Update on the Clinic

Update on the Clinic

The new year is now 3 months old, and I am way behind in writing to you but this year began with a surprisingly, almost tragic, situation as I was faced with one of my greatest challenges, that of the struggle between an impersonal money-oriented program/society, and love and service to others, so I delayed until I could give you all more positive news. It is a long and complicated story which affects our health ministry, but I will try to give you the important details.

The new year is now 3 months old, and I am way behind in writing to you but this year began with a surprisingly, almost tragic, situation as I was faced with one of my greatest challenges, that of the struggle between an impersonal money-oriented program/society, and love and service to others, so I delayed until I could give you all more positive news. It is a long and complicated story which affects our health ministry, but I will try to give you the important details.

On the 25th of January, we received an e-mail stating that our NGO would have to fire all 42 of our employees within 30 days, that is, they would work with us only until the 28th of February for the Mayor of Rio had installed a new health system in the city, and all NGOs and private health programs would enter into this system run by Social Organizations which would be taking over. That is, in our case, our NGO was being discarded!

You can imagine the shock! Fire all these wonderful women, some of whom had worked with me from the beginning of our city contracts in 1999! We had just signed a new contract with the city in October and rejoiced in the victory of finally having our wonderful physical therapy program included!  And even though we had heard that this new health system was being implanted in other parts of the city, in all of the meetings our health workers had attended to explain the new system, our family health program in Canal do Anil was never included, for we were always classed as being different because of the fact that our NGO owned the buildings (that we work in) and 95% of the health equipment, plus the new contract included the physical therapy program, which is so unusual in basic Brasilian health care.

But finally, soon after that sad day when I received the news, and with tears in my eyes and in the eyes of the women, I had to give them their severance papers. And the battle began!

a)  To make sure all 42 women were employed by the Social Organization, CIAP.

b)  Find the legal ways to protect our buildings and equipment, that is, fight against this total take over by an organization from another State, Paraná, without making some demands.

And thus the problems began!

With members of our Board of Directors, I was able to schedule a meeting with the health secretary of Rio de Janeiro to attest to our rights to at least to have CIAP pay rent for the use of our buildings/equipment and have the same employees hired. The health secretary said we would have to have a meeting with his assistant who was in control of this new health system, Dr. Daniel. At this meeting, he suggested immediately, that we get in contact with the leaders of this Social Organization, CIAP, and discuss all this. This we did, our Board of Directors, 2 politicians from the local electoral system, president of the Assoc. of the dwellers of the shanty town, 3 members of our community, and 3 members of the local health supervision responsible for our area.

This meeting, as were the others following, was catastrophic! An example of money versus love and concern! Nothing solved! Then came Carnaval and nothing in Brasil functions during these days. We sent e-mails back and forth, and none were even answered. We went again to Dr. Daniel and explained that we would have to close up the first of March, for our NGO had no more money to pay for light, water, etc., and our employees were desperate without salary and a guarantee they would be hired again. Dr. Daniel said he would contact CIAP, and then I pleaded with him to let me at least keep the pharmacy open. He pointed out that the building could not be used for the family health program, nor could the women go there for they were no longer employees of our NGO.

He also pointed out that CIAP would probably refuse to pay rent as they had a specific amount to be spent on each health unit, and ours was different as we had more employees, for example, 2 nurses assistants for each health team, (others had only one), a separate pharmacy with me as volunteer (volunteers not allowed) and an administrative assistant, plus a physical therapy program, all extra!!! Of course, we realized that extra payment would mean less for the leaders of CIAP to receive as individual benefits.

A week passed, and the clinic had to be closed except for the pharmacy, and the people in the shanty town began to react as well as friends of mine in the health and political fields, priests and a pastor. Another meeting was called with Dr .Daniel, and he asked what we wanted so that the clinic could be opened again.(politically, the closing of one of the largest health units was not good!) We said:

1. hire all the women who were working there before,

2.  as the physical therapy was not included in the program,  pay our NGO enough rent so that we could support the program,

3. allow me, as president of the NGO, to continue to work in the pharmacy as well as supervise the care of our building and equipment, and coordinate our other projects such as the children’s program, that is, work in partnership with the coordinator, appointed by CIAP for administration.

