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MSF in Brazil, 2009
Field Staff: 51
Reason for Intervention:
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Approximately 170,000 people live in Complexo do Alemão, which is a conglomerate of 11 poor communities in Rio de Janeiro, Brazil. Like hundreds of other slums in Rio, it is controlled by heavily armed groups that traffic drugs in the area. Violent clashes can erupt at any time, anywhere, as a result of police incursions or fighting between rival groups. Besides physical wounds, the effects of the violence also leave psychological scars. MSF offered emergency medical care and psychological support to the residents for two years until the end of 2009, when a local organization took over the activities.
After a series of violent clashes between police forces and armed groups in 2007, during which residents caught in the cross-fire had no access to emergency medical care, MSF started a project in Complexo do Alemão. Even in peaceful times, ambulances do not enter slums such as these, leaving residents with little or no life-saving assistance. The MSF project aimed to provide much needed help right inside the community, where no other medical service was available, even at times when violence was at its peak. To enable rescues and referrals, MSF converted a van into a basic ambulance narrow enough to go through the alleyways and roadblocks. In two years, MSF provided 19,000 medical consultations and undertook 650 emergency rescues using the customized ambulance.
Having established a presence inside the community, MSF teams recognized a much less visible facet of the violence: the psychological scars it leaves on both adults and children. Although mental health services were part of the project from the start, they have become a crucial component of the assistance provided. Through individual consultations, a team of psychologists helped residents cope, and many for the first time in their lives took the opportunity to express their suffering in a professional and confidential environment.
Between 2007 and 2009, MSF gave more than 3,000 psychological consultations to 1,300 patients in the area. Psychosomatic complaints, depression and anxiety are the most common symptoms found in adults, whereas in children aggressiveness, behavioral problems and learning difficulties are common. Half the patients seen by MSF’s psychologists had a story of violence to tell. More than one third had been in a situation of conflict and, in one in five patients, a family member had been killed.
After two years of activities, MSF ended its presence in Complexo do Alemão at the end of 2009. The decrease in violent clashes in the community and the creation of new health services nearby that are available for all residents meant MSF’s emergency role was no longer needed. By the end of 2009, negotiations were in place with a local organization willing to take over the services established by MSF, ensuring continued medical and psychological care for the residents of Complexo do Alemão.
A patient at the MSF clinic
‘My brother was killed in the community when he was 16 years old and ever since I have suffered from depression. There were times when I didn’t want to leave the house, I didn’t want to talk to anybody, I was completely isolated. Twice, I wanted to kill myself. Then I lost my daughter in an accident. I just wanted to die. It was during one of these crises that I found out there were psychologists here at the clinic and I was able to I find the support I needed to carry on living.’
MSF has worked in Brazil since 1991.