Casa Weekly

Monday, October 30, 2006

Eyes Wide Open

Last December, we raffled off two round-trip tickets to Rio amongst CatComm supporters, signers onto our 2006 fundraising campaign at PledgeBank!

Jason and Justin Yax, two physicians from Michigan, won the tickets and recently joined us for a week in Rio, from October 4-11.

When their week was up, Justin offered to write a narrative detailing the most memorable part of their visit for us to publish in the Casa Blog.

Here is what he sent us...


Catalytic Communities (CatComm) offers an entirely new way of thinking about Non-
Governmental Organizations (NGOs) or “nonprofit organizations.” Seven dedicated employees make up this amazing organization based in Rio de Janeiro, Brazil, which provides resources and support for over 1000 community based projects - some of them other NGOs - each one with its own independent focus and goals. When one does the math, taking into account that each community project reaches at least 40 people, CatComm today positively impacts the lives of over 40,000 individuals either directly or indirectly. Its potential to affect hundreds of thousands worldwide is limited only by its public exposure.

Passively hearing what CatComm is and actively seeing what it is are two very different experiences. I’m enthusiastically putting off other assignments in order to write this entry into CatComm’s blog and share my experience of seeing the effect CatComm had on two particular grassroots projects based in one particular favela in Rio de Janeiro. The changes that CatComm affects are as extraordinary as the individual people the organization is designed to help.

Our adventure began at the end of a train ride into the North Zone of Rio de Janeiro, a place many worlds away from the tourist areas Rio is famous for. I had traveled here with my brother, Jason to witness first-hand what CatComm was about. Both doctors, we wanted to see what sorts of community health programs were out there. Two other Americans, Perry and Monica, a couple from New York City, a marketer and journalist, had heard of the great things CatComm was accomplishing as well and joined us on the visit. The suburban train clamored along its tracks as we neared our stop at “Parada de Lucas” – it was both the name of the train stop and the favela we were to visit -- our adventure begins at that moment:

I leaned over so Rose, CatComm’s Portuguese website editor and our guide that day, could hear me over the screeching breaks,

“How do you pronounce her name again in Português?” I asked.

Rose looked at me smiling, knowing I had a difficult time with the phonetics of the Portuguese language and its nasal characteristics. It was the 4th time I had asked her for the correct pronunciation of Neuza’s name.

¨Neh-ow-suh,” she slowly repeated the sound for me to imitate.

I practiced silently saying the name over and over, complete with the nasal ‘ow’ that gave Neuza’s name such a beautiful tone. My brother Jason was on the other side of the train talking with Perry and Monica, who were just as curious as Jason and I about what Catalytic Communities was all about. Rose and Rosa waited patiently with us as the train came to a stop at Parada de Lucas.

Rose had worked for CatComm since its first staff was hired in 2002. She, along with Rosa, a Chilean, are both site editors for CatComm’s award-winning website. Rose runs their Portuguese site, Rosa the Spanish. They had offered to introduce us to Neuza and her community NGO, “CIACAC,” which is a Portuguese acronym that translates to “Integrated Center of Support for Children and Adolescents of the Community.” Neuza started her organization after she went with her 9-year old son to a local favela-based “funk ball.” These are parties generally geared towards youth, given by the dominant drug lords of a favela to curry favor with the community and its individuals. Drugs and sex are commonplace which commonly beget violence. CIACAC provides the youth of the community with, among many other things, extra help with school, and field trips outside the favela to steer them away from these ‘funk balls’ and show them that a world free of drugs and poverty exists.

The train door opened to a typical inner city train station - a cement platform elevated above the streets of Rio from which the familiar noises of rush hour traffic came. We began walking down a zigzag ramp to reach street level. At the end of the ramp, we saw a disheveled older gentleman seated cross-legged on the ground next to a tattered woolen carpet. Upon this carpet he carefully displayed articles he was selling: a nearly new camera, watches with broken straps, a new video recorder, and three empty leather wallets. As we passed by, I instinctively reached for my front pocket of my Levi’s and felt comforted feeling my own wallet still present in the front pocket. Soon, we passed underneath a highway overpass which created a dry shelter for a sprawling marketplace selling everything from expensive furniture to fruits and vegetables. A few dozen steps more and we reached the opposite side of the overpass and the entrance to Parada de Lucas, home to 30,000 residents, 8,283 of them reported to be between the ages of 4 and 17. This is where Neuza lived.

