It is a warm Spring night and I am driving my car illegally up a cobblestone street in the centre of Florianopolis. Night has fallen and I have finally, finally found a parking spot for my car. I position my car between two other randomly-parked cars on this pedestrian street, right next to the imposing Cathedral.

I am late.

I glance quickly at my reflection in the rear-view mirror for a last look at myself. I am a mess. I ran out of the house half an hour earlier, detaching tired, moaning children from my body as I left, with my friend C assuring me they would be fine. I had no time for a shower, throwing on a colourful skirt and grabbing a woolen, hooded top to warm me against the slight chill in the night air. I am wearing no make-up, my hair is barely combed and I have a red sore right under my nose, where I had hit myself against the car door earlier in the day. I sigh, open the door and run towards my destination, the Alvaro de Carvalho Theatre, at the top of the cobbled-stone street.

The whole area is heaving with parked cars. There are bright lights and music coming from the Theatre. I run up the marble steps, panting. Two tuxedoed bodyguards move closer to block me from running straight inside. ´Are you one of the candidates?´ they ask dubiously. I stop to look up at them. ´I am,´ I say to them, suddenly feeling intimidated and out of place. They hand me a sticker for my lapel and move aside to let me in.

The Theatre lies grandiose before me. Gentle, welcoming lighting ushers me forward into the anteroom. Glamorous women in their finery waft from side to side. An air of perfectly-manicured elegance accompanies them. Ah, nobody told me it was black-tie! I breathe deeply, smoothing down my creased peacock skirt. I follow the muffled sounds of laughing chatter and piped background music into the main theatre. The stage rises up large before me, with a string quartet preparing to play at its centre. I look around for my colleague T from Child Health Florianopolis who has kept a seat for me. She waves at me from the third row and I walk up hurriedly to sit beside her. Just as I sit down, the quartet begins to play and a silence hushes over the crowd. ´Thank goodness the Brazilians lack punctuality as much as I do,´ I think to myself, trying to quieten my deep breathing.

The MC, a beautiful well-groomed blonde woman stands by the podium. ´Welcome to Florianópolis´ annual awards´ ceremony for Women Who Make a Difference. Let us all stand for the Brazilian national anthem.´ I notice contentedly that the one woman in the quartet is a volunteer at Child Health Florianopolis, having played at our annual Fundraiser earlier in the year.

The awards´ ceremony is organized by Florianopolis´ high-profile Industry and Commerce Association. I have been coerced by T into leaving the children and coming along. In between the quartet´s tasteful repertoire of classical music, the presidents of different branches of the association make short speeches to the crowd. The MC briefly presents the forty seven candidates and their work and pays customary homage to local policitians, philanthropists and successful business professionals. There will be one prize awarded in each category: public sector, commercial sector and the third/NGO sector. Ten anonymous judges have independently rated each of the candidate´s achievements and the barriers they overcame to make them.

I watch as my photo appears on the screen above the stage and the beautiful blonde stumbles over my name. ´This candidate has come from Ireland to honour her deceased husband in setting up Child Health Florianopolis,´ she summarises, before moving on to the next candidate.

I twist uncomfortably in my chair. Once again, I feel out of place. I watch as a familiar battle plays out within me. My culturally ingrained aversion to showiness and self-promotion wrestles scathingly with a more gracious acceptance of external recognition.

As they name the three finalists in each group, I am surprised to hear my name among them. I do not know if it is modesty that makes me blush as they call me to the stage or a hesitance to take personal credit for a collective effort. I walk awkwardly onto the stage with the three other finalists in my sector and receive a bunch of flowers. When requested, I turn to the photographers and give something between a smile and a wince.

The three of us are asked to leave the stage and I sigh in relief, almost tripping down the stairs as I move.

Back in my seat, the finalists in the public and commercial sectors are announced and two tall, well-dressed women take their awards and make short, forceful speeches, each one overflowing with self-confidence.

Now it is time to name the winner in the Third/NGO sector. To the backdrop of Vivaldi´s Spring Quartet, the MC stumbles over the name of the winner and immediately I know: I have won.

My jaw dives floorbound in surprise. It takes me a few seconds to compose myself, before I stand up and slowly walk to the stairs and climb up to the stage.

I accept the applause and the congratulations. I accept the tasteful trophy with my name engraved on it. I stand before the microphone and breathe deeply. Somehow, I do not feel a hint of nerves.

I look down at the audience. The theatre is full before me. Many of Florianopolis´ wealthy families are represented, including many successful business professionals and a handful of politicians. I see my colleague T and in my seat, Dr. M is now sitting and beaming up at me and applauding. I had not known she was in the audience and I am filled with pleasure at her presence.

´It is proof of how international Florianopolis is, that a gringa could win this prize,´ I begin and there is gentle laughter in the crowd.

