By nfiszer
This semester, I had the incredible opportunity to get to know various people and communities within Brazil through field study and community engagement. I was able to live in traditional rural communities and a major city, experiencing daily life and comparing the routines and relationships of Brazilian families, with my own life. I also gained access to health clinics and hospitals, getting a chance to study the health system close up through participant observation and interaction with providers. These amazing learning experiences culminated in the three - week period I have to conduct my own research about health here in Brazil. I chose to shadow and understand community perceptions of community health workers - a basic part of the Brazilian health care system that aims to provide preventative care services and human face to the health system for all citizens. The idea of a community health worker is something that has always interested me within public health, as it demonstrates the best of motivated community members taking action to promote health among their friends, families, and communities. By pinpointing which aspects are most necessary and impactful through the lens of community members, I hoped to provide insight into how a program like this can be strengthened, or established from the beginning.
I am conducting my research in an impoverished neighborhood outside of Ilhéus, a small city in the north of Brazil. The initial portion of my research consisted of shadowing the daily routines of community health agents to witness and understand the relationships and dynamics between them and their community patients. I was pleased but somewhat surprised by the way that I was warmly welcomed into each home without hesitation. While many of the community members do not have much, they were always willing to offer me their time and attention. Some days, I experienced some difficulty and guilt simply passing through these people's lives and seeing how little they had. Many people mentioned their difficulties in accessing necessities like food and water, and their poor living standards were often clearly visible in the construction of their homes. Particularly for populations like the elderly and those with chronic disease, I could witness the community health workers program clearly working by supporting these people and making sure they got the access to health care they needed.
One of the biggest obstacles I encountered was conducting all of my research in Portuguese. The second part of my research consists of informal interviews with community members, discussing the role that community health workers have and should play in their lives. My first day was both disappointing and frustrating, as many community members could not understand the questions I was asking or were not responding with the information I had hoped for. I found that some of my questions were too complex and open ended, and some things I was asking were off putting to community members. I went home and completely reworked everything, coming back the next day with a new strategy and an understanding that I would need to continue adapting with the community. Over the week, I got better at posing and explaining the questions in a way that people could understand and answer. I continued to have some interviews where people simply did not understand or were not interested in giving much information, but I began to use all of these experiences to improve my future interactions and interviews. I am proud of myself for working through the disheartening and frustrating aspects of research that I did not foresee, as well as the language barrier. As my first experience with research, this project has been difficult but rewarding. Qualitative research like this takes more time and analysis than I had ever imagined, and I hope to further develop my research methods through courses at GW after this experience.
As I finish my research this week, I hope that my final analysis will provide solid areas in which the role of the community health worker can be strengthened and improved. I hope to give my research back to the community and the health post with suggestions of how to best utilize this program. Apart from my research, I am incredibly thankful for the people I have met and connections I have made within this community. The professionals at the health post, including the community health agents, are some of the most dedicated and selfless professionals I have met, who truly love and live for their jobs. Several of these health workers are involved in various other community development projects, and have come to me for my advice and opinions. These projects include a simple waste management project putting public trash receptacles on the street, and a small library and computer lab for the community to use. Through my past internships in DC and experience with volunteer and grant-giving organizations, I hope to connect these inspirational individuals with organizations that might be able to help them do these things for the community. I plan on staying in touch and monitoring the progress of these projects, and doing what I can to help. Back in DC, I hope to continue my research on the benefits of community health workers in improving preventative health. Throughout my time at GW, I have worked extensively with the DC homeless population, and I am interested in looking into and working with community health workers for the homeless, which are being developed in different US cities. I hope to use what I learned about the role and success of this role here in Brazil to inform a program like this in the US.