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HEALTH-BRAZIL: Japanese Man’s Big Heart Makes Mark Deep in the Amazon

Mario Osava

RIO DE JANEIRO, Jul 4 2006 (IPS) - In a story that evokes comparisons to Ernesto “Che” Guevara’s famous voyage decades earlier, a one-year backpacking trip around the Americas forever changed the destiny of Japanese student Toru Sadamori. He returned home to finish his electronic engineering degree, but by then his dreams no longer included landing a good job at Sony or Panasonic.

The stark contrast between South America and the wealth of Japan and the United States, as well as the region’s many street children, moved Sadamori in much the same way Guevara was affected in the 1950s by his work attending to the sick at a leper colony in the Peruvian Amazon.

But where the Argentine later took up arms to fight for social and political change in Latin America, Sadamori chose a distinctly different path – peaceful social work in Sao Paulo’s “favelas” (slum neighbourhoods). His original plan was to work in the area for one year; 14 years later he is still in Brazil, and has spent the last three years living in Manicoré, a municipality deep in the Amazon region.

After 11 years of setting up day-care centres and mobile clinics and providing orphan and mother-infant care in Sao Paulo and Ceará, a state in Brazil’s impoverished northeast region, Sadamori was hired by the Japanese non-governmental organisation Health and Development Service (HANDS) to develop a health promotion plan for Manicoré.

By the time the two-and-a-half-year project ended in March, 150 community health agents had been trained to provide basic care for families, said Municipal Secretary of Health Elvis Roberto Matos in an IPS interview.

Covering issues such as hygiene, infant health and water treatment, courses were given in monthly two-day modules.

The courses had to be short, because of the challenges involved in bringing together in the city the widely dispersed community health agents. Two-thirds live in rural zones and depend on boats for transport, sometimes travelling “almost an entire day” for the sessions, explained Matos.

HANDS provided recources for training, which was developed jointly with the local municipal office and funded by the Japanese International Cooperation Agency (JICA).

Some 60 people were trained as community leaders of the Pastoral for Children, a Catholic organisation that oversees close to 250,000 volunteers throughout Brazil. Its work in areas of health and nutrition has helped to reduce infant mortality significantly.

The HANDS project was “very important,” Sister Luisa de Souza, local coordinator of the Pastoral, told IPS. In addition to the training, the cooperation between health agents and those who accompany the children “improves care, saving and maximising resources,” she said.

If someone from the municipality visits an isolated community, “we go along with them,” she added.

At 76, the nun has devoted 54 years to social work in Brazil’s northeast and Amazon regions, and intends to keep at it “for as long as I’m able.” She praised Sadamori’s work for its “humanity,” saying, “He does everything for the community, not for himself.”

Manicoré covers an area of 48,282 square kilometres – 15 percent larger than the Netherlands or the Japanese island of Kyushu. The official population is 38,000, but it could reach as high as 50,000 this year, due to agricultural expansion in the south of the municipality – a new soy frontier, said Matos. Small farm families make up more than half the population.

The region’s income is based largely on food crops such as fruit and manioc and, to a lesser extent, gold mining, natural rubber, chestnuts and wood.

Located on the banks of the Madeira River, the second largest in the Amazon basin, Manicoré is rich in water. Yet this very resource is the source of many illnesses that commonly strike children, such as diarrhoea and verminosis (parasites from the Metastrongylidae family), because the people drink from waterways contaminated with sewage and garbage.

The water-treatment aspect of the health agents’ training is essential, said Sadamori. For example, residents have resisted using chlorine treatment, complaining “it tastes bad,” and arguing that they have survived fine without it, he told IPS. However, mothers have slowly come around, and now recognise that the chlorine has reduced cases of diarrhoea.

HANDS conducted before-and-after surveys to evaluate the programme’s effectiveness. Prior to the implementation, only 12 percent of urban dwellers and 74.3 of rural dwellers believed that the agents played an important role in family health. The numbers following the project rose to 79 and 94.9 percent, respectively.

Respondents reporting that agents took their blood pressure rose from 10 percent to 75 percent in the city, and from 51.5 to 93.94 percent in rural areas.

The lower figures for urban dwellers are attributable to a difference in infrastructure. City residents tend to go to hospitals and health centres for care, and thus did not value the agents as highly – an attitude that is changing. Rural dwellers, in contrast, relied on the agents, both volunteer and government funded, for their “only source of care,” explained Sadamori.

Sadamori is promoting another project, pending HANDS approval, to further advance health care and positively affect other aspects of life. His plan is to install a radio communications network to address some of the accessibility challenges posed by the widely dispersed population.

The project would set up a central station in the city hospital and 30 transmission-receptors in rural communities. Doctors or nurses would be able to use the system to guide agents in cases that require more than basic knowledge, or make a decision to bring the patient to the city.

The project also would provide three motors for boat-ambulances, which would be deployed in three “strategic points” in the municipality to transport patients in need of urgent care.

Sadamori, who is married to a Manicoré woman and has a son, also plans introduce health topics in regular schooling, by providing special training to rural teachers.

>From there, he hopes to replicate the experience in other Amazon municipalities.