Keeping the Faith

I had planned to wait until our long awaited physical therapy contract, announced in the official city newspapers in November, was signed so we could all breathe a sigh of relief and victory. But I write this letter with so much disappointment and frustration. Rosa, our treasurer, and I went to a meeting in the office of the City Health Department to ask why it was taking so long to sign this contract. We were told that the contract would NOT be signed, that the city was revoking the announcement of this contract.

I had planned to wait until our long awaited physical therapy contract, announced in the official city newspapers in November, was signed so we could all breathe a sigh of relief and victory. But I write this letter with so much disappointment and frustration.  Rosa, our treasurer, and I went to a meeting in the office of the City Health Department to ask why it was taking so long to sign this contract.  We were told that the contract would NOT be signed, that the city was revoking the announcement of this contract.

We just stood there speechless for our reaction was that this was not possible, that this was not happening. After recovering, we began to ask questions. First, I need to add that the person talking to us, Sr. José Carlos, a lawyer in charge of city contracts, has handled the finances of our Association’s contracts for the city family health program for 10 years. He knows of our work as well as our excellence and honesty (rare in NGOs here) and has great respect for us. His face showed the same disappointment as ours for he had written this physical therapy contract with us and had been pushing it for many years. He had been almost as excited as we were when the project was approved in November. He explained that in December a law was passed that physical therapy programs can only hire city employees and also, PT programs must be held in city owned clinics or public health centers. This rules out being hired by NGOs and in buildings owned by the NGO such as ours.

Rosa and I returned and didn’t sleep much for the next few nights. How do we tell the three dedicated women therapists of our excellent, well equipped physical therapy program, as well as the two hundred plus persons of our shanty town and surrounding areas treated per month, that we might have to close our doors?  Physical therapy treatment, as I have explained in other newsletters, is not considered a part of the city’s basic health program thus there are NO programs in our area.  It is a treatment for persons who can afford to pay for private health plans. Gus and I have a health plan and over the last months after shoulder surgery, Gus has been using our PT treatment for it is much better than the clinic our health plan covers. I, too, have been using our physical therapy team, for in January I injured my sciatic nerve and for a time could hardly walk without extreme pain. Our health plan sent me to a PT clinic for the well to do, and the service, as well as the employees, was indifferent and inefficient with no evaluation. I was told that, at my age, I probably had so much osteoporosis that I would probably never return to my old self!!! You don’t tell that to Barb de Souza!!!! I began doing physical therapy in our clinic and within two weeks there was improvement.

This morning, March 22, Rosa and I with two other members of the Association’s Board of Directors had an emergency meeting and came to the conclusion that we must try to maintain the program somehow. Laws here change overnight as well as a possibility of finding a loophole or exception in this new law. This, however, will not happen this year. In February of 2009 our family health clinic program contract with the city must be renewed and with José Carlos’ help, we hope to find a way to incorporate at least some of the salary for our PT employees. We will not buy any other equipment and will try to find volunteers to maintain the equipment including our air conditioners so necessary in this climate.

We just recently received a letter from Sheila Hussing of the Mizpah United Church, Hopkins, MN. In it was enclosed notes from some of the members of the congregation and two of them were so pertinent that I would like to quote them. (no names were enclosed)  “Keep fighting city hall.”  And “Even though hope may seem small, keep up the effort for the cause. Never give up on what you believe in………I pray for your safety and that you will win out in the end.” Whoever wrote these gave us all an impetus for our future struggle.

In addition to the physical therapy program crisis, we are in the midst of the worst dengue fever epidemic in Rio’s history. This fever is caused by a particular mosquito and can be fatal if it causes the hemorrhaging type. It is also far more dangerous for the aged and children. Some forty six have died in Rio, among the thousands infected, and twenty five were children, one just a few months old.  We have lost four of our patients, three were children.

This mosquito breeds in clean, standing water and propagates best in rain and heat, a combination common at this time of year in Rio.  Shantytowns are a very dangerous area because of lack of adequate garbage collection containers, water tanks on the roofs of the homes with no lids or lids with holes in them, rain puddles and lack of sewers and roads. Our shantytown is no exception.

Whom to blame? It is a combination of lack of infrastructure by the city, lack of adequate attention to the poor areas as well as the culture of the people. They wait for those in power to solve their problems, or believe that God will save those who deserve to be saved, etc., and lack community spirit.  Only in crises, as when the threat of removal of some 542 homes due to the Pan American Olympics occurred, does the community really come together. And they were victorious, at least for the present. These, of course, are my observations after forty years of adapting to this country of which I have become so much a part.

We are all overworked in the clinic, frustrated, sad and stressed with the situation. Several of our health agents have come down with the fever that debilitates the patient for some time. Thus we have had a shortage of workers. Our doctors and nurses are unable to do their normal consultations and home visits for they are over taxed with dengue patients. We are doing intravenous hydration on our physical therapy beds and in consultation rooms because the hospitals cannot take all of the patients. The lines for hospital care are so long some people have fainted waiting for attention.  It was announced in the newspaper today, that the Federal Government has been called in and a military group will put up tents for emergency centers for dengue patients and only when the platelets are below 50 will patients be sent to regular hospitals. We are doing twenty to thirty blood tests per day which is a high percentage for our health center.  Please continue to keep the people of the shantytowns in your prayers.

God bless you all,
Barb and Gus de Souza

Barb de Souza is a volunteer with the Institute of Religious Studies (ISER).  She serves as an advisor for popular education and training in the areas of health and sexuality.