Monday, December 24, 2012

Christmas 2012

What a joyful day, Christmas Eve. During my upbringing in the States, Christmas Day was the Big Day for families and especially children. Early in the morning on Christmas Day, families gathered round the Christmas tree and presents were opened. This seremony is done during the evening on Christmas Eve here in Norway as in most countries in Europe.

What I have taken with me from the States in our family tradition with turkey dinner, stuffing, mashed potatoes. And I'm the cook today. The turkey was made ready for the oven yesterday. 8.5 kg (18.7 Ibs) is the largest turkey we could find at the local store. The bigger the turkey the better is what my father always said. I remember one year as a child in the States my father said that the turkey we had was so big that it's head was outside the stovedoor during while it was in the oven. And I of course believe him. Everything is big in the States.

I'll put the turkey in the oven today around 10AM and let stay ther for around five hours. After that I'll let it rest for another two hours before serving it. The traditional stuffing I make is with bread, fried onions, mushrooms, bacon, lemon, parsley, celery, milk, butter, eggs, and a special seasoning mix I get from my aunt Unni every year from the States. Brussels sprouts, carrots, and mashed potatoes are a must. We'll be eating all this wounderful food this evening. And after dinner, CHRISTMAS PRESENTS WITH SANTA!

My son Eirik came home from Oslo yesterday and will be with us this Christmas. My daugther Kristine and her husband Steen are coming here later today togehter with our grandchildren Leo and Herman. They'll be staying till tomorrow. The greatest present of all is having ones family gathered togehter for Christmas. My other daughter, Anette and her husband Tom and our other two grandchildren Stella and Nora, are in Bergen this Christmas with Tom's family. Miss them, but I'm sure their going to have a great time in Bergen. 

It's still early Christmas Eve morning here in Sandefjord, Norway. A cup of coffe, a quiet house, and lots of snow outside. Thoughts go to why we celebrate Cristmas, and I am greatful. 

To all my followers and friends here on my blog, I wish you all a Merry Merry Christmas. 

My parents. Torgny and Ulla, in a winter Wonderland in Evje, Norway, 1973. Thanks for fantastic memories.

Sunday, December 23, 2012

A Merry Fucking Christmas to you too

As a social worker I visited a young man for a while back. Lets call him John Doe. There are many John Does out there. This John Doe is a drug addict with psychological problems and socially excluded from society. He has no where to live. Lives here and there. He has three children, all with different women. Child welfare has taken over the care for the three children and placed them in foster homes. All three children have learning difficulties and the youngest one has also severe psychological and phsysical problems because of her mothers drug addiction during pregnacy. 

I have known John for 15 years. I think I know just about everything there is to know about him, but what do I know. He has been beaten and sexually misused by his father as a child. He stopped going to school when he was 10 years old. He says he has never had a childhood. Never had a job. Has been on disability pension since he was 18. His mother took her life when he was 12 and he had to live with his alcoholic father until he ran away from home as a 16 year old. He has never received help from child welfare, a school psychologist, or recieved any form for psychiatric help. He has been in prison for eight years, mostly in solidary isolation. All of his convictions have been for violence against authorities, like me. He says he is good with his knife that he always bears on him. His younger brother killed himself with a knife last year. Cut his throat. I knew him also very well. Had the same upbringing as his elder brother John.

John and I sit on the floor and talk about all the years we have known each other. I ask him why he trusts me and has never been violent towards me. He answers that he believes in me. Everyone needs to believe in someone, he says. "But I have never be able to do anything for you", I tell him. And he looks at me, with almost glowing eyes that lay deep in his eye sockets and smiles, " No. But you've never promised me anything either, you've just been here for me", is his answer. John becomes more and more unjust during my visit, he becomes restless and starts to say some weard things. He goes to the bathroom and takes a syringe of morphine that he has got from his doctor. When he comes back, he's calm and smiling. He says that after taking his daily dose of morphine, he feels almost normal. Without morphine, he says he feels sick. 

That has my visit with John. A Christmas visit. He lead me to the door, opened it for me and I steeped out. I reached out my hand to him, but he wouldn't take it. We looked at each other for a couple of seconds, before I wished him a Merry Chirstmas. He looked at me with tears in his eyes and said, "A Merry Fucking Christmas to you too". He closed the door and I had also tears in my eyes as I left him behind me. 

This Chistmas, my thoughts go to John and all those who have difficulties with Chirstmas. A Merry Fucking Christmas to all of you, and take care.

