Reflection

It has now been three days since my return from Brazil, and even though I've told stories of my week to countless friends and family since then, it has been much harder to try and organize my final thoughts and reactions in writing than I thought it would be. I saw things over the course of the week that although I had heard of before in class or on the news, I realize now that only after seeing them with my own eyes do I finally understand just how dire the circumstances are. I am speaking of course about the severity of the poverty facing so many individuals on a daily basis. Until you witness first hand the impact that a lifetime of hunger and sickness has on a child, or on a young mother, it is hard to be truly affected by such a harsh reality.
A lot of students voiced that they felt a great amount of guilt when visiting the favelas, so as a means of providing us with some comfort we were reminded that this was the only existence many of these families knew. We were judging their homes and lifestyles by how it would make us feel if we had to move to a favela from our comfortable homes in New Jersey. But I think what made me the most upset was that these individuals were being deprived of their most basic rights as human beings; the right to food, the right to security and the right to good health. No one should have to grow up in a home where they are not safe, or well fed, or even loved. For this reason, we were reminded how important our presence at the center was. Just by touching the lives of these children, by getting the opportunity to hug them or make them smile even once, something so simple, was in some ways better than any material gift we could give them.
One thing that I found particularly difficult during the week was the transition between spending the day at CREN, to going out at night where we would sometimes spend as much on our dinner as some of the families we would meet from the favelas would make in an entire month. I have never in my life experienced anything so emotionally draining, and by the end of the week it was hard some nights to find the will to even eat a full meal.  São Paulo is unique in that the range of extravagant wealth and dire poverty is so extreme, that you can walk down one road and find a mother begging on the street with her children, and find designer shops and five-star restaurants on the next.  It's hard to accept the reality of how unfair the world that we live in can really be, and it leaves you questioning if there really ever will be a solution.
All of that being said, this one week spent in Brazil has left a lasting and powerful impression on me that I had never anticipated. I remember first walking back into my house on Sunday, and the moment my mother saw me she said, "that changes you, huh?" And only then did I realize it was true. The culture of Brazil was absolutely beautiful; the exotic fruits, the crafts at the market, the traditional samba dancing... all of this I will remember. But it is the faces of the children, and their mothers, whose lives we touched even in some small but significant way, that is ingrained in my mind and that I will never forget. 

A Taste of the Culture

On Friday afternoon we visited the Municipal Market, which I can only describe as every "food-ies" dream. The incredible assortments of fresh fruits, meat, vegetables, spices and desserts was truly incredible to see. The vendors of the fruit stands would enthusiastically call us over and allow us to sample as much fruit as they had time to slice up for us. Some of the types I particularly enjoyed was maracujá or passion fruit, caqui or persimmon, and lychee which tasted much to me like a grape.
Many of the other students also tasted the notorious mortadela sandwich. This mountainous sandwich is built on a French roll and piled high with the Brazilian equivalent of bologna sausage. Though I was told it was delicious, I personally chose to indulge myself instead at one of the many dessert stands where fresh strawberries were coated in front of me with rich chocolate. 

Solutions Amongst Chaos

On Thursday we piled into the CREN van to visit a new center that was built outside of a community called "Vila Nova." This community was originally a favela, but in recent years the government has intervened to provide these residents with amenities to improve living conditions. These amenities include electricity and running water, as well as paved streets and a free medical clinic directly within the community itself. There was also an initiative to paint the homes of the community with bright colors chosen by the families, to give them a sense of control over their surroundings and to provide some asthetic appeal. I must admit the bright colors did make the entire community look very picturesque and did a lot to soften its overall appearance.

 

We first toured the CREN center with Sonia Vendramaim, who told us all about the different programs provided by the center. This location provided both inpatient and outpatient care for malnourished children, but also catered to older children and teenagers. A computer lab has been set up for their use, and we were even able to sit in on a music class where a group of nine to twelve year old children sang a beautiful song to us that they had proudly practiced for the past month. In addition to classes for older children, we were able to sit in on a needlepoint class for the mothers whose children are attending the CREN center. It was easy to see how proud they were of the crafts that they were making, but we learned that another reason these classes are provided is as a means of connecting with the mothers on a more personal level. A huge belief of CREN is that all the employees at the center are of equal importance, despite their titles. So in this case the center´s psychologist was participating in the needlepoint activity with the mothers in the hopes of further gaining their trust and compliance. 

We then visited the free clinic after a ride through the community, and even though the improvements being made were tangible, there was still so much devastation. I remember seeing a group of children playing soccer, running barefoot on a dirt clearing with shards of glass scattered on the ground they were playing on. Their ball was deflated and flat, and the soccer goals didn´t even have nets on them. Other children chose instead to simply play their games in the streets. Inside the clinic, the doctors assured us that each family was provided with free care, and that any children whose measurements were below average were recommended to attend the CREN center for nutritional intervention. But the sounds of crying babies and the exhausted faces of the mothers sitting in the waiting room made us all feel guilty that we were simply passing through on what felt like a tour of these people´s realities.

Our last stop was a local community garden that was being built to provide some of the residents with classes on how to grow their own vegetables, and maintain a garden as a means of supplementing the diets of themselves and their families. Just like in the United States, too often soft drinks and fast food make up the diets of too many who do not have the time or the will to prepare foods themselves, so initiatives like the urban or community gardens will hopefully provide a solution.

Getting Our Hands Dirty

On Tuesday, our first full day at CREN, we met with Paula the center´s pediatritian and were introduced to some of the children at the center. The first was a little girl named Victoria who was severely malnourished and as a result suffered from a very poorly functioning immune system. Because her mother felt that she had nothing to give Victoria, she refused to feed her anything much but breast milk for the entire first year of her life. As a result, Victoria had difficulty eating and accepting the solid foods provided to her by CREN. As I watched her cry in Paula´s lap and heard the story of how she came to the center, I became extremely emotional and almost started to cry myself.

