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

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