Kaare T. Petttersen

Friday, December 21, 2012

Race in Another America

I've just finished an in-depth reading of a wonderfully written book called: Race in Another America. The Significance of Skin Color in Brazil.  The author, Edward E. Telles is Professor of Sociology at the University of California, Los Angeles. The book has won a number of prizes, both in the US and in Brazil. This is really a book I recommend. Thankyou Jean Carlos Handlykken Luz and Åsne Handlykken Luz for giving me this important book when I met you in Rio de Janeiro in November 2012.

Understanding Brazil is not an easy task. I've been to Brazil six times in the past few years carrying out two research studies there. One in Rio de Janeiro and one in Espiríto Santo. The first thing I needed to learn was to dismiss the notion that I could understand Brazil with a Norwegian way of thinking. As most Norwegians I like to define things as clearly as possible and I am quick to categorize my observations. Brazilians on the other hand seem to celebrate ambigity. After several years of contact with Brazilian culture and inhabitants, and after many months of visting the country, I am just starting to understand how important it is to leave my Norwegian way of thinking in Norway when I'm studying Brazil.

Brazil is the world's most miscegented country and the world's most unequal country in the same breath. Racial inclusion and exclusion coexist in this vast country. Race in Brazil refers mostly to skin color or physical apperarence, rather that to ancestry -like in the US. If you have a drop of African blood in your veins in the US, than your black. In Brazil, large numbers of persons who are classified as white (branco) have African ancestors. The Brazilian Institute of Geography and Statistics (IBGE) have since 1980 used five different categories in their statistics: White (Branco), Brown (Pardo), Black (Preto), Asian (Amarelo/Yellow) and Indigeous (Indígena). Since only one percent of the nations population is Asian or Indigeous, we can speak of three main categories or skin colors in Brazil: White (Branco), Brown (Pardo) and Black (Preto). The Brazilian Black Movement has started to use only two skin colors: White (Branco) and Black (Negro) in an effort to destigmatize the notion of being black in Brazil. There are 80 million blacks or browns in Brazil. That is half of their whole population of 173 million people. In the USA their are 30 million blacks or the equivalent of 12 percent of the total population of 270 million people.

Brazil was the last country in the western hemisphere to abolish slavery. This was done in 1888. Between 1500 and 1850, over 3.6 million slaves were brought to Brazil. In 1988 Brazilan Constitution revolutionized the legal basis of the defense of human rights. The Constitution also recognized principles of tolerence, multiculturalism, and individual dignity, rights and identities, and became the basis of hundreds of antiracist laws at various jurisdictional levels. But it was not until the mid 1990's that the Brazilan state started to regcognize racism in Brazil and implement racial reforms. There is now widespread recognition of racism by Brazilian society and the Brazilian government has begun to search for ways to deal with racism. Brazilian elites, academics, media, and policy makers have just in the past 10 years begun to openly discuss racism and racial inequality. Social exclusion, including discrimination, poverty, and violence, continue to be persistent problems in Brazilian society, disproportionately affecting the black and brown population.

Brazil is renowned for being the world champion in overall income inequality. This inequality is the root for all of Brazil's major problems, including its poverty, poor health and education systems, high rates of crime, and the lack of social and political integration of the majority of the population. Black and brown men earn 40 to 50 percent of what white men earn in Brazil. The top 10 percent of Brazilians earn incomes worth 52 percent of the total income of all Brazilians. South Africa has the second most unequal structure among the large countries in the world, in which the top 10 percent of South Africans earn 47 percent of the country's total income. This high rate of poverty, couple with the sizable large number of persons in the top 10 percent, relects the status of Brazil and South Africa as the two most unequal large countries in the world. Brazil is at the same time the seventh-largest economy in the capitalist world. Siince the 1950's, Brazil has experienced a tremendos economical growth, making it on of the largest industrial economies of the world. A growth that has disproportionately benefited the white middle class. One third of the population lives in poverty.

Blacks and browns are nearly absent from the middle class in Brazil. Many whites also live in poverty in Brazil. This means that poor whites, browns and black have to compete for teh same jobs and they compete to enter the middle class. Poor whites tend to be preferred to poor browns and blacks in schooling, and middle-class jobs. This makes it difficult for browns and blacks to come out of poverty. Most difficult is the situation for black women. They are considered the poorest of the poor. They confronty greater health risks, are especially affected by poor reproductive-rights policies, are severely isolated, and are more subjected to violence.

Kaare T. Pettersen

Telles, Edward E. (2004). Race in Another America. The Significance of Skin Color in Brazil. Princeton: Princeton University Press.

