Send in the clowns

When the circus comes to town in the Amazon, it's not only fun and games. The juggler might be a doctor, the clown a nutritionist, and the tightrope walker a community development expert. Here's some rural assistance that's too small and sensible for the World Bank, too remote from Brazil's political and economic turmoil perhaps even to survive, but too good a model to lose.

Charles L. Johnson

When most folks think about poverty in the Third World, the prevalent image is one of urban crowding in favelas or colônias. These are words for the shantytowns that "symbolize what is wrong" with the countries where they exist.

Outside of its major cities, the Brazilian Amazon is not known for favelas, although the poverty is nonetheless real. Isolated communities appear as islands of misery in the midst of splendor. These are places that suffer from a lack of resources, detached from the amenities that "civilized people" enjoy.

Water, Water, Everywhere. . .

But not a drop that is potable without treatment. Though many species of Amazon wildlife depend on the flood cycle for their survival, it can be hazardous to humans. Rainyseason flooding means less land for farming, fewer pastures for livestock, more difficulty in catching fish and pollution from human waste that mixes with the drinking water. The result is disease caused by poor sanitation and undernutrition.

This describes the situation faced by Dr. Eugênio Scannavino when he arrived in Santarém, a city in the heart of the Amazon, near where the Tapajós and Arapiuns Rivers meet the Amazon River. It was early in the 1980s, and Dr. Eugênio had just finished a stint in the favelas of São Paulo. He could see that there was little medical care outside of Santarém, and an even shorter supply of technological skills for utilizing the area's available resources. It wasn't long before he developed a plan to deal with these problems — the Health and Happiness Project (Projeto Saúde e Alegria).

Founded in 1984, the project soon came to a halt due to a lack of funds. It got off the ground again in 1988, and since then has become a popular and effective means of improving the quality of life of people living in virtual isolation: there are no roads connecting the 19 communities and 94 settlements which the project covers, other than the rivers. It reaches more than 20,000 people.

The 32member staff is divided into seven sections: Health, Education, Art, Communication, Rural Production Development, the Information and Research Center, and Administration.

If any undertaking is to be successful, it first has to get the attention of its target, which is every member of the community. What better way than to stage a show, an idea that led to the creation of the Great Mocorongo Health and Happiness Circus. (Mocorongo is the local name for people living in this area.)

Send in the Clowns

The circus is a lot more than a bunch of clowns and jugglers and tightrope walkers. Behind the masks and greasepaint hide doctors, nutritionists, veterinarians, agronomists, educators, and other communitydevelopment experts.

When the circus rolls into town — make that "sails into town" — it is first of all a call to work. The Health and Happiness team uses the spectacle as a means of generating excitement in order to promote its three main communityoriented objectives: health, rural development, and maintaining the local culture. The show is a drawing attraction that helps teach people about health care, how to boost production, and how to improve other activities such as gardening, smallanimal raising, handicrafts, rubber tapping, teacher training and tree raising. The key is environmental education.

The H&H staff quickly focused on two emergency needs: health care (there were few medicines, almost no clinics, and a slew of misconceptions about good health practices) and improving the output and variety of foods available (especially during the flood season, when fish become scarce and most people subsist on a mixture of manioc flour and water known as chibá).

The first programs to be carried out reflect these priorities: "Contamination and Illness Cycles," "Life and Environment Cycles," "Community Health" and "Human Ecology."

Is Health What You Haven't Got?

As the project was getting underway, community members were asked about their conception of health. They tended to define it as "getting sick and then getting well." Since there were essentially no clinics or medical personnel, prevention was mostly an unknown process. A clinic, for most people, was a place where you went only when you were severely sick or hurt. The low economic level precluded any sort of investment in this area. And when one lacks the means and the knowhow to stay healthy, the result is, not surprisingly, a fatalistic attitude toward death and illness, poignantly reflected in the high infant mortality rate.

Once the emergency situation was under control, the time came to go beyond merely treating injuries and illness and providing medicines. The next phase involved training what are called "health monitors" in each community. These people learn medical skills at a paramedic level: first aid, giving vaccinations and performing emergency tooth extractions. Equally important, they teach community members the fundamentals of good health, stressing preventive measures. As far removed as these communities are from medical facilities, fast action is often required to combat chronic problems. Diarrhea is one example. Among North Americans, the word has a somewhat humorous connotation — the "trots" and so forth. But among these riverbank people, it is a matter of deadly seriousness, especially in the case of infants. Sudden dehydration through diarrhea in young children is a common killer. It can be treated with a homemade oral rehydration solution of sugar and salt in water. Other simple yet lifesaving methods include adding a chlorine solution to polluted water to make it safe to drink.

