Projeto Saúde and Alegria (PSA – Health and Happiness Project)
Working in the Amazon region of Brazil since 1987, the non-governmental organisation (NGO) Projeto Saude and Alegria (PSA – Health and Happiness Project) supports participatory, integrated, and sustainable community development, managed by local residents themselves. PSA is active along the lower stretch of the Tapajós river and its tributary, the Arapiuns river, near the Amazon river. The beneficiary communities are riverbank villages in two nature reserves. An interdisciplinary team of doctors, agronomists, and educators from a range of disciplines regularly visit the communities to engage people in activities devoted to: community organisation, health, agro-forestry production and management, income generation, education, gender, children and youth, art and culture, popular communication, and participatory research.
PSA’s programmes in community health, the forest economy, and education, culture and communication come together in the concept of community-driven development. The project’s initiatives are low-cost and designed to bring results within just a few years. The founder, a physician who launched PSA in an effort to bring medicine to those who most need it, has developed communication strategies to encourage simple, inexpensive hygiene measures, like channeling water and disseminating the use of chlorine to sterilise drinking and cooking water, as well as widespread vaccination campaigns and community-built septic tanks with concrete lids.
Community leaders, health workers, traditional midwives, rural producers, women, teachers, children, and young people built their capacity to carry out these activities through training to become trainers. The project invested in basic sanitation (chlorine, filters, toilets, wells, and adapted water systems). Community events promoting the health of the children, with vaccination campaigns every third month, were initiated. Rural farmers received technical assistance to increase the availability of food stuffs produced using agro-ecological practices. Groups of women were involved in activities to promote reproductive health and combat malnutrition through the consumption of local plants of high nutritional value. In the schools, teachers and children participated in health and ecology workshops. A communication network was developed through which youth were trained as reporters – allowing them to produce, exchange, and disseminate educational materials via community newspapers, radio, and videos.
The name of the project sums up its methodology. Promotion of health in a positive vein – rather than a disease-oriented, punitive one – is the focus of its actions. Health – identified as the main problem in participatory debates with local residents – is a broad concept that encompasses the environment, education, and food security, thus requiring sustainable economic development. As a main strategy when visiting communities, team members and community members use music, poetry, and educational and cultural sketches to promote healthy behaviours, such as breastfeeding, the use of oral rehydration therapy, and hygiene, among others. One of PSA’s three general coordinators (who, like PSA’s founder, is from São Paulo) is an educator who had studied law, social services, and physical education… and clowning. He leads the Great Mocorongo Circus, which mobilises local communities and teaches hygiene and disease prevention – through laughter. “Mocorongo is an interactive circus, with no distance between actors and spectators, who also express their ideas in the circus language,” said Magnolio. Children and adults paint their faces and take part in the show. Everyone is an artist, and the entire PSA staff performs some circus routine at one point or another. The project also uses methods from the Theatre of the Oppressed, a street theatre method created by Brazilian playwright and director Augusto Boal. The plays teach techniques for preventing diseases or for using homemade rehydration solutions, for example. In one play, dozens of men running towards a circle of women represent the race among sperm, in which only the winner will fertilise the egg. The sketch is part of sex education efforts aimed at fighting the spread of sexually transmitted diseases like AIDS.
The idea is that keeping teaching on health and other matters fun will inspire people to eagerly await the return of the “Abaré”, a boat that serves as the PSA’s mobile hospital. The project’s most visible tool, the boat makes periodic tours from one riverbank community to another, providing medical and dental care, vaccinations, family planning, and minor surgical procedures.
Young people in the area have been mobilising through PSA’s education and communication programme (EDUCOM). The Mocorongo Communication Network involves 350 young people in community radio stations and the production and distribution of small newspapers, videos, and television programmes. Telecentres with a cultural focus, six of which are operating and five of which are in the process of being installed (as of March 2009), are designed to provide new opportunities for communication and to strengthen community organisation and mobilisation. The telecentres are two-story wooden eco-friendly buildings, with the first floor open to meetings and cultural activities and the second dedicated to bringing the internet and new technologies to local people and expanding digital inclusion. PSA leaders say that access to new technologies, like the telecentres and videos, have encouraged youngsters to emphasise and rescue local culture, contrary to fears that they would be drawn in by modern urban lifestyles.
For instance, Mónica de Almeida, 20, a community leader trained by the Mocorongo Network, is now a video producer after receiving training in participative video techniques at the Biskops-Arnö Nordic school in Sweden, which periodically sends teams to Brazil to give workshops to young people involved in PSA. Today, Almeida coordinates “the telecentre that brought the age of the Internet to the town” of Belterra, near Santarém, by training more than 700 people in its courses, she said. Almeida’s team has also produced five videos on issues like teen pregnancy and youth unemployment, and has held workshops on collective blogs. The hope is that these young people will ensure the continuity of the local development initiatives promoted by PSA.
Health, Education, Rural Development.
According to PSA’s Davide Pompermaier, the “caboclos” (a term referring to Brazilians of mixed indigenous and European descent who live in the Amazon jungle), with whom PSA works, “do not have an enterprising mentality” – a characteristic that has been aggravated by
broad government income transfer programmes. Moreover, “their traditional means of production are unsustainable,” because they are based on the clearing of forests by the slash-and-burn technique and the cultivation of mandioc, “which is labour-intensive and of little value.” But the forest economy group that Pompermaier coordinates has shown results in fomenting craft-making, community-led ecotourism ventures, agroecological production, and the generation of solar energy and other kinds of electricity. The focus is “to invest in young people to change local mentalities,” and produce more food in a sustainable fashion, he explained.
PSA sees economic and financial aspects as the project’s main challenge today, because of the difficulty in generating sustainable incomes for local populations in the jungle. Natural resources like fish and forestry products are becoming more and more scarce, limiting extractive activities like the gathering of nuts and fruit, while alternatives such as agroecology initiatives take years to consolidate. Furthermore, processing the fruit and nuts to add value takes time, energy, and capital that are not readily available in the area.
PSA reduced the infant mortality rate to 27 per 1,000 live births in the 150 communities it serves, which have a total combined population of 30,000. In contrast, the infant mortality rate in nearby neighbourhoods that are not served by PSA averages 52 per 1,000 live births. In addition, the illiteracy rate among people over 15 is 5.5% in PSA communities, compared to 11.3% in surrounding areas.
Principle funders include Terre des Homees, Ford Foundation, Konrad-Adenauer-Stiftung, Ministério do Meio Ambiente, Banco Nacional de Desenvolvimento Econômico e Social (BNDES).