Thursday, December 20, 2012

Seksuelle overgrep - Den skjulte byrden

Verdens Helse Organisasjon (WHO) har definert en skjult byrde som “en stigma som er under-rapportert og som dermed er vanskelig både å måle og evaluere”. WHO definers stigma som “et tegn på skam, vanære og kritikk som resulterer i at individet blir unngått eller avvist av andre”
(Mental Health Problems, Sheet nr 218, Nov.2001). Et slikt fenomen som er vanskelig å definerer og derfor også vanskelig å måle er  "mishandling".

Omfangsstudier viser at det kan ofte være vanskelig for forskere å få eksakte målinger av hvor mange menn og kvinner det er som har vært utsatt for seksuelle overgrep. Finkelhor (1984) sier at mellom 9 og 52 prosent av alle kvinner og mellom 3 0g 9 prosent av alle menn har vært utsatt for seksuelle overgrep. En undersøkelse gjort av DeMause (1991) viser at 60 prosent av alle kvinner og 45 prosent av alle menn har vært utsatt for seksuelle overgrep. En verdensomfattende undersøkselse gjort av FN i 133 land (2006) viser at mellom 13 0g 27 prosent av alle barn i verden har vært utsatt for seksuelle overgrep. Noe som er felles for alle disse undersøkselsene er at det kommer ikke klart frem hvordan de definerer seksuelle overgrep. Man lar den enkelte respondent selv avgjøre hvorvidt det de har opplevd er seksuelle overgrep eller ikke. Da kan alt fra verbale krenkende utbrudt som "din hore" til voldtrekt og incest være seksuelle overgrep i disse undersøkelsene.

En undersøkselse hvor ulike former for seksuelle overgrep er tydeliggjort er av Mossige og Stefansen (2007). De har gjort en studie blant 7033 elever ved 67 ulike videregående skoler. Deres resultater viser at  22 prosent av jentene og 8 prosent av gutten har opplevd mindre alvorlige former for seksuelle overgrep som beføling, mens 15 prosent av jentene og 7 prosent av guttene har opplevd alvorlige former for seksuelle overgrep som samleie. 9 prosent av jentene sier de har opplevd voldtekt eller voldtektsforsøk. Dette viser at det er viktig informasjon å hente med å være tydelig på hva man ønsker å finne svar på i undersøkelser, ikke minst når temaene er tabubelagt som de er med seksuelle overgrep.


Barnevernet i Norge registrerer alle nye barn som får hjelp av dem hvert år. De registerer både hva slags hjelp de får og hvorfor de får denne hjelpen. Dette er med å dokumentere den store innsatsen de gjør mht til et megt vanskelig samfunnsmandat som de har. Men hvor mange barn får hjelp i barnevernet hvert år pga seksuelle overgrep? Tabellen under viser at det i 1993 var 9937 nye barn i barnevernet som mottok hjelp mens det i 2010 var hele 13727 barn som mottok hjelp. Antall barn som har mottatt hjelp pga av seksuelle overgrep har gått ned fra 199 barn i 1993 til 99 barn i 2010.

Tabell 1: Nye barn i barnevernet (Kilde: SSB)

 Under 1 prosent av nye barn i barnevernet mottar hjelp pga seksuelle overgrep. Dette er vanskelig å forstå når undersølsen til Mossige og Stefansen (2007) viser at 15 prosent av jentene og 7 prosent av guttene har opplevd alvorlige former for seksuelle overgrep som samleie, mens 9 prosent av jentene sier de har opplevd voldtekt eller voldtektsforsøk. Man skulle tror at barnevernet ikke bare gav hjelp til disse barna, men også til mange flere. Etter mitt syn er dette et argument for at seksuelle overgrep er en skjult byrde, noe som er vanskelig å snakke om og søke hjelp i forhold til. Ikke bare er det vanskelig, men mange forsøker til å med å holde denne erfaringen skjult for hjelpeapparatet og andre. Mange, mange barn får hjelp av barnevernet i Norge, men få av dem får hjelp begrunnet med seksuelle overgrep. Begrunnelsen for hjelp kan være atferdsproblemer, problemer på skolen eller i hjemmet, foreldre med psykiske problemer eller rusproblemer, mm. Men det er skremmende at det var 199 nye barn i barnevernet i 1993 som fikk hjelp grunnet i seksuelle overgrep, mens antallet i 2010 var gått ned til 99 barn. Dette er med på å skjule seksuelle overgrep som et alvorlig problem for mange barn i samfunnet.

