What led Médecins Sans Frontières to open a project in Rio de Janeiro?

The project came in response to outbreaks of violence in May/June 2007 within the community called Complexo do Alemão, in Rio de Janeiro. During these episodes of heavy violence, there was a great deal of shooting, which led to reduced access to health care, schools or any other services- everything shut down. The unit was set up to provide health care to people directly affected by this violence, for example, people hit by stray bullets and those who have health needs as a result of the violence. We are based within the community and now, as the situation is quieting down, we are providing for more general needs. We now see between 200 and 250 patients per week on average.

What services does the project provide to the population of Complexo do Alemão?

Our focus is primarily on emergencies, especially the heavy trauma emergencies. In these cases, we stabilise patients at the Médecins Sans Frontières unit and refer them to specialised care; our medical team will treat them if we cannot refer them elsewhere. We are not dealing with chronic problems, such as controlling diabetes or hypertension, as there is already a system in place within the Government’s structures. The same is true for HIV and TB. We have a protocol to screen for acute problems that need to be treated on the day and the more chronic cases are referred to the appropriate places.

As the community is under tremendous stress due to exposure to the violence, psychosocial services have become as important as medical services. The Médecins Sans Frontières unit has local psychologists providing counselling services to patients on a daily basis. We have patients coming in with medical complaints that might primarily be psychological stress, and we can refer these cases to the psychologists. The psychological service is proving to be very beneficial for the community.

Are there other health structures in that area?

The Médecins Sans Frontières clinic is the only medical unit within the boundaries of the community. It is an area that is isolated from the rest of Rio. Barriers make conventional means of medical intervention virtually impossible – the police cannot come in, the ambulances cannot fit through the narrow streets; it is literally cut off.  On the outside there are health care facilities, there are hospitals and ambulatory services, but inside none of these services are available.