Jaunt to Joinville and Another Whirlwind Week

GA Day 88 (Feb 28, 2024). Time continues to move quickly by as work piles up, presentation deadlines become real, and more opportunities abound. And one impact is being way behind in blog postings! Much of the previous week was spent in Joinville with Maria Alice (who I co-supervised on her PhD) and her husband, Taiã. Both were wonderful hosts while I learned about the Federal Institute of Santa Catarina (IFSC), toured healthcare institutions, had a visit to a Quilombola, and met many wonderful people. The experiences of last week have been quite eye-opening in so many ways and probably the most humbling and moving of all my experiences to date in Brazil.

On Thursday, February 22, I did part 2 of my environmental scan workshop that was, once again, well attended. I think there were about 27 or so people, both graduate students and faculty, participating. It is always a great sign when most people return for the sequel. 😊 I got some very positive feedback on the topic matter and some great questions were asked about the methodology; I believe there may be some graduate students interested in using it for their work.

I also got positive comments on my teaching style and preparation; this was especially good to receive since I am used to getting scathing feedback from baccalaureate students who criticize me for expecting they read materials and come to class prepared or that I do not put enough information on my slides (essentially the materials they are expected to read) or "tell them what they need to know." This is but one of the reasons I am contemplating leaving nursing education in the near future but that is for a different blog at another time. The contrast here is that learning seems to be much more appreciated and valued.

On Friday, February 23, it was off to Balneário Camboriú (I just say "BC" because the pronunciation is too challenging for me) that is often called the Dubai of Brazil. I was so fortunate to have hitched a ride with João and Rita, friends of Angela, who have a condo near the beach there. Approaching the city the skyline the array of towers really did look like Dubai; however, unlike Dubai there is a statue of Jesus holding either a satellite dish or pasta plate on his left shoulder.

The beach in BC was so incredible and it is another wonderful paradise. I overnighted here to meet Athena, Gawdess of Tattoos, and I do not regret doing so. The place is beautiful with great eateries, a grand promenade along Rua Atlantic and the beach, and a much more energetic vibe than downtown Floripa. And if you ever go there, the BRUT by Slaviero Hoteis is a cheap and high quality place to stay - seriously a great value for the dollar with helpful people and a fantastic breakfast! I would definitely come back to BC for a longer stay and take in more of the sights and time at the beach.

Maria Alice and Taiã came to pick me up in BC for the trip to Joinville. The drive was a great time to get caught up on everything (so much has happened since last Summer!) and to see more of the Brazilian coastline. The main reason for going to Joinville, besides visiting Maria Alice was to see her university and the nursing program plus tour health programs there. Leading up to arrival in Joinville there was an incredible rain storm with an impressive lightning display that we caught the end of. It rained 120 mm in three hours that, with a full moon and high tide, led to some pretty spectacular flooding. Rivers were backed up and it was a right mess in places. I had no frame of reference, but apparently this was one of the worst rainstorms in quite a while - many roads were impassible and there were a few stalled cars with water over the hoods. I was to learn that Joinville is a rainy place in comparison to BC and Floripa - in many ways it reminded me of Vancouver in our winter season, but with native palm trees and much warmer. When the rain abated, the mercury rose to +31C with a humidex of +38C.

In Joinville I was to experience two distinctly Brazilian cultural traditions - drinking mate, a herbal tea, out of a communal cup (I suspect a few of you will find that quite amusing knowing my germaphobia) and a Brazilian BBQ. If I remember correctly, the name of the mate tea is Chimarrao and it is rich in caffeine (yah!) and herbal nutrients. I actually quite liked it, although in the heat was wondering if there might be iced options. 🤔 And the BBQ, well...that was a meatasaurus event on mega proportions and Taiã did an incredible job in the presentation. I then realized that most condos with balconies in this part of Brazil have built-in barbeques for this very purpose. Another reason to love Brazil!

On the Monday, February 26, I did a major presentation to nursing students and faculty but also others of the IFSC community to talk about my background, my nursing career trajectory, a bit about nursing and healthcare in Canada, and some of the history of colonial impacts on Indigenous peoples in Canada. I may have mentioned earlier that Brazil has a similar history of colonization and that Indigenous peoples here have also been hugely affected. As well, under the policies of Bolsonaro, there was an apparent further attempt to further inflict social injustice on some of the groups - almost bordering on genocide. I did not hold back on Canada's history of residential schools, the 60s Scoop, the unmarked graves of children, or the legacy of murdered and missing women. The presentation was quite well-received and there was a lot of interest in Canada's attempts at truth and reconciliation; we ran into a time crunch but over half the group of about 120 people stayed as we went overtime. As I said before, learning seems more valued here.