Politi og domstolene

Tall fra Statistisk sentralbyrå (SSB) for 2010 viser at 724 personer ble straffet for seksuelle overgrep dette året, hvorav 716 menn (98.9%) og 8 kvinner (1.1%). Tabellen 2 viser at kun 2 personer ble straffet for å ha begått incest i Norge. Når vi vet at seksuelle overgrep skjer oftest innenfor hjemmets fire vegger, må man spørre om 2 straffede (begge menn) i 2010 gir et riktig bilde av det som er et alvorlig problem for mange barn i Norge.
Tabell 2: Type seksuelle overgrep, antall straffede for delt på menn og kvinner for 2010 (Kilde: SSB)

Problemet her handler om at etterforskning av incest saker er kanskje noe av det vanskeligste og mest krevende etterforskningssaker politiet har. Det skal legges frem bevis for domsstolene som bekrefter ata overgrep har funnet sted. Vi har saker hvor menn og kvinner er blitt uskyldig dømt for påstått overgrep. Av den grunn er det viktig at politiet gjør en grundig jobb i etterforskningsfasen. Og politiet er blitt meget flinke. De er skolerte i det å samtale med barn, de har tillit i vårt samfunn, de våger å være i vanskelige situsajoner over tid, og behersker etterforskning som metode. Når kun 2 personer blir straffet for incest i 2010, betyr ikke dette at det var 2 barn i Norge som ble utsatt for seksuelle overgrep av sine fedre i 2010, men at det var kun 2 saker som var godt nok etterforsket at de førte til straff.

Tabell 3 (under) viser at antall anmeldelser til politiet om seksuelle overgrep mellom 2000 og 2010 har økt kraftig, fra 2713 til 4160. Men antall anmeldelser av incest har gått ned fra 84 til 77. Vi ser av tabellen også at antall domfelte i samme periode har gått opp fra 356 til 724 (1999). Dette synes å tyde på at seksuelle overgrep har høy prioritet hos politiet og at de er blitt dyktigere til å etterforske slike saker. Men tabellen viser også at antall domfelte i incestsaker har ligget nokså stabilt i denne perioden på 2 personer hvert år.  

Tabell 3: Antall anmeldelser om seksuelle overgrep mellom 2000 og 2010, antall domfelt og prosent av anmeldelser som førte til domfellelse. Tall for incestsaker er i parantes (Kilde SSB)

Legg til bildetekst

Tabellen viser at antall anmeldelser som fører til domfellelse har økt fra 13.1% i 2000 til 17.6% i 2009. Det er flott at vi ser en prosentvis økning i perioden, men dette betyr at det fortsatt i 2009 er 82.4% av anmeldelsene som ikke fører frem til domfellelse. Men enda verre blir dette i incestsakene. Her er økningen fra 1.1% i 2000 til 2.8% i 2009. Hele 97.2% av de anmelde incestsakene fører ikke frem til domfellelse. Igjen viser dette hvor vanskelig det er å etterforskse disse sakene på en slik måte at de fører til domfellelse.

Avslutende tanker

Mine tanker går avslutningsvis til de mange tusen personene som hvert år anmelder seksuelle overgrepssaker til politiet, men står igjen etterpå med uforrettet sak. De er ikke blitt trodd. Uansett om overgrep faktisk fant sted eller ikke er spørsmålet - hvem følger dem opp? Trenger vi et nytt system som fanger opp alle disse konfliktsakene? Kan konfliktrådene, barnevernet, familierådgivningen, psykiatien og politiet bemannes til å ta disse konfliktene og samarbeide for å løse dem til beste for alle parter? Noe må gjøres og vi trenger radikale løsninger - NÅ. At 97.2% av anmeldte incest saker i 2009 ikke fører frem i retten, betyr ikke at det er kun 2 barn som ble utsatt for incest dette året, men at det finnes mange hundre familier i en krise, hvor en voksen tillitsperson for barnet er blitt mistenkt for å ha begått seksuelle overgrep. Disse sakene er krevende. Barn lider, de voksne lider, søsken lider, familiemedlemer lider, og denne lidelsen blir holdt skjult som en skjult byrde for hele familien og omgivelsene. Noen må ta ansvar for å gi disse barna og deres familier hjelp NÅ.
Kaare T. Pettersen

Wednesday, December 19, 2012

A public health study with CEPAS, Brazil

A public health study of 705 families and 2616 family members in a poor living area in Brazil

Professor Pedro Fortes
One of the research projects Østfold University College is a part of in Brazil is together with Professor Pedro Fortes from the Federal University of Espiríto Santo and founder of CEPAS. Medical students from UFES have, under the supervision of Professor Pedro Fortes, a period in their studies with practical social medicine at CEPAS. CEPAS stands for Center of Studies in Promotion of Health Alternatives or as it's called in Portuguese; Centro de Estudos de Promocão em Alternativas de Saude. One of the tasks they have is to interview families about health and living conditions by use of a questionnaire. They have interviewed around 1400 families in the last 10 years (2000-2010). All of these families live in a poor living area that surrunds CEPA. The study can therefore be valuable as a longitudinal study, and see changes in the area over a 10 year period. 705 of these interviews are being analyzed in this study by Kaare T. Pettersen from Østfold University College. The first step was to transfer the answers given on the questionnaire to the statistical data program SPSS. The data has thereafter been analyzed to find correlations both over the 10 year time spread that the and between different variables. A total of three scientific articles are now beeing written with results from this public health study.

