Publique e seja criticado

Abstract

In September 2005 I visited Brazil for the third time; the second was in 2000. The welcome was as warm as ever and I was greatly impressed by what I saw. The civic environment is improving. The channelling and landscaping of Sao Paulo's two rivers have made a huge difference to one's first impressions of the city. Once the planted trees have grown to maturity the areas around the riverbanks will be beautiful, and wildlife will return. A slight reduction in traffic volume is also noticeable, although perhaps not at the 'Rush Hour'! I learned that this is due to restrictions placed on the use of private cars for a specified day each week. I understand that this is not a popular move for people who have to cross the city to work, but the change was noticeable before I received the explanation. These civic improvements are part of the wider environmental aspects of the Public Health, but equally impressive was the work that I observed being carried out by Public Health Nurses in the Family Health Programme teams. Their work includes initiatives to reduce HIV/AIDS infections; contact tracing in the poorest districts where patients and their families are affected by Tuberculosis; monitoring of the incidence of Leprosy and Sexually Transmitted Diseases; Maternal and Child Health Programmes that are attempting to lower maternal and infant mortality. At the same time, nursing staff are actively engaged in the development and maintenance of nursing information systems to keep track of disease prevalence, workload and staffing. This is the routine or 'bread and butter' of public health work as advocated in numerous publications by the World Health Organization since the Alma Ata Conference in 1978. The work is not dramatic. Often it takes an outsider to come in and appreciate how much is going on at the 'grass roots' of community life. Sometimes, as postgraduate students pointed out to me, the work can be dispiriting when the people's poverty and problems appear to be intractable and overwhelming. These are occasions when we have to take pride and pleasure in small achievements for, like the trees along Sao Paulo's riverbanks, it can take a generation for health improvements to grow and flourish. Why then, when they have so much to teach the rest of the world about their work at home, are so many nursing staff in Brazil dreaming of going to the West? Of course, travel is a wonderful learning experience. I have been privileged to visit many countries myself and I would never say that nurses should not travel. But, frequently, the nurses that I spoke to seemed to think that there were lessons to be learned that they did not already know. Sometimes, Brazilian nurses appear to be afflicted by a collective sense of under-achievement. Come to the West by all means, but come prepared to tell us of the work that you are doing, and of the successes that you achieve. The language barrier is one of the difficulties that many Brazilian nurses face. This prevents them from publishing in western journals accounts of what they are doing i...