A modest playground marked the entrance of Parada de Lucas. As we approached, despite all our attempts to appear inconspicuous, we immediately became the center of attention – we were clearly outsiders and a group of 10 children approached us. An assertive child no more than 11 years of age emerged from the group and approached us. I was to find out later his name was Roberto. Rosa spoke to him in Portuguese asking him where we could find Neuza. As they spoke, I observed this child clearly had a Body Mass Index (BMI) greater than 40, which placed him in the category of morbid obesity (one of the many consequences of poverty) – and he wasn’t yet a teenager! Paradoxically, children like him commonly are malnourished, taking in many calories, but few nutrients. I then noticed a very characteristic pigment in the crease of his neck. It was unmistakably acanthosis nigricans – a skin finding commonly associated with insulin resistance. But I had only seen this in adults! This child was in the first stages of developing type 2 (adult onset) diabetes – as a pre-teen!

Roberto looked at me as he spoke in Portuguese and pointed to the direction of Neuza’s house and offered to take us there. We began walking along a river of open sewage, 50 feet wide that began just behind the children’s playground and ran through the center of the community as far as the eye could see. During our walk, we were joined by a svelte young boy of 13 named Victor, who was quite a bit thinner (and shorter) than Roberto. Before we knew it, we had reached our destination.

Neuza’s house was marked by a whitewashed wall punctuated with a colorful mural of children playing under the rays of a bright yellow sun. It was a stark contrast to the earth-colored and cinderblock walls that were the homes of her neighbors. Rose knocked on the brightly painted wooden door which was the entrance to her home and Neuza answered. Her eyes were strong but gentle. Upon seeing Rose, they immediately twinkled with recognition. Then, with a smile and vigorous hand waving she invited us into her home.

Neuza’s home was also the home of CIACAC: the brightly colored murals with children’s colorful handprints and photos of multitudes of children on fantastic field trips were a testament to this. When CIACAC began, it encountered many obstacles, both financial and social. First, local banks would not perform a site visit in the favela so CIACAC was unable to open a bank account. Her organization was also too small to qualify for social support through local social programs. CIACAC’s lack of Internet capabilities also limited its access to resources and visibility to the world. It was Catalytic Communities, with its established status as an NGO and greater visibility that acted as a fiscal sponsor for CIACAC so it could receive the funds that enabled it to formalize itself as an NGO. Then, when CIACAC placed itself on CatComm’s Website, it became visible to the world, which, among other things, brought her project to the attention of a generous Periodontist from Italy who donated enough funds for Neuza to double the square footage of CIACAC’s home. The bank also used CIACAC’s listing on CatComm’s website as a substitute for a site visit, enabling her to finally open a bank account. Catalytic Communities was, well, a catalyst that helped CIACAC blossom into the successful organization it is today.

When it was time, we left Neuza’s house. Neuza walked with us to meet Sergio, the man I had heard so much about and, as a physician, wanted to meet. Sergio was another community leader, like Neuza, who had started a community project on the other side of Parada de Lucas. During our walk, I began thinking about Victor and remembered the significantly short height he had for being thirteen years old. Though I didn’t know his parents height or family genetics, I speculated about chronic malnutrition secondary to intestinal parasites among the children in Parada de Lucas. Undiagnosed asymptomatic parasitosis is not uncommon in poorer communies throughout the world and can lead to malnutrition, anemia and learning deficiencies. The open sewage we were walking beside certainly placed this community’s children at risk for many diseases -- intestinal parasites being one.

Suddenly Rose nudged my ribs. Her voice was low and soft, “Keep walking and don’t take your camera out,” she instructed.

This was, of course an invitation for my eyes to wander to my left, where I saw a shirtless man my age, standing in front of the door of a local convenience store with the barel of his semi-automatic pistol tucked into his jeans just under his navel. It was unclear to me if this man was a vigilante or part of the drug cartel. I didn’t ask. But this was a sobering reminder of what world I was in, and how very different it was from my own.

Rose was always beside me as we walked, and with a simple smile and a few words, quickly brightened the mood of the whole group again. Both Rose and Rosa possess this amazing gift of lifting spirits – and they used their talents wisely, and often. Positive attitudes are contagious, especially where they are needed. We were soon coming to the place where we were to meet Sergio.

