A Doctor’s House Call in Rio

by

Rio de Janeiro

My first visit to a favela, one of the most famous urban slums in Latin America, was unexpected. As a result of poverty, huge waves of migrants move to the countries’ main cities and end up living in these ramshackle settlements, which lack basic health and sanitation services. The so-called favelas in Brazil are known as ranchitos in Venezuela, pueblos jóvenes in Peru or villas miseria in Argentina.

At a meeting in New York I got to know a young Brazilian physician—Dr. Paulo as everybody knows him—and we became friends. He told me repeatedly that if I ever was in Rio de Janeiro I should visit him. He said that he would take me to the best places in Rio de Janeiro where he lives and has an active practice that puts him in touch with all segments of Brazilian society.

Soon after our meeting in New York I went to Rio de Janeiro for a medical meeting and called him up. He came promptly to my hotel and we had long chat. He asked me, since the weekend was coming, what I wanted to see in Rio, as the city is normally called. I told him I wanted to visit a favela. He looked at me quizzically and said, “I want to take you to the best places in Rio and you ask me to take you to a favela? I don’t understand you.”

I explained to him that in New York I already have access to very fancy places but, although I have visited slums in Argentina and in other Latin American countries, I had never been to a favela. “OK,” he said, obviously disappointed, “if that is what you want to do…One of my patients lives in Rocinha, Rio’s largest favela, so I’ll come for you tomorrow morning and we can go there.”

Unlike ghettos in the United States the population in the favelas is racially mixed, although blacks make up the majority of the population. Increasing poverty drives many people to live in the favelas, which are built on several levels on hillsides, crowded with poor-quality housing and besieged by the drug trade. Paradoxically, people living in those hillsides have a much better view of Rio de Janeiro than those living in the most expensive areas of the city.

Because the favelas built on hillsides are very close to rich neighborhoods below them, there is active drug traffic from the favelas to the wealthy neighborhoods. The police are normally unable to enter the favelas and, when they do it, they go in powerful armored vehicles called caveirôes (literally, big skulls).

There are some social codes in the favelas which prohibit those living there to engage in criminal activities inside their own favela. However, favelas house many people involved in drug trade and other crimes, which make a visit there relatively unsafe. Frequent shoot-outs between traffickers and the police, and other illegal activities, lead to murder rates higher than in the rest of the city.

Perhaps my friend was thinking about all these issues when I asked him to visit a favela. He was a good sport, however, and took me there. As soon as we reached the lower level we saw a small group of men talking on the side of the steps. My friend went directly to them and said, “I am Dr. Paulo, this is my friend Cesar and we are visiting one of my patients called Mercedes who lives in the upper level.”

Without waiting for a response we continued climbing the steps to the following level where we also found a similar group of men. My friend repeated what he had said before and we continued climbing, at each level following the same script.

I was surprised and a bit irritated by his behavior so I told him, “Why do you have to tell everybody who we are and why we came here?” My friend looked at me and said, “Because if I don’t we won’t reach the upper level alive. These men constitute the most efficient communication system you can imagine so we have to clear our presence here at every level to remain safe.”

Finally, after a steep climb we reached the upper level and knocked at the door of my friend’s patient. Mercedes, a woman of around 80 came out and was totally taken aback when she saw us. “Dr. Paulo,” she said, “what a surprise seeing you here!” and as she opened her arms she came closer to him. Then, in an almost conspiratorial manner she asked my friend, “Dr. Paulo, I want to be first one to know it, are you running for office?”

Dr. Cesar Chelala is an international public health consultant and a co-winner of an Overseas Press Club of America award. 

Dr. Cesar Chelala is an international public health consultant.

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