The questionnaire has a total of 48 questions with 203 variables and is approved by the research ethical committee of UFES. Part 1: Family (n=705). 28 questions concerning : living conditions; and family economy; -and with a total of 113 variables. Part 2: Family members (n=2616). 20 questions concerning: education; work; health; religion; maritial status; family relationship; - with a total of 90 variables.

A total number of 167 medical students have carried out the interviews in this study. Most of the interviews are carried out by groups of 2-3 students, but in some of the interviews 5-6 students participated.  The first interview in this study was carried out August 3rd 2001 and the last June 19th 2010. The students used 214 days to visit 705 families between 2001 and 2010. They visited on an average 3 families per day, with a range from 1 to 12 families per day. The statistical data will give an overview over important socio-economic issues (including health, education, beliefs, etc.). 
Kaare T. Pettersen

Tuesday, December 18, 2012

Center of Studies in Promotion of Health Alternatives , Brazil

Center of Studies in Promotion of Health Alternatives 
Jacaraípe, Espírito Santo, Brazil
Østfold University College (OUC) has had a formal agreement of intention with the Federal University of Espiríto Santo (UFES) and CEPAS, for developing research projects together and to have student and teacher exchange programmes, since July 2010. The "Center of Studies in Promotion of Health Alternatives – CEPAS" is a non-governmental organization, without lucrative goals, recognized as being of public utility in the city of Serra, state of Espírito Santo and that developed in partnership with the department of social medicine of the Federal University of Espírito Santo – UFES the extension project: "Primary CommunityHealth Care" (PCPSC).
The motto for CEPAS is "having initiative and defending life" and, as an orientating principle, what the World Health Organization advocates as the definition of health, which is not just the absence of diseases, but also the complete physics, mental, social and economic well-being. The major concern is not in promoting cure, but consists of teaching the prevention of diseases by means of primary health care.
In commitment to the preventive health work, CEPAS promotes professionalizing courses that permits self-sustainability of the aims: community; opening doors for individuals; and group citizenship. CEPAS has no connection to religious or political entities.
Jacaraípe (the rich)
Jacaraípe (the poor)
CEPAS itself and its network has grown, and most important a lot of work has been put done. Today, CEPAS takes place in allotment Laranjeiras, in Jacaraípe, city of Serra, state of Espírito Santo. Everything that is known of CEPAS today began with an idea from the entrepreneur of the project, who is also professor at the Federal University of Espírito Santo (UFES), Pedro Florêncio da Cunha Fortes. However, the ideal of Professor Fortes would be very hard to be fulfilled without the help of the tutors, students of medicine and nursing of UFES who take part on the project and coordinate, along with Professor Fortes, not only the curricular activities but also the extra-curricular activities that take place there.
With the actual team that follows CEPAS, it has been tried to turn CEPAS more actual, in the way to make it more accessible and dynamic. One of the branches of this modernization is this new website, more dynamic, modern and actualized.