One of the highlights in Joinville was visiting the regional hospital and one of the primary health care facilities. Similar to Canada, Brazil has a public health system with a parallel private system for people with money; however, the for profit sector apparently does not guarantee any better care. One thing that is profoundly different is that Brazil's system includes pharmacare and dental coverage - everyone, in theory, has access to medications (critical for managing chronic health issues) and full dental care (in addition to tattoos there is a high prevalence of braces and perfect teeth!). I say "in theory" because there are many challenges with access to services in rural and remote areas of Brazil just as we have in Canada, as well as a workforce shortage in some health professions.

In the hospital there was a stark difference in terms of security and staffing compared to what we see in Canada. During the tour I noted that most people did not have any identification on them and that there was almost free access throughout the whole facility. Even as we went through the ER department the only time we actually got stopped was at the resus room as there was some event going on. Like our ERs, there were gurneys in the hallways with patients everywhere. As for staffing, most of the acute care (including in the ICUs) is provided by technical nurses that are like our LPNs. The RN ratio in ICU is something like 1:4 technical nurses and, for mechanical ventilators, there is only one respiratory technician on during the day. I asked whether there was much litigation related to patient safety and malpractice and the answer was not so much.

The one thing I have been told many times is that nurses here in Brazil are not well paid and not valued, at least in the hospital system. However, in the primary health care (PHC) system they are better utilized and have a very broad general scope of practice that includes advanced care. They do not have nurse practitioners but do deal with things like family planning, STI screening, PrEP, and other treatments. The PHC centres are much like our community health centres in Canada with a very diverse mix of health professionals that work very collaboratively together. The site I visited had nurses, GPs, a dentist, outpatient service for things like wound care, and space for specialists such as OBGYN, psychiatry, and the like. The PHC centres are a hub of care within each of the neighborhoods that includes community health programs. As well, they have a system of health outreach workers that go into homes to help with health promotion and support linkages to the providers.

The most humbling visit of all was with Maria Alice and one of her teaching colleagues, Josi, to one of the Quilombola settlements outside of Joinville. These communities were originally formed by groups of escaped slaves who would find uninhabited lands to set up a sort of shantytown. But the Portuguese colonists would attempt to hunt down and raid these settlements often killing the residents. Some Quilombola communities would be fortified with palisades and defenses to ward off attacks or would ally themselves with some of the Indigenous peoples. When slavery was abolished, the Quilombola communities were often regarded as squatters and harassment continued as loggers and ranchers tried to drive them off the land.

After a rather messy time of changing presidents, the Quilombola are now being protected and issued land titles for their settlements. However, the stigma and racism continues, as do other social injustices like structural barriers to services. We were welcomed to this settlement by the community's leader, her sister, and her daughter (Vanessa). Once we had earned trust of the three women (who I must say were an impressive and collective force to be reckoned with!), I was humbled by their warmth and generous sharing of history. In spite of the limited resources they have, it was clear they were rich with spirit and an incredible pride for their community. I learned so much about the history and the African-Brazilian culture they maintain in spite of the challenges. For instance, during the Lula transition to power, Bolsonaro supporters would intentionally harass their community, bring guns, and threaten violence (physical and sexual) to the 103 residents that includes young children. The police apparently did nothing to protect them - systemic racism at its worst. But the community banded together and rode out the political storm. I asked about how religion was part of their culture and was told that each Quilombola is somewhat unique, some practicing Christianity while others adhered to traditional African beliefs and values. In the case of this community, Catholicism is the main belief system.

The final visit while at the Federal Institute of Santa Catarina was a meeting with the leadership team that included two people from the international department based in Floripa. Unbeknownst to me was that these two people came prepared to discuss partnership - a bit of a surprise, to be sure! While one of my goals in coming to Santa Catarina has been exploration of potential partnerships I am well aware that it takes time to forge relationships, determine what contributions might be made by each of the parties, and to negotiate expectations. It is hard not to get caught up in the excitement and be enthusiastic of blasting ahead to capitalize on these opportunities but there are so many things to consider - language, logistics, legalities, and all the related challenges and facilitators. Language, alone, is huge for prospective students from either side of the hemisphere and, as I have discovered, there is no translation app that can quite capture all the necessary thoughts and nuances needed to function in a culturally different place. And apps are also not that efficient when it comes to communications.

At the end of this visit to Joinville and the stops to BC enroute I have continually been impressed with the generosity of people and the connections I have made thus far. Thank you to Maria Alice, Taiã, the IFSC people (Josi, Sarah, and everyone else!), and all the folks from the hospital, PHC centre and Quilombola for your gift of time, knowledge, and cultures! I hope to be back to learn even more from all of you.