Partnering with Communities
Transformation Happens Within Relationships
Favelas are makeshift Brazilian towns and cities, sprawling structures of tin and cinder block which house the poor, living in crowded and precarious conditions. Within them are complex internal systems of communal support which developed in the void of governmental assistance, the result of decades of neglect. Favelas are viewed by many as eyesores that lie on the outskirts of some of Brazil’s most exclusive neighborhoods. In Rio de Janeiro alone, nearly 25% of the population, or 1.5 million people, live in over 1000 favelas.
A recent story in the New York Times showed how grassroot communities in Brazil’s favelas partnered with scientists and physicians to substantially reduce the number of deaths from Covid-19. Residents in the favelas had no trust that the government would lend a hand to their neighborhoods as a result of the skepticism rooted in a long history of discrimination, neglect, or abuse from people in authority.
On their own initiative, community leaders in favelas mounted creative efforts to address the enormous challenges posed by the pandemic. Thiago Nascimento, a leader in the Jacarezinho favela, raised money to provide food and masks to those in need during the pandemic. He also co-founded LabJaca, a collective to report Covid-19 data, because of suspicions that official counts underestimated the numbers. LabJaca joined with other groups to accurately track the disease across 450 favelas in Rio de Janeiro.
Janice Delfim, a teacher and activist in the hilltop favela of Morro dos Praseres, printed out lesson plans for children; when schools closed, families didn’t have access to computers. She also appealed to nongovernmental organizations for donations of food, face masks, and hygiene products. In other favelas, community leaders installed faucets in heavily trafficked areas so that people without running water could wash their hands.
Fernando Bozza, a public health researcher, understood that he needed to work at a grassroots level through relationship building as Covid-19 spread to the favelas. He joined with other scientists in partnering with Redes da Maré, an NGO which had provided services to the residents of the massive Maré favela for a long time. Residents in the favela were the essential component of this coalition: Through it, the scientists provided free Covid-19 tests. When someone tested positive, a member of the group would offer to deliver food, cleaning supplies, and masks to the person’s home, as well as phone check-ins with a health worker.
Residents in the coalition relayed rumors that were circulating so the scientists could address and correct them. And neighbors with popular social media platforms, such as WhatsApp groups, Instagram, or TikTok, created content to combat misinformation that was spreading.
It was a continuous process of listening and relationship building, with community members being at the forefront of any initiative. The death rate in Maré dropped 60 percent after eight months of working with the grassroots coalition, compared to the 28 percent of people living in other favelas without coalition support.
Most public health scientists recognize that community engagement is necessary for the success of any initiative, whether the initiative aims for behavioral or environmental change. But collaboration requires real relationships maintained over time, not just in times of crisis.
The New York Times article mentioned two common problems that befall most public health initiatives. The first is that alliances built during the pandemic dissolved as projects shut down with the decline of Covid-19 cases. The second is that science is often attached to hierarchical models of knowing, causing advice from community members to be ignored.
The favela communities that formed coalitions during the pandemic continue to strengthen their bonds, even as outside support waned. Mr. Nascimento remains connected to community leaders from other favelas and they continue to coordinate efforts for the benefit of all of their community members. Together, they have helped residents impacted by flooding and tackled police violence. And more people have joined Ms. Delfim’s residents’ association because they, too, want to help. The emotional benefits of the way they came together during the pandemic are part of the ongoing, empowering collective experience.
When health professionals disappear immediately after funding dries up, or fail to integrate community input into their initiatives, communities reasonably question whether scientists and health professionals are worth the time of their continued investment in relationship building.
The pandemic was the impetus for the formation of dynamic and powerful partnerships all over the world. The opportunity is there to build upon them, nurturing both long distance (via the internet) and local relationships.
An ongoing relationship between health care professionals, scientists, non-governmental organizations, and partnership communities doesn’t have to be time-consuming, but it does have to be reciprocal. What is needed is the expression of interest and care, a willingness to share concerns, insights, and positive things that are happening. It might look like sharing a meal a few times a year with community representatives, or university-affiliated physicians having conversations with general practitioners who work out of storefronts, those that are there for their neighbors day after day.
A sincere desire for relationship with the communities whom we serve in any capacity will enable us to meet challenges as they arise. Partnerships between communities that are mutually beneficial and consistently nurtured are the most effective foundations for creative and lasting solutions, making us healthier, happier, and more resilient.
Thanks for reading The 3 Cs of Belonging: Care, Connection, and Community! Subscribe for free to receive new posts.