We are Jessica Mackenzie and Selma Azzubair, two students on the Global Health & Social Medicine BA and BSc. Over the first fortnight of June 2016 we were fortunate enough to take part in an internship offered by the Institute of Social Medicine of the State University of Rio de Janeiro. The focus of the project was to observe and understand the integration of mental health services in primary healthcare through Brazil’s nationwide health service, the Sistema Unico de Saude (SUS). Over the course of the two weeks and based in Rio’s ‘Programatic Area 2.2’, we were able to shadow professionals both within the healthcare system as well as the Institute of Social Medicine.
We arrived in Rio on Sunday morning at 5am. Immediately it was clear that Selma’s Spanish was not going to translate as easily as we had thought. Once we arrived at the hostel it was clear that this was not so much a hostel but a beautiful house and we were of the few guests to inhabit it over the following two weeks. In our first week we hit the ground running (as we only had two weeks). We were taken to a different clinic each day. In the clinics we were able to sit in on the psychiatric assessments and check-ups. Given that my Portuguese was non-existent and my Spanish was basic, Selma translated during the sessions for me. It was fascinating to not only go into the clinics and see how they worked but also to get the opportunity to sit in on patient interactions because it really gave us a sense not only of the types of illness that the psychiatric professionals were dealing with (anxiety disorders, depression, psychosis, victims of abuse etc.) but also revealed the way in which the internal day-to-day encounters took place. The psychiatric staff were assisting local family doctors (GP equivalent but much more family centered) in assessing the patients that the family doctors flagged up as being particularly in need of psychiatric help. In doing this there was also an element of education taking place as the psychiatrists taught the family doctors about mental health and its importance. It was fascinating to be a fly on the wall in the clinics. Dr Sandra Fortes, a psychiatrist, was incredibly warm and friendly and took time to explain the system and its strengths and weaknesses. Whilst it is clear that there are significant funding issues the system is holistic and well-structured.
The second week we spent at the university. This was a different experience entirely. Here we met Dr Francisco Ortega who, along with Dr Carlo Caduff at King’s Global Health & Social Medicine Department, developed our internship. The latter, we quickly realised, came at a particularly interesting, and crucial, political and financial point both for the state of Rio and Brazil as a whole. The state university, the Universidad Estatal de Rio de Janeiro, has been on strike for 3 months and as such there were no undergraduates taking classes at the university. Only one of the 6 elevators were working and the whole building seemed as though it had survived an apocalypse. However, once we reached the Institute of Social Medicine the story was completely different. The department was a post-graduate department and, thus, functioning as usual. We attended a masters and PhD supervision where a student presented her work, we were invited to attend a lecture which was incredibly interesting covering subject matters similar to those our course engages with, more so as the students responded to the material from a different perspective. We also visited the IMS department where new and ongoing research projects were discussed as well as issues faced in the university.
Close to the main building was the university hospital where the effects of the current, political and economic climate were evident. This was but one example of how the provision of healthcare in the country and the future of the SUS, a system we found to be incredibly comprehensive and holistic – despite the usual setbacks in terms of resources – will be tested and determined by changing circumstances, a future which seems uncertain.
The project was a truly incredible experience, one we both found to be very eye opening and stimulating, and a unique chance to witness and assess the importance of providing accessible, quality mental health services particularly in such unstable circumstances. We’d both like to thank all those involved, particularly Dr Carlo Caduff at the King’s Department of Global Health & Social Medicine for arranging the internship, Dr Francisco Ortega and Dr Sandra Fortes at the UERJ for welcoming us and giving us an insight into the day-to-day challenges faced by primary mental health services and the SUS as a whole, and Jacque Wilkins Region Head of the Latin America office and Deputy Director of Global engagement at KCL for her support. We hope this partnership will allow many more students to witness the changing panorama of healthcare provision in Brazil, a truly unique experience!