Feature: How students can change realities?

September, 2015

I will tell a brief history from some different students from south of Brazil. It is merged with my history. I am a medical student and like most students I have had a lot of concerns.

In 2010 in my first year at the Medical School I was disappointed. The University was not exactly what I expected: “a place to change lives and where I could practice my humanity”. It was very biological with biochemistry, physiology, anatomy, etc. However, once each week I had the chance to experience the routine of a Health Basic Unit in the Brazilian Health System, the place for community based Primary Care in Brazil. Maybe this was a place that would prove to be exciting? Sadly, after one semester, it was just disappointing. Once, coming back from the university campus in the bus I discovered that I was not alone. My colleague was disappointed as well. To exemplify our experiences in a few words: the doctor said to the patient to do something (like eat less salt), the patient did not do it, so the doctor gave the instructions again, the patient did not listen again, and at the end of the consultation, doctor and patient were both frustrated.

We needed to plan a project that would enable us to find what we were missing in the community. We decided that we would like to go to the community to listen and learn (and maybe share and exchange something). So, in August of 2010, we started the Health Education League. An initiative of the junior medical students of the Universidade Federal do Rio Grande in the very south of Brazil. We wrote the project and structured our ideas in a week (we used all our time and energy for that). To get more people to participate in the project we stood after a biochemistry class to invite others to participate in a project that would go into the community, not to impose our knowledge, but with the aim of learning different realities. As you can imagine no one raised a hand. Anyway, we believed in the project, so we talked and convinced a few close friends that it was a good idea. After a while, we found a Family Medicine professor who decided to guide the project.

We decided to start with heavy theoretical meetings to discuss popular education, health promotion, health education history and community approach. We wanted to change the paradigms of our medical education, once, a student said: “our minds are like boxes that just store content: in the first year they put in Guyton, Netter [medical books]; in the second year Bates(…). I wouldn’t like to be a box anymore”.

After one month, we started the practical activities with a meeting in the school of the Carreiros community with a Youth and Adult Education class. We decided to sit like a wheel and mix medical students with community. We brought some brown paper and marker pens. We introduced ourselves and ask for them introduce themselves.

Photo: Students and Community

We started with a question: “What is health?” that we wrote on the brown paper. They started to say: “It is take vaccines”, “It is have a good head” (referring to mental health), “It is take medicines”, “do activities”, “do not use drugs”, etc. In the end, we have generally the same concept as the WHO of what health is, however it was not imposed, it was a construction.

The problem started when we did the second question of the day: “Why I do not go to the doctor”. We wanted to do this question to address one of our anxieties about patient adhesion. It was almost a shot in the foot when we opened it for the community.

Photo: What is health?

The first reaction was anger. A man stood up and with his finger pointing at me asked: “are you here for money?”

I was totally in shocked, but I managed to react to say that I was there because I liked people. They started to say that doctors liked coffee more than people, that they do not care, that doctors do not look into the eyes of the patient, and a range of other disappointments. It was half-frustrating and half-encouraging. In the end, they had the power to choose what a “Health Education League” could offer them and we organized the project for the year.

The project grew and this is just the beginning of the history. We worked in communities in the very south of Brazil trying to empower them (and us) using Freire’s Popular Education. It was a great learning process.

Just to tell another achievement (and probably another long text to read) was the empowerment of a fishing community, more isolated from the city centre, and a community that almost do not have primary health care. After less than a year of the Health Education League working with them they decided to organize themselves to advocate for their right to health, for the implementation of a Health Basic Unit with a Brazilian Health Strategy.

I could write a book with all a range of histories … actually, we wrote a book, community and students together, it is in Portuguese and it is called: “The Quilt: experiences of Health Education League” (A colcha de retalhos: vivências da Liga de Educação em Saúde) available in Portuguese here:

Since beginning the project we changed the way that we understand medicine, medical education, empowerment and health communication. We used our creativity to create group dynamics and a constructive process of learning where “no one knew more than other, we just know differently” – like Freire said. We constructed ways that go from how to explain and share knowledge about hypertension to how discuss health rights.

Photo: Image from a dynamic made by a junior student to explain health communication and medical relationship at the Health Education League Space.

In the beginning I got tired of listening “you are a dreamer” or “it will not work”. Now more than 100 students have experienced it and we have changed realities together with (and not for) community and students.

The First Family Medicine Cafe Saturday October 3rd GMT-3

Also, in the coming days I am organizing the first Family Medicine Café. It will be an informal meeting on Google hangouts to chat about themes related to Family Medicine focusing on Rural Family Medicine. It will be a space to discuss and spread ideas of global FM. The idea is to put together practitioners from all around the world to talk about selected themes. The estimated duration will one hour and it will have around five experts discussing the selected theme. The first meeting will be with me, Sarah Strasser, Amber Wheatley and Veronika Rasik. Please check more information on this link

Mayara Floss
5th year medical student
Universidade Federal do Rio Grande, Brazil
Blog (portuguese):
Twitter: @mayafloss