1.    Background
The idea behind CEPAS started already in 1984 by Professor Pedro Florêncio da Cunha Fortes. Its activities began in the districts of Cristal and Morro da Caixa D’água, both in the city of João Neiva, at the countryside of the State of Espírito Santo. By that time, CEPAS was already connected to UFES.
At these communities, the impact of the medical students' presence brought results, but the difficulty in dislocation made the program move to Laranjeiras allotment, near Jacaraípe, city of Serra, 25 Km far from the capital, Vitória. The easier dislocation turned possible a more expressive students' acting, who were more stimulated to work on the project, due to the proximity. In this new reality, the benefits brought to the population enlarged, and are growing day after day.
Pedro Florêncio da Cunha Fortes
The population of Jacaraípe has identical social issues, as the ones observed in João Neiva, and very similar to those found in any areas at social risk around the globe. At the beginning, the students' participation was limited, although it grew quite rapidly. Therefore, the project needs very intensive work, so that all the interested students are able to participate, including exchange students that come from many countries, such as Austria, Germany, Norway and Netherlands.
Nowadays, CEPAS counts on the unconditional work of its idealizer, who not only coordinates CEPAS, but is also responsible for the subject Health System, during the first year of the medical School, at the Federal University of Espírito Santo (UFES). The other part of the work at CEPAS is made by the students of the subject Health System and their tutors. Students who choose to go to CEPAS are divided in groups and are oriented by the tutors of the subject, so that they can cooperate with the work.
The tutors are also an indispensable part of CEPAS. Today, nine tutors work at CEPAS, although this number can vary as some tutors enter or leave the project. Nowadays, students of the fifth and sixth semester of medicine and nursing take part on the project. The tutors are very interested in their work at CEPAS, and want to see their actions perpetuate; so, they go to CEPAS every Saturday. During their vacations, tutors choose days of the week to do their work there. One can say that the tutors are the right hand of professor Pedro Fortes, assuring the maintenance and the functionality of the project, with serious competent work. Volunteers are also welcome at CEPAS and work at Saturdays.
Another important part of CEPAS is the community itself. CEPAS work is based in a system of changes: the health care, the primary attention and the assistance to children and teenagers are rewarded by the work of some mothers, who help to clean the place, cook for the children and do other maintenance work in the project.
In 2010, a description of CEPAS is: a group of people interested in having initiative and defending life above everything: "Constructing dreams and citizenship". There are many slogans and guidelines that could define CEPAS. Despite that, it's very difficult for us to choose words that represent perfectly our work at CEPAS. Therefore, we prefer not to restrict ourselves to words, by work so that we are able to defend life, build dreams and promote citizenship, health, social integration, education, and everything we can assure.
CEPAS as a Center of Studies in Promotion of Health Alternatives is not just an institution, but a group of people who have the same ideals and goals: to defend life and help people who work to realize their dreams.
Associate Professor Kaare T. Pettersen from Østfold University College  discussing research findings with the founder of CEPAS Professor Pedro Fortes

2.    GOALS
CEPAS establishes, as its major goal, the promotion of health and citizenship in communities located in risk areas by means of health orientation and assistance, prioritizing health education as preconized by the International Conference about Primary Health Care that took place in 1978 in Alma Ata.
At the same time, CEPAS acts in the formation of university students of the most different areas, offering the opportunity of a contact with our country's social reality.
Professor Fortes in conversation with a seamstress in the poor living area of Jacaraípe
The philosophy of the program is not to give donations to the poor and needing, but working in order to defend individual social dignity and to create opportunities for self-sustainability for the approaching population.

2.1. Community's Goals:
Increase the development of the community by the following actions:
- Increasing the community`s health knowledge;
- Call attention to the need of a better knowledge about the resources and existing needs in the community;
- Cultivating the knowledge about prevention of diseases and the plain health concept since the younger until the elderly people;
- Developing the communitarian spirit in the inhabitants, with focus on propitiating children young people, women, elderly and so on;
- Training multidisciplinary teams by giving adequate training;
- Making possible a real social ascension through specializing courses that assure the maintenance and an improvement in life quality.

2.2 Students' Goals:
- Making the university students aware of the social reality of the community, promoting direct knowledge application in loco.
- Training the university students as technicians specialized in primary health care and creating a multidisciplinary team, calling attention to the need of a common universe of action.
- Making possible the creation of fixed teams of technicians and volunteers, focused on the exchange of experiences and the continuity of the program.
- Promoting the university students means that let them understand their suggestions and aspirations to an educational policy, which prioritizes the community's health and the subsequent life quality improvement.

3.1           TUTORS
Tutors who work at CEPAS, majorly, study at the Center of Health Sciences of the Federal University of Espírito Santo. These tutors are Medicine and Nursing students from the second year onwards. Each semester, the tutors group is renewed. Below, you can see a list that contains the actual tutors group:

CEPAS is an organization without economical profiting goals. When it comes to money, the situation is not simple. We receive some support from Federal University of Espírito Santo (UFES), but, if there was no contribution coming from the community, enterprises and other organizations, CEPAS would probably be in great financial difficulty.
Today, the amount of tutors is enough and supplies the basic needs of the approaching population. However, our satisfaction with our job is not enough. We would appreciate if there were more resources, of course; but we would be particularly happy to receive in the project anyone who could help us by working in any field useful to the community itself.
The fact is that we have no developers, except the tutors. Therefore, we would really feel grateful if the spaces above were not empty. More than that, by seeing several names in the list of tutors, we feel that we are capable of making the difference for some people. That is the only way to spread our work and, then, to make a bigger difference to the population we help.

