otherwise it doesn’t work. There exists that patient, for example, who arrives at the center and if he doesn’t get medication or if he doesn’t meet a doctor to attend him, he becomes offensive. He’s angry because he arrives sick, needs medicine. I think a person should be more polite because I think like this: the situation already is bad, there isn’t a doctor available, so the people here should unite to fight for improvements. Insulting a doctor or an employee of the center you are not going to improve things. Here we haven’t experienced physical aggression, thank God. Verbal aggression we always see, but physical no. The center is a success. It’s lacking in infrastructure, in the area of employees, but the health center really is a success because it is closer to the community, it is part of the community.
Assassination of Brother
My brother was murdered in January 2001. My brother was very outgoing, he was very happy. He was a calm person. Why was he assassinated? I don’t know, until today we don’t know, but he was murdered in a really brutal way. He died from nine gunshot wounds. It was right here, next to here. He had arrived from work, sat down at a bar and was conversing with some people when others arrived and started shooting. It was a very strange situation. My brother was married… with two kids. So then, like, until today we think maybe his woman had kept something secret because, after, she disappeared and left the kids with her mother. So then, like, it is a complicated story. But in truth, based on the facts, until today we don’t know. My brother was a drug user. He always was. We think it might have happened for this reason because he used drugs for real. Before, my brother lived a life like this: he lived using drugs and didn’t work. But then, after marriage, after some two years of marriage he stopped for a while and found a fixed job. He was a doorman. He stopped using. Later, it seems he became kind of distressed, started to drink, even while working. So I think that he returned to drugs again. To enter into the world of drugs is very complicated.
I remember as if it was today. It was very sad. I was at home and someone called me and I went there to see. My brother was lying on the ground, lying face down, completely full of blood. It was horrible! I saw my brother fallen on the ground, dead… when I arrived there, more than one hour had passed since he had been killed, but he still remained there. His daughter today is nine years old and his little boy will turn five. We, as sisters, we feel it… but for parents, for a mother, like, it is very difficult. My mother until today has not recovered. She hasn’t accepted the death of my brother. It is very difficult, even more so when a person dies murdered like this. We think of the brutality, so we are not able to accept it. My mother has a very strong personality. She is a very quiet person. My mother is a person, like… I think that they are consequences, they are things of life, you know? All of the difficulties that she has passed, so then I think that it has left her kind of bitter. My mother is a very closed person. She once had been a more spontaneous person, but after my brother was killed came a lot of suffering.
Drug Dealers in the Favela
A mural in Belo Horizonte
Here in Cafezal it is just one leader really (9). There are other small ones, but in reality it is just one. When there were many, it created that confusion, that confrontation among them and it became a war. Now, with just one person it is different. With one, since he already is commanding everything, I would say between quotes, “Now it is more organized.” It’s difficult to talk like this, but you have to say it. I am not going to say I am not afraid of violence. I am afraid of violence, but I try to not involve myself with them. They are there and I am here. I think it has to be like this. They do their work there and I mind my own business. Now, for example, Cafezal is calmer. We don’t hear about so much violence anymore. A dispute over a drug selling point generates some violence… one wants that selling point, another wants the same selling point, this generates a dispute between them. I think like this: the bandits in the vila, if they see someone rising with more business, they also want it. So this generates conflict among them.
There’s a law, this law, they call it the “Lei do Morro” (10). If someone steals, for example, from another resident of the vila, you can’t call the police. You have to call them and let them resolve the situation (11). Why? Because they don’t want the police inside the favela. I am not even against them, no, because with them many things improve. Before you had more people stealing from one another. These days you don’t see it because people know if they steal there is a punishment. It’s not to give a vote of confidence for crime, it’s not to help them, no, but maybe talking to bandit from the favela is one thousand times better than calling the police. Because the police—it’s not all of the police—but the approach of the police inside the favela is complicated, many times the police are very arbitrary. The police arrive in a very authoritative way, thinking they are better than everyone. Really, I think the police are very random. They should have a better mannered approach inside the vila and not arrive spreading everyone out against the wall. It ends up people become revolted and instead of improving the situation it gets worse.
