UPDATE 11/16/2014: This is an evolving story, so I’m adding an update below the original story. Also, some minor inacurracies have been corrected. The four fired workers Dr. Carvalho stoor up for were administrative health care workers, not doctors. Also, some more details were added as to what exactly lead to their and Dr. Carvalho’s dismissal.
Dr. Alexandre Carvalho, who had dedicated himself to providing health care to the homeless of Sao Paulo was fired for organizing a protest in his public clinic, when four health care workers were dismissed in a labor dispute. Two members of the clinic’s administrative staff, a psychologist and an auxiliary nurse had been notified that they would be transfered to a different public clinic after they had spoken up about grievances they had regarding their work conditions and the treatment of some patients. The four workers had requested that more doctors be hired that can meet a large part of the clinic’s patient population were they live – in the streets. “The four workers refused the transfer as they understood it to be punishment for their criticism of senior management’s decisions. Three of the health care workers were subsequently fired, while one accepted the transfer after increased pressure from management.
Learning of the dismissal of his four colleagues, Dr. Carvalho decided to speak up himself, requesting greater autonomy in the decision making process public health care clinics had in regards to the treatment of their patients and work conditions as well as a reduction in punitive action by management against workers raising criticism.
“It all began with a decision by the city of Sao Paulo’s health department to stand quiet as 4 workers from the Bompar Public Clinic lost their jobs for questioning management’s abusive retaliation tactics against workers and patients who questioned management decisions,” Carvalho told a group of activists in an online forum. “I stood up for more decision decentralization, collective autonomy, less punitive practices and more ways to solve our differences other than transfers or arbitrary dismissals. [I believe] workers are in a better position to decide through mutual respect and consensus the conditions of our own work, and it is a fact that street folk are discriminated at Hospitals and clinica based on their appearance and living situation.”
As he was very popular with his homeless patients for his genuine commitment to their health, word spread quickly from shelter to shelter that he was organizing a solidarity protest for the fired workers, with a rally planned in Mocca Park this coming Monday.
Once managers at the Sao Paulo Health Department learned of the planned protest rally, Dr. Carvalho was fired quickly from the position he had held over two years at Bompar, bringing on enraged protests by his patients.
Dr. Carvalho’s program at the Bompar clinic was ground breaking in many ways as he worked closely with social workers and a team of scouts to ensure that the transient population from which most of his patients came did not only receive medical care when they found their way into the clinic. By making house calls at street corners, tents pitched under highway bridges, and even makeshift homes inside catacombes in a local graveyard, he ensured his patients received the follow-up care they needed to battle illnesses like tuberculosis, which is prevalent in Sao Paulo’s homeless population and requires a regular medication regimen over a six months period in order to be cured.
When I met Dr. Carvalho in Sao Paulo last June he quietly indicated that senior management at the Health Department was sceptical of his approach, because it required a more ongoing personal engagement from clinic staff than had been the norm. However, all the staff I met at Bompar clinic were enthusiastic about their efforts, even if it meant harder work, because they felt they could make a real difference.
A social worker I met with Dr. Carvalho who requested anonymity for fear of loosing her job if she was caught talking to the press, told me that the homeless receive very little mental care, relationship and drug counselling under the current health care regime in Brazil, even though the constitution entitles every Brazilian to free public health care. “Poor people don’t matter to government officials,” she had told me then. “Government officials don’t know what these people are dealing with and since they don’t vote officials don’t care if they get help.” She then told me of a variety of examples of women who became homeless after leaving abusive relationships, where she felt that Dr. Carvalho’s approach of combining a health care regimen with social services brought on much more lasting results, as the patients felt motivated to follow through with their treatment.
In the run up to the 2014 FIFA World Cup in Brazil government authorities repeatedly fired health care and transport workers who organized protests demanding better work conditions. At the time many anti-FIFA activists I met in Brazil felt that this tactic was used to suppress any protests ahead of the world’s favourite sports tournament.
As Dr. Carvalho found out, these tactics haven’t stopped once the trophy was handed to the German team and all the soccer fans went back home.
When I was in Brazil during the FIFA World Cup, I wrote a profile of Dr. Carvalho and his work at the Bompar clinic. You can read that here
Dr. Carvalho has shared his letters of dismissal in which no explanation is given for his immediate termination, as the letter merely states that his “services are no longer required”. Yet, as Dr. Carvalho explained to a group of activists in an online forum, “Patients warned me that they were trying to taint my reputation in order to justify firing me, including fabricating false allegations of malpractice. ” However, his patients don’t seem to agree with management’s assessment of Dr. Carvalho’s work. “One of the patients whose name was used to promote this campaign called me to reassure it was a false allegation and that she would testify in court against them if necessary.”
It seems that senior management officials of Sao Paulo’s health care administration have called for a meeting later today under the highway near Bompal clinic, where most of Dr. Carvalho’s patients live, trying to dissuade them from participating in Monday’s solidarity rally for the dismissed health care workers. Given Dr. Carvalho’s popularity with his patients, that effort may not be met with open ears.