The area of ​​operation corresponds to a region which lies near the resort of Jacaraípe - Sierra, about 25 km from Victoria.
Laranjeiras was in the early nineties was home to about 2,000 families, all with great fecundity (average of more than 3 children / mother) and consisted of a high-risk area, subject to drug trafficking and high level of violence.
We realized over the years that the lack of opportunities was a constant challenge for all age groups, unemployment, absenteeism, child exploitation, training and poor threat to future generations that would enter the labor market. The population was exposed to extreme risk because of the activity of drug trafficking in the region, creating a situation of extreme violence.
After 16 years in the neighborhood, infrastructure has improved, 70% of streets were paved, 80% of households have access to piped water, since it is uncommon to find today, a house that uses dry sump, or otherwise to eliminate their waste.
There is a nursery school hall, two municipal schools from 1st to 8th grade, and a public school high school, with almost all children enrolled (although the teaching of poor quality), however, the problem of family structure, poor and no areas recreation create problems for children who use most of their time on the streets.
Access to employment is better, prevailing informality due to low education; the population of this area shall be reserved for low-paid occupations, which makes them easy targets of seduction offered by drug trafficking and other criminal activity, whose activity remains intense, the incidence of homicide rates is largest in the country.
The population is served by a Health Unit, however no favors primary prevention activities
In the last survey conducted on 29/05/06 data showed that 912 families are registered in the strains and this corresponds to 3407 people, that is, an average of 3.736 persons per household.
When we analyzed the health data is observed in all blocks a triad always Sedentary 19% of the population (less physical activity at least 4 x 40 min per week), smoking and 14% 12% hypertension, showing high prevalence of risk factors for cardiovascular disease, so this is a great challenge for the project now and in coming years.
But when we observe the hygiene habits of the population and when correlated with clinical findings (diarrhea, abdominal pain, iron deficiency anemia, positive parasitology) concludes that the new suspected cases of parasitizes is a proportion of 6% over the entire population visited upon registration.
The epidemiological transition is a reality, diseases such as obesity (with dramatic reduction of malnutrition), diabetes, hypertension and sedentary lifestyle have emerged with increasing force, which add to existing problems, especially infectious and parasitic diseases, smoking and alcoholism.
During the registrations were found 30 patients (1% of the population), all of which are accompanied during the prenatal and lactation in partnership with the group of integral attention to children's health.
No significant difference between the sexes, except for alcoholism, the CAGE (Cut down, Angry, Guilty, Eye opened) reaches the alarming prevalence of 7% among men, and only 1% among women.
The above information is outdated, and is part of the modernization project CEPAS the computerization of records of registration and reregistration in order to allow tabulate the information obtained in areas with more agility, updating the data already available