Monitors are the educational link in making their fellow community members aware of the effective home remedies at hand. The name "monitor" is significant since these workers are also taught how to keep records to track the status of public health in the community, as well as to detect and advise health authorities of impending problems, such as threatening outbreaks of disease. This is truly a "bootstrap" program, in that trained monitors fan out into surrounding areas to pass on their skills to others. H&H estimates that these monitors are now able to handle upwards of 70 percent of health problems, evidence of their crucial role within the project.

It is common for children to be left in charge of their younger siblings when mom and pop are out farming, hunting and the like. Consequently, H&H has created a Kiddy Monitor program, whereby children between the ages of six and fourteen are taught basic skills that they apply to caring for their brothers and sisters.

These programs indicate a core concept of H&H: To endeavor to involve 100 percent of the people in the decisions that will lead to improving their quality of life.

Realizing the need to break away from the fishandchibá cycle, the project has put teeth into its nutrition program. It has a team of agronomists that work with farmers to show how the quality and yield of local plants can be improved, with a number of experimental farms now in progress. A veterinarian provides small animal raisers with support, knowing that increased production means a diminished need to deplete wildlife in the surrounding forest.

In the belief that knowledge of the environment enhances respect for it, the H&H approach strives to make community members aware of the resources available in the surrounding forest — food, curatives, housing and potential income — while emphasizing the need to properly use and preserve these resources.

Education forms part of an ambitious H&H project intended to revamp teaching methodology along two lines. First, the overriding philosophy is that teaching should be tailored to local realities, drawn from the geography, climate and culture of each community. This concept stems from the fact that in Brazil, education curricula are based on a national "standard" that reflects little of the country's vast cultural spectrum. Secondly, learning should be based on gameplaying; things that are fun sink in deeper. With their obvious reflection of the good feelings produced by the circus, games are an important educational tool that can be applied to virtually every activity. After all, it's much more exciting to learn about bees if, for example, for a brief while you can actually be a bee.

A Day in the Life

As the H&H boat chugs in, it is greeted by the community amid much hullabaloo. Since many of the staff show up in clown garb, the walk into town often becomes a miniparade, jugglers juggling and musicians playing.

But hold everything. Business before pleasure. During the day, activities are mainly divided between checking and doing. In conjunction with health monitors, children are examined and weighed (especially the newborn), expectant mothers are given checkups in the presence of midwives, community health status records are updated, and immediate medical problems are treated. Each community has a Mothers Club, one of whose duties is to work with nutritionists to learn how the family diet can be improved. This may include pointing out the medicinal herbs that are found nearby, plus tips such as using ground eggshell as a handy source of calcium, or sticking a rusty nail in an orange to furnish iron to combat anemic deficiencies. Another program that ties in with the Mothers Clubs is called "Women: Body and Soul." It deals with a wide range of subjects, such as motherchild relations, body awareness, cottageindustry production and handicrafts.

Experts in the Rural Production section work with community members in many agricultural areas. Included are chicken and pigraisers, rubber tappers and farmers who are being taught to develop new and more nutritious species of plants, particularly the ubiquitous manioc. Another good tip is the use of the termites that abound in the region as a source of protein for feeding chickens.

In communities with a school, H&Hers meet with children and teachers to check on programs such as proper toothbrushing techniques or the tree nursery, a popular activity among children. Part of the Fruition project, the latter is an attempt to preserve and upgrade local varieties of trees, as well as to introduce useful species that are not found in the region, such as certain citrus fruits.

As the day wears on, preparations begin for the evening performance of the circus. Once again, the goal is educational entertainment. No way is it merely a show for the people, it is a show with the people. The local pavilion is made ready, costumes are prepared, and skits are rehearsed. H&H acrobats set up their gear — they, too, often pass on their skills, training aspiring tightrope walkers, jugglers and other performers.

Not long after night falls, the curtain rises. The circus is open to everyone; it is a showcase for local talent such as musicians, storytellers, hams and anyone else who might have something to contribute. Those with wellhidden abilities can slap on a little greasepaint and clown around. This is no spectatorinthebleachers event but most definitely a handson production reminiscent of street theater. At each performance, the community joins with the H&Hers to put on skits with a message: the benefits of forming coops; how contagious diseases are spread; the causes and prevention of undernutrition; the dangers of drinking untreated water. These "household hints" are intended to save lives, rather than make your shirts a whiter white or remove that nasty stain from your carpet.

Some places have formed what's known as a Headcold Choir, which sings about respiratory problems that can result from neglecting a simple cold or from the overuse of medicines.

