Brazil: MSF provides emergency care in Complexo do Alemão, a deprived neighbourhood of Rio de Janeiro

It’s a warm noon of February in Complexo do Alemão when shooting suddenly starts. Complexo de Alemão is a deprived and violent neighbourhood of Rio de Janeiro, one of the main cities in Brazil. The area is well known for regular clashes between local armed groups and with the Rio de Janeiro police forces. The local population, estimated to be around 150,000, lives trapped in the violence.

Since October 2007 Médecins Sans Frontières (MSF) has been providing emergency and mental healthcare to the excluded population living in the area.

“We visited Complexo do Alemão and we found out that due to the peculiar violent situation there were difficulties of access to quality and timely medical and psychological care for the inhabitants, especially during fighting” says Alberto Cristina, Head of Mission for MSF in Brazil. “Once the main needs had been assessed, we decided to open an emergency room”.

Sonia is at home. She is 40 years old and she suffers from heart problems. After two hours of uninterrupted shooting close to her house she starts feeling bad, she can hardly breathe and feels palpitations. When fighting occurs there is no means of transportation, Sonia cannot move from her house. Her brother decides to go out and rush to the MSF emergency unit with her medical records.

MSF runs an emergency room in the community of Fazendinha, located in the heart of the neighbourhood, where four main services are offered: emergency care, mental health services, referrals through MSF vehicles and orientation to patients not fitting into the MSF admission criteria.

Right away the MSF car goes out to pick up Sonia at home. When she arrives in the MSF unit Sonia receives a red code. Her electrocardiogram shows a serious arrhythmia, the MSF medical team assists her immediately. Thanks to the defibrillator action, an acceptable heart rhythm is re-established. Once Sonia is medically stable, the psychologist approaches her to provide mental health support. If she wants to she can come back to the MSF centre in order to discuss ways to better cope with her anxiety problems. At the end of the day the calm has been restored in the neighbourhood and Sonia is transferred by an MSF car to a second level hospital, 20 minutes outside Complexo do Alemão.

In addition to emergency care, MSF offers psychological support to people living in similar situations as Sonia, affected by the violence. There is also the case of Maria, a young girl who was one of the direct victims in an attack several months ago. During the fighting many children were wounded, Maria was one of them. She was transferred to the hospital where she had to undergo surgery three times. Today, Maria has recovered from the external physical wounds but not from the most hidden ones. Maria regularly attends individual sessions with the MSF psychologist.

“In February we visited 776 patients. One of the goals of our action is to reduce the time between the trauma and the hospitalisation”, says Gianfranco De Maio, medical doctor for MSF in Brazil. “We need to treat the patient during the first 60 minutes after the time of the injury. I remember a  patient  our medical team assisted, a man wounded by gunshots: he arrived at the emergency unit in serious condition, we stabilised him and then we transferred him to the reference hospital”.

MSF medical staff implement several techniques such as the advanced trauma life support, establishing an efficient triage able to rapidly diagnose patients needs.

Since the beginning of its activities, MSF has attended almost 3,000 patients mainly for violent and accidental injuries, respiratory tract infections and suspected dengue fever, among others. All patients are screened before being treated, referred or transferred to other public medical structures.

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