Thirteen years ago, at the age of 30, Sergio started an organization called “Amor Pela Vida” (Love of Life) which brings physical rehabilitation services to individuals suffering from physical disabilities brought about by stroke, accidents and, not uncommonly, gun shot wounds. Sergio, like Neuza, was born and raised in Parada de Lucas. When Sergio was 28, he was the victim of a hit and run accident and suffered a shattered right femur. He was taken by ambulance to the government hospital where he waited 47 days before surgeons had a space in their schedule to operate. He eventually underwent a successful operation and subsequently spent two years on crutches while receiving physical therapy through the public hospital system. He was so impressed with his results, and was so sensitized to his predicament that, when he recovered, he started visiting residents that had similar disabilities to help them how he could. His dream was to open a rehabilitation clinic. How he got to that point, though, is a truly brilliant example of resourcefulness and dedication.

We saw Sergio standing in front of his rehabilitation clinic waiting for us to arrive. He appeared younger than his age and was of solid stature. To my surprise, he had no noticeable limp when he walked, but had the surgical scar to prove his story. We walked up a ramp from the sidewalk to the entrance of his clinic, which consisted of a modest desk where patients were checked in and, further back, the main therapy room, consisting of a simple patient table and the most basic pieces of physical therapy equipment. Upon entering this clinic, I was struck by a carefully constructed display case within the wall, in the most prominent part of the room. The case contained three shelves, upon each of which several ink cartrages were carefully displayed. A plate of glass was secured over the display and backlighting was installed proudly displaying its contents. I was unsettled. My myopic perception could not fathom the purpose of this. What was the significance of a display such as this in a physical rehabilitation center?

The answer was quite simple. Before companies began refilling their own ink cartridges, empty cartridges could be re-sold to the manufacturer for refilling. Sergio saw this opportunity and had gone to local companies to ask them to donate, to his cause, their empty ink cartridges. He was able to gain the support of 56 local companies. He asked several churches to help him collect empty cartridges as well, which they did. He would collect the cartridges once a month, and his son Ariel would clean them and carefully place them in egg cartons for safe storage. He would then resell the clean, empty ink cartridges to the recycling company – over 8000 of them, which raised over R$12,000 (US$6000)! With this money, Sergio was able to purchase construction materials. He tore down the shack that was previously on this property and built the clinic we were all standing in. He had money left over to purchase a small plot of land next to the clinic which he is planning to use for expansion.

Sergio had created a sustainable rehabilitation clinic for his community where a licenced physical therapist oversees the physical rehabiltation needs of over 276 patients in over 6,700 clinic visits over the past 3 years. In 1991, Sergio had no place in his community to offer this service. Now, patients with physical impairments from stroke or trauma, who receive recommendations from their physicians for rehabilitation services have a place to receive this service for a nominal fee (which is only charged when they can afford it).

Sergio is now actively raising money to purchase more physical therapy equipment and expand his clinic building using the adjacent land he recently purchased. The positive effects “Amor pela Vida” has on his clients’ lives and the lives of their families cannot be overstated – it gives hope and encouragement to those who have suffered physical trauma in their lives. It helps treat not only their physical body, but their spirit as well.

Despite “Love for Life” existing within Neuza’s neighborhood for 13 years, Sergio met Neuza by chance only one month prior to our arrival! Through Neuza, Sergio was introduced to Catalytic Communities and placed his project and its extraordinary history in CatComm’s online Community Solutions Database so others could learn from his experience and ideas. Our very visit was a display of the power Catalytic Communities has bringing people and ideas together. Perry, Monica, Jason and I were the first international visitors to “Love of Life” in its 13-year history. We were worlds apart just one short month ago. Now we are part of a joint network that links us in support of community change.

Through Catalytic Communities, Sergio´s idea of recycling ink cartrages to help finance a grassroots health project can be posted and read by commuinty leaders in Brazil, Africa, or even India through the power of the Internet -- and the road goes both ways! This is the function of CatComm. It is a unifying force, a network for these otherwise independent heroes to help them accomplish even more amazing and powerful projects for good.

The idea behind an NGO such as CatComm is as revolutionary as the Internet. In Rio de Janeiro alone, CatComm has already brought over 1000 individual project leaders together, like Sergio and Neuza, and its potential for growth is limited only by its public and financial support.

Heroes do not wait for the world to change - they change the world. In amazing people like Neuza, Sergio, Rose, and Rosa, we see what we can become, what we can do, and who we are capable of becoming as individuals. We need only to pay attention.

Justin Yax, D.O. is board-certified Internal medicine physican currently doing his fellowship in Infectious Diseases at the University of Michigan in Ann Arbor. He has particular interests in international health, medical resource allocation in developing nations, and malariology. This is his frist humble attempt at narrative writing.