By the time the evening's festivities have ended both H&H staff and community members have had quite a workout. And this is a project that works. Its ingenious blend of learning and having a good time leaves people feeling good in body and spirit.

Visits normally last three to four days. H&H staff members may also come to call under specific circumstances — the agronomy section, or the medical team in case of a disease outbreak, and so on. A recent event of great significance has been the cholera epidemic in Latin America. It is to the credit of the Health and Happiness Project that cholera has thus far been kept away from the areas where the project operates. This is most likely due to three factors: the effectiveness of the healthmonitor program, the three years that the project's Hygiene, Rural Sanitation and Diarrhea Prevention Program has been implemented, and the widespread use of chlorine solution to create potable water.

The Caboclos —Preserving a Culture

The current world focus on the Amazon has almost exclusively dealt with the Indians. Very little has been said about the ethnic group that makes up the great bulk of the Amazon population — the caboclos (Portuguese for mixed Indian and white: the majority of the population in the area covered by the H&H Project). The caboclo culture is perhaps less flamboyant than that of the Indians. There are no tribes of caboclos, no ritual dances, no tribal gods (or Hollywood movies). However, translating the somewhat highfalutin Portuguese word acervo, these people are the "storehouse" of folklore in this part of the Amazon, a valuable body of knowledge.

Herein lies another goal of the project: to keep alive a culture threatened by two problems confronting most developing areas, rural flight and the encroachment of the outside world. Here's where the Communications Sector steps in. Besides documenting activities, great efforts are dedicated to recording the caboclo culture. As always, the key is to get people involved, as evidenced by the program's name, "Grassroots Communications."

Teenagers and youth — being the most likely candidates to skip town and head for the big city — are encouraged to become what the project calls Local Correspondents. They are given the task of documenting the local life, which may range from interviews (oral history) to acting as recording secretaries for meetings of community groups. There is also Live Radio, with recorded material first "aired" to the community itself in a simulated broadcast (at a circus performance, for example) and with some material taken to Santarém for actual broadcasting as part of a Rural AM program. Toward this end, Grassroots Communications provides training in the methods of broadcasting. There are also community and intercommunity newspapers that offer prospective journalists a chance to work in this medium, as well as serving as a tool for the exchange of ideas.

Other popular media forms are educational photocomics with plots developed by community members and then shot by the H&H crew, and a News Wall, a large bulletin board where community news, photos, and other items are posted. The outcome is two-pronged: media skills are taught, while the people gain increased awareness of their culture and how they can improve it.

The Information and Resource Center puts out the word about the project, along with serving as a center for research on present and future activities. It works with virtually all media — still photography, video, and audiotape recordings — to compile data on community life and lore. The archives of the IRC are available to anyone who would like further information on the project.

The Future of the Project

Project scheduling is naturally keyed toward expansion, aimed at reaching more and more of the isolated communities in the mid Amazon. The ultimate goal is for these communities, through their health monitors, teachers, mothers clubs and other involved groups, in tandem with general awareness campaigns, to be selfsufficient to the greatest possible degree. It's good to know that your problems are being solved, but even more satisfying is the sense of pride in realizing that you have taken an active part in the process.

The demand cannot be underestimated. As neighboring communities learn about the project there is an increasing number of requests for information, assistance and training. The Health and Happiness Project is a nongovernmental organization administered by the Center for Advanced Studies in Social Care. Its main headquarters are in Rio de Janeiro, and there is a regional office in Santarém.

In mid1991, government funding for the H&H Project was put on hold for ten months. The circus came to a halt. This was not the first time a shutdown had occurred. The subsequent release of governmental funds in no way implies that the flow will be constant. For this reason, the project is attempting to assemble backers to ensure that at least current work will not be halted. Any type of support is useful, including donations of money or equipment.

Additional information on this project may be obtained from the following addresses:

Projeto Saúde e Alegria (CEAPS) - Rua Paulo Barreto, 23 - Botafogo CEP 22.280010 Rio de Janeiro, BRAZIL - Tel.: (55) (21) 2667896 - Fax: 2667897 Email (AlterNex): Ax!ceapsrio

Projeto Saúde e Alegria - Av. Borges Leal, 2284 - Cx Postal 243 - CEP 68.040080 Santarém, Pará, BRAZIL - Tel. (55) (91) 5231083 - Fax: 523-1083

Excerpted from Fighting For the Soul of Brazil, Edited by Kevin Danaher and Michael Shellenberger, Monthly Review Press, New York, NY, 1995, 274 pp. You can order the book by calling (415)255-7296 or mailing your request to Global Exchange, 2017 Mission St., Suite 303, San Francisco, CA 94110. Each book costs $14 plus $2 for postage and handling. Visa and MasterCard accepted.