We then saw a little boy named Victor who was a year or so older, but even more lethargic than she was. He came from an abusive home and had five other siblings. He suffered from a number of ear infections, respiratory problems and had dental caries that made it difficult for him to eat solid foods. Seeing these children was an incredibly moving experience for me. I remember thinking that it was nothing like reading about the symptoms of malnourishment in class, because they were no longer words on a page. Now they were transformed into a living, breathing human being, staring back at me.

         

Many of the children at the CREN center grow up in the favelas, or slums, of Sao Paulo. On Wednesday, we visited one of these favelas and a community center that had been built within it for use by the residents. I was unable to bring my camera that day as I was told it was not safe. Earlier that day there had been a strike due to the shooting of a subway driver, so tensions in the city were very high and transportation was difficult. We could only take the subway half way to the center itself, so we had to walk two miles or so, then take a small bus to the favela. Two women who worked at the center, a dietitian named Carolina and a student studying to be a dietitian, escorted us to the community center. The favela was nothing like I expected it to be. The conditions were very dangerous, with low hanging wires and poorly constructed overhangs. The air smelled damp and there were stray dogs running freely. The entire favela was very claustrophobic, no car would be able to fit on the dirt walkways between the homes that were stacked one on top of another.
I noticed that there were a number of construction workers with bulldozers working right next to the section of homes we were walking through, and it was not until we reached the community center that I learned what they were doing. As the residents of the favelas are squatting illegally and not paying to live there, the government will often come without notice and bulldoze sections of homes at random. Imagine waking up one morning in your bed, and by noon that day everything is flattened to the ground. Where do these families even go when they have so little to begin with? It was very difficult for me to listen to and the thought still haunts me.

The good thing is that these families receive free medical care from the clinics that are built specifically for their use and professionals are able to monitor the health of each family member to intervene when necessary.

Just the beginning!

Finally after a grueling 10 hour plane ride, I have arrived in Brazil! And although I was not able to get much sleep on the flight over, the city of São Paulo made my inital sleep deprivation far worth while. The city is not only beautiful, but incredibly unique. As it is not typically a stop for many tourists, the residents are clearly as curious of us as we are of them.

Yesterday after checking into our hotel and grabbing a quick lunch, we went on a walk down Avenida Paulista, the main street more or less. We did some souvenir shopping in a small market outside of Parque Siqueira Campos, and between the music, traditional crafts and the beautiful landscape from inside the park, I began to truly develop a feel for the city of São Paulo.

We woke up early this morning and took the subway to the CREN center for our orientation. We were only there for about two hours, but a woman named Malu gave us a tour of the center and we were able to meet some of the children currently being treated. We needed our friend Thaisa to translate for us, but just by watching Malu speak you could see how passionate she is about the work she does at CREN. The children were all so well behaved and friendly, it was hard to look past their smiling faces and imagine how much they have already had to struggle in their short lives. The CREN center not only provides in-patient care for severely malnourished children, but ambulatory or out-patient care for those that have less severe conditions. Five meals a day are provided to children receiving the in-patient care, along with lessons to stimulate them mentally that incorporate the importance of proper nutrition. There are also many programs provided to the children´s parents in the hopes of gaining their trust, which allows the CREN doctors and nutritionists to gain a better understanding of their struggles and barriers. I left the center feeling anxious for the days to follow when we will be able to work directly with these children and the employees at the nutrition center. 

For lunch I got my first taste of authentic Brazilian cuisine at a small local restaurant about three blocks from the center. This restaurant, like many of the others I have seen, provides buffet style service, which I think we all took complete advantage of by piling our plates high with rice, beans, fresh vegetables and savory meats. My favorite dish by far was made with chicken, or frango, and a thick delicious curried sauce. The most shocking thing I saw at the buffet were cubes of fried pork fat! While this is definitely not something I would recommend as a nutrition student, it was very unique! Each table also had homemade hot sauce, some of the spiciest I have ever tasted. The arrangements of peppers and vegetables used to make the sauce also made them beautiful centerpieces for the tables.  

Oi! Você fala inglês?

Oi! (That means hello in Portuguese) "Oi" along with a few other key words and phrases I've managed to memorize over the past few months, and a general understanding of the Spanish language from high school, is unfortunately the extent of my knowledge of the Portuguese language. Does this worry me as I'm about to head to São Paulo, Brazil for a week? To be honest it does, but only slightly...

Last semester I registered for a course entitled "Global Nutrition" with Professor Daniel Hoffman, as a number of friends of mine had taken the course during the previous semester and told me how much they had enjoyed it. It was a few weeks later that I learned how the course also offered students the opportunity to travel to Brazil for a week as part of a "service learning" experience in São Paulo. Being that the course focused on nutritional epidemiology, especially that of developing countries, students would be given the opportunity to volunteer at the Center for Nutritional Recovery and Education (CREN), a fully staffed center supported by the Federal University of São Paulo, Brazil where children from shantytowns are treated for under-nutrition. 

Obviously I have some reservations, I have only traveled out of the country a few other times in my life and have the same concerns regarding safety and the inevitable language barrier as any other traveler would, but mostly I am incredibly excited. I am very passionate about the field of nutritional sciences, and this is an aspect that I am particularly interested in learning more about. Not to mention, I will be exposed to an entirely new culture, which is why as I leave this evening for the 10 hour direct flight, I am bringing with me not only my passport and digital camera, but an open mind...

Até mais tarde! (See you later!)