Inequality
I believed that, with this new politician who entered, it would get better (12). But he has disappointed us, right? I hope Brazil improves a little. But the way it is, I am not an optimist. Inequality exists and it’s not going to go away. Why? Inequality doesn’t just come from the asphalt, no, it comes from inside the community too. I believe that it also comes from within the community because some people discriminate against themselves. For example, a person thinks that because she lives in a favela she’s worse than others. Understand? There are people in the favela who feel inferior. I, for example, I am black. There is a party to go to with only white people, fancy hair, and I am going to feel inferior in front of them? No, on the contrary. I am just like all of them, I am a human being too. Only there are people in the favela who think differently. They think: I live in the favela, so I am inferior… I am poor, I am a slum dweller, I am ugly. So then, our own people discriminate against themselves.
A Community of Fighters
On the other hand, I see our community like this: they are people who even though they are needy, they have a very good life, they are fighters, they are always investing in something. I know many people here in the vila who have experience as artisans and culinary experience, for example. So then, they value themselves. They don’t think they are inferior because they live in the favela. They themselves are fighting to better themselves. To live in a favela, this isn’t going to be a barrier anymore.
Lunch break in Vila Fatima.
I see people I really admire. They really have difficulties, but they also have immense expectations for life. For example, there is a family in my area that I really admire. There are many children. She has seven kids and she takes care of them alone. They are without a father, right? She was married, but she lost her husband, he passed away. I admire her, because with all of her difficulties, she works and each and everyone of her children are in high school. The children continue studying while she works, I think this is beautiful.
I thank God very much because my mother, despite all of the difficulties she passed, she didn’t give up. She worked. So then, we saw this. Sometimes we arrive at a home where the mother and father are unemployed, they don’t have anything to eat… and so what? Are you going to cross your arms, are you going to remain idle? I also already passed this situation: to not have anything to eat at home. But I ran after something, I knocked on the neighbor’s door… we can’t let suffering and poverty be impediments in our lives.
Andréia’s Dreams
I want to have children, I want to have a family, but I want to study first. My dream is to have my own home and I really want to study. In reality I wanted—no, I want to study psychology. I also want my own home, I plan to have kids, to get married, all of this I want. But, I want to be a psychologist. I have this in my head. I am going to fight for this and I am going to achieve it. I feel like I have to work in this area: psychology, or work in the area of social sciences. I am not going to give up, no way! Education, I don’t know, for me is a victory. Through studying you are going to acquire experiences. These days, people have to have this conscience that you need to study; you have to really go after it. I believe that when you want something, you have to fight for it. Barriers exist, yes, obstacles exist, but you have to fight, you have to believe in yourself and that you are going to make it. I think things become more difficult when people give up. So then, believe in your dreams, fight for them and you will achieve them.
« end »
Please feel free to comment on Andréia’s story.
Footnotes:
(1) “Colegio interno,” or boarding school.
(2) Andréia uses the word “vila” to refer to a favela, or a neighborhood community within a favela.
(3) In Brazil, a “diarista” refers to a person who works on a per day basis.
(4) Copasa is the local water company in Belo Horizonte.
(5) Lourdes is one of Belo Horizonte’s wealthiest neighborhoods.
(6) Andréia’s phrase, “people from the asphalt,” refers to people from outside the favela.
(7) Roughly $1,740 per year based on exchange rates at the time.
(8) INPS, Instituto Nacional de Previdência Social; a retirement deduction similar to social security in the United States.
(9) Commanding drug lord.
(10) Law of the Hillside. Also encompasses “Lei de Silêncio,” or Law of Silence, in which silence sometimes is maintained by witnesses after a homicide, or other crime, has been committed in the favela.
(11) Drug traffickers.
(12) In reference to President Lula.