The CEPAS, and extension activities, students attend the 3rd period of Medicine UFES to perform the practical part of the discipline of Epidemiology II. Both have their eyes on the promotion of health through primary prevention guidelines for basic and easy to assimilate. His philosophy puts the college student as a social actor of transformation, and most of the work they conducted.
CEPAS runs daily tutoring and vocational courses. Especially on Saturdays to make academics attend the meetings of the health groups and home visits.
The CEPAS field area in four sectors
The field is divided into four sectors, where the population is registered, regardless of their participation in the project for purposes of demographic research. The CEPAS health programs, home visits and professional training courses through two fronts: the "health groups" and "Skills development". Each front is independent and can set your goals, objectives and ways of working. Thus, it reaches about 500 families per month.
The Group Health and Home Visits Health act so symbiotic, where students recognize health care in the family’s basic needs and begin regular monitoring of them, leading to homes on the notions primary health care.
5.1 Group of Children and Preteens
It aim to raise awareness about aspects of life in society in search of a better life, encouraging the practice of citizenship. Meetings are held weekly in style "show and tell." Monthly meetings are also made with the mothers of children to educate them about vaccination, personal hygiene and home, proper nutrition and disease prevention. At the end of the day soup is offered to children.
We aim to focus on the future pre-adolescents participating in the school building, complementing its activities with learning and artistic activities, in the same way that they can generate some income that can contribute to the monthly income of the family, but always emphasizing the importance of studies and stay in school.
It is expected that pre-adolescents can have a growing participation in the project, since learning the importance of education, the achievement of self-support and an outlook on life.
Two Social Work students from Østfold University College teaching children English. The children teach the Norwegian students Portuguese
5.2 Group of teenagers (GRADO)
The GRADO's participants  is a group of about thirty adolescents aged 12 to 18 years in school development, and aims to act in the formation of healthy people and integrated into the community, striving for health education, sexual orientation, citizenship and self-rescue to thereby make it active in the community in which they live as disseminators of knowledge.
There is held weekly discussions with topics of interest to teens brought by the GRADO’s monitors, who are students of Journalism, Education and Physical Education. In addition to group dynamics - for better development of the work, leisure activities are performed, among them Dance Workshop, which is held on Saturday mornings.
In four years the GRADO has existed, there is a greater awareness of adolescents with respect to the problems that surround them: they know how to ask questions, find answers, propose solutions and make a responsible and critical analysis of the context in which they live.
The dance group, composed of GRADO students, has achieved a progressive recognition and presented their numbers in Espirito Santo II Children's Theatre Festival and the Second Information Fair Professional UFES.
5.3 Program for Integrated Women's Health (PAISM)
PAISM accompanies the onset of sexual activity to menopause and menopause, divided into two basic groups: Pregnancy and Family Planning. With each group meetings are held in which various issues are addressed, including: sexually transmitted diseases (STDs) and HIV / AIDS, violence to women, and general personal hygiene, prevention and complications of hypertension and diabetes mellitus, severe pre -menstrual syndrome (PMS), stress, frigidity, dysmenorrhea, obesity, etc..
The monitors specific PAISM perform home visits for each participant, as needed, and pregnant women should receive monthly visits and last month gestational fortnightly, weekly if possible.
In the first half of 2002, 82 women between 18 and 43 years of age, were followed regularly, but in the last half of 2002 that number fell to 60. The mean frequency of meetings of Planned Parenthood was 30 women, since they were divided into 2 groups (names beginning with A through K meeting in odd-numbered month to L and Z, in the even months), with bimonthly meetings to each subgroup. During the year, only one woman had an unplanned pregnancy, due to the disruption of the male condom, showing the efficiency of the program. Women who did not tolerate oral contraceptives were advised to use other methods such as condoms, diaphragms and ligation.
5.4 Program for Integral Attention to Child Health (PAISC)
PAISC serves children living in the area of ​​action of strains (Laranjeiras – Jacaraípe). The action axis of the program is to monitor the growth and development of these children through:
1) Child care (routine consultations with anthropometry and execution of the complications likely to care solution at the primary health care);
2) Health education, with monthly lectures to mothers (average participation of 20 mothers), which addresses issues related to child health (diarrhea, acute respiratory infections, family life, intestinal parasites, iron deficiency anemia, and so forth) and;
3) Home visits, and we can have a broader view of how and under what conditions the family lives of that child assisted by PAISC.
In child care, PAISC is as a tool to aid an adapted form of CLAP (Latin American Center for Perinatology and Human Development), which are recorded data on child health and, moreover, anthropometry is made according to standards Ministry of Health for monitoring child health at the primary level.
PAISC also has training as a function of the other monitors CEPAS in child health, being in charge of assembling handouts and train monitors to perform anthropometry correctly, in the care of the newborn, attention to diarrheal disease and therapy oral rehydration therapy (ORT), attention to acute respiratory diseases and in encouraging and promoting breastfeeding.
The PAISC expects these actions to meet the power demands of the community regarding child health at the primary level, providing support to other monitors strains and especially to mothers of children in the program.
It aims to raise awareness about aspects of life in society in search of a better life, encouraging the practice of citizenship. Meetings are held weekly in style "show and tell." Monthly meetings are also made with the mothers of children to educate them about vaccination, personal hygiene and home, proper nutrition and disease prevention. At the end of the day soup is offered to children.
5.5 Program for Integrated Oral Health (PAIS)
It is the newest of the programs present in the strains and is currently being structured.
It intends to act in conjunction with the PAISC, Children, Preteens and Teens and includes the participation of two academic courses of Dentistry UFES.
The goal of the country is passing relevant information on how to prevent and maintain oral health, appropriate for the target population of each group through individual counseling and / or lectures in groups.
5.6 Program Comprehensive Health Care of adults (parents)
The country acts in the promotion of primary health care by the adult community, focusing on preventive complications of hypertension and diabetes mellitus as well as the transformations which are individuals from the 5th decade of life. Promotes monthly meetings with participants and guides the other monitors CEPAS regarding adult health.
Its objectives are to address the adult as a productive individual to society, with special focus on the elderly and their physical, mental and social health, preventing acute and chronic complications of diabetes mellitus and hypertension, minimize risk factors for degenerative diseases; awareness about the importance of membership and attendance at drug treatment and to promote integration as a way to combat problems of socialization and how to regain citizenship and happy to be alive.

CEPAS has a main headquarters and a second house (both rented), in Laranjeiras, in Jacaraípe, city of Serra, state of Espírito Santo. The main resources are the following:
1)      Main headquarters consist of: a computer lab, classroom, a room for special education courses, kitchen, office, event room, meeting room and restrooms for both genders.
2)      The secondary house, which lies on the same property, consists of a meeting room, kitchen and storage room. The second house is under rehabilitation and is not in use.

Source: CEPAS website 
              Kaare T. Pettersen