We asked Dr. Daniel to write out all that was agreed upon at this meeting in a formal bulletin.

We came home victorious, but that victory was short lived. No formal letter followed, and the leaders of CIAP refused all contact with us and the area supervisor, Dr. Leonardo, and refused to pay any rent! We continued with closed doors except for the pharmacy! The only thing we accomplished was that all the women were hired by CIAP but were forbidden to enter our building, and the doctors and nurse were sent to a health center in the violent shanty town, the City of God. And the health educators were to visit their patients and explain what was happening.

As the 2nd week ended with the doors closed, help came from all angles, the police of the area encouraging us to make a public manifestation (protest) on the entrance to the highway near us with leaders of other communities near by and, of course, our shanty town dwellers.

Then someone called the local radio station, and reporters from various popular newspapers heard about the public manifestation planned and SO DID THE CITY MAYOR! This was not, of course, good news to a rising politician, and with the swine flu virus vaccine campaign beginning, so he called the local mayor of our area, and then on Monday of last week, the beginning of our 3rd week closed, the local mayor, 2 of his assistants, Dr. Leonardo, health supervisor of our area, and two of his assistants plus an official journalist arrived at the clinic.

There was no time for me to call any of our Board of Directors, so I called the president of the Assoc. of shanty town dwellers and a couple of leaders of the churches and community, and we sat down to bargain. As the mayor wanted at all costs to prevent a public protest manifestation which was scheduled for Friday, the 26th of March, he agreed to interfere and contact CIAP to force the acceptance of our demands, and we were to open again on Tuesday. A separate document was signed allowing us to open with a two month temporary contract leasing the buildings to CIAP until a final contract including our demands are agreed upon.

And that is what we are now doing. However, there was one issue which was not final, that is, the rent CIAP would pay so we could support the PT program, something they had refused from the moment of the take over of our clinic. We explained that our first request for rent was high because as we would no longer receive any money from the city, we would have no money for the maintenance of our buildings/equipment, not even for supplies, electricity, telephone, etc. Our NGO had no more money!  CIAP refused; our second appeal for rent had been for the salaries of our physical therapy program which CIAP would absolutely not include! This is still under negotiation, and until it is solved, we will have to pay these salaries from donations as more than 100 patients per week use our services, and in fact, we need a 3rd physical therapist for home visits.

Right at this very moment, the finance director of our NGO, Rosa, is meeting with the vice-president of our NGO, Marivani, and a lawyer, to draw up this contract including all our demands, our rights to the building and the administration of it for a two year period. The big question is the amount of rent they will agree to pay, so that we can support our physical therapy program. Rosa was told to calculate this, which she did, and then she was told to reduce it, and the sum she was allowed to give will not cover completely the 2 physical therapists we have now. Thank heavens for these great assistants, for Rosa is an excellent accountant, and Marivani, a theology professor and involved in shanty town political struggles for rights to their lands and homes.

I have had so much support from the area health supervisor, Dr. Leonardo, whom I have known for sometime, but he is new in this job, for all of these jobs are political nominations and are temporary depending on who is in power. We were lucky in that we had had the same mayor for 8 years so not a lot of change. The new Mayor is slowly destroying the institutional structure of so much in the city. As our NGO no longer employs any of our workers, we theoretically cannot hire whom we want to or promote anyone, as I have always done, if you remember. However, Dr. Leonardo, the area health supervisor, has assured me that he will work very hard to see that the promotions of the two women I have suggested will be honored, one who is now a health educator to a nurses assistant and one of our cleaning women to a health educator, both have acquired the requisites for these positions.  Also a new doctor and nurse (the others left in order to avoid working with CIAP) to work with us in can be chosen by me.

For all of you who knew of these happenings, thank you for your prayers and confidence, and we know if the rest of you knew, you would have added your prayers and encouragement. We have lost a lot but we have maintained our objective: to serve the people of the shanty town of Canal do Anil in your name for the love of Christ.

My daughter, Judy, recently sent me this quote which seems so appropriate:


Blessings of gratitude to all of you, our partners.

Barb and Gus

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.