I clear my throat. ´I would like to thank everyone involved in this award,´ I continue, ´and tell you that I am very surprised to receive it. In the audience here, I have seen several people from different NGOs who have worked tirelessly for many years to provide support to people in need in Florianopolis. It is an honour to be in their presence and receive this award representing Child Health Florianopolis, an organization that is at the beginning of its journey. Although Child Health Florianopolis is important for the children and families that it serves, it is a grain of sand in a desert of need.´

A quote that a speaker had mentioned at the beginning of the ceremony pops into my mind. It is a quote from the Brazilian poet Cora Coralina: ´I am the woman who climbed the mountain of life, clearing away stones and planting flowers.´

´I enjoyed the quote from Cora Coralina earlier,´ I share with the audience, ´and it strikes me that Child Health Florianopolis is the result of an effort to clear away stones and plant flowers . When I was thirty one, my husband Alastair Ramsay died suddenly, when our youngest son was just one year old. This was a gigantic stone that fell across my path. Since his death, I have been trying to clear away this stone and plant flowers in its place. Child Health Florianopolis is one of these flowers. And I am not the only woman who has been doing this. Here tonight is the co-founder Dr. M and our Board member T.´ I point them out in the crowd and there is a hearty applause in their honour.

´Hundreds of women in Brazil, England, Ireland, America have helped to plant this flower. This is a collective, not a personal effort. So many volunteers have been involved. There is even one on stage right now.´ I point now to the violinist in the quartet, who smiles up at me. The audience laughs audibly, surprised, and applauds her. The presence of all the volunteers, staff and contributors of ARCH and Child Health Florianopolis is palpable to me and this applause extends to all of them.

´We even have some fine men involved in this effort,´ I say laughing, ´in fact, although I am receiving an award for the Woman Who Makes a Difference, my part in Child Health Florianopolis should be attributed to a man. I did this work in my husband´s name.´ My voice begins to break slightly.

´And, ´ I stammer, `and I would like to take this opportunity to thank him.´ The crowd applauds.

´At the heart of Child Health Florianopolis are the mothers who are dealing with poverty and their child´s illness. Each one of these women is trying to clear away the many stones in their paths and Child Health Florianopolis aims to help them to do that and to plant flowers of health and happiness in their children. Since we set up the organization in 2008, we have helped more than 60 families and over 200 people. Our first few families have graduated, relating improvements in child health, family income, housing, education and social inclusion. With your help, we can support more families. With your help we truly can make a difference. Thank you very much.´

I leave the microphone to the sound of enthusiastic applause. Offstage, Dr. M and I battle our way out of the Theatre, kissing cheeks and thanking everyone for their generously offered congratulations. We walk arm in arm across the road and down the cobblestone street. We hug warmly as we part ways and I walk down the street toward my parked car.

I am awash with a sense of mission accomplished. Three years ago this month, I arrived in Florianopolis with two small children and three suitcases. Alastair´s mother P was with me to help me with the children on the journey and generously give me away to a new life. With the help of hundreds of people in Brazil, in Ireland, in the UK and America, this project in Alastair´s honour came into being. At the end of the year I will step down as Chair of the NGO and a local supporter will continue in that role. What the future holds for Child Health Florianopolis, for the boys and for me is unknown. I have found that a good way to make God laugh is to tell him your plans. No matter what happens in the future, what has come to pass over the last three years can never be taken away.

I arrive home to the hugs of three little boys. I kiss them and marvel at them. We have survived Alastair´s death. We have kept him alive in our hearts, in our work. His memory, his love is intricately intertwined in the core of each one of us, even in little Eoin who has awakened the whole family into a new, more hopeful life.

This is my last blog on setting up Child Health Florianopolis. I am signing off. Thank you for joining me and supporting me on this journey. It has been an incredible learning experience. It has also been the best way of mourning Alastair´s death and I simply could not have done it without you.

This mother, Eida*, has been with us for a year and always reacted dismissively of Community Therapy, as she stated knowingly, with pursed lips, that no counseling was going to get her out of her difficult situation.  ´I have been depressed for 8 years,´ she would rasp through pursed lips, ´nothing can change me.´   

As I arrive at the NGO and go towards the room for Community Therapy, Eida is not even inside.  Instead, she is on the black leather couch in the tiny hall, holding an enormous baby.  ´Come on inside,´ I urge her.  ´I am minding the baby for the other mother,´ she answers aggressively.   ´Bring the baby,´  I tell her.   ´No´ she says, ´he makes a lot of noise.´  I suggest that the baby go to one of the volunteers, but again she rejects the idea forcefully.  ´To change, you have to want to change,´  I say to myself silently, touching her lightly on the shoulder and going into the group inside. 

Five minutes into the Community Therapy, Eida comes into the room and hands the baby to his mother.   I smile to myself.  This in itself is a small miracle.  With some coaxing, she states what is worrying her at the moment.  Her sister is ill, very ill.   She has a problem with her kidneys and has a disease whereby she ages prematurely.   Her sister has also participated in the programme and I was surprised when she told me she was only 31.  She looks in her fifties with a lined face and an emaciated body.   ´She is in hospital now again and is down to 29 kilos,´  Eida tells me, looking at me defiantly like a truculent teenager.  ´She needs a transplant, but she probably wouldn´t survive the operation.´   Everything is said in a curt, aggressive tone.  The silent ´fuck you- fuck life´ is almost audible.

Eida´s story is chosen as the focus for the session.  She looks at me quizzically when I ask her to elaborate, but seemingly despite herself, she begins to answer.   Words pour out of her and her tone softens.  ´It is hard on everyone,´ she says, ´my father is an alcoholic and my mother already has a hard time.  My other sister has the same premature aging illness and she finds it difficult.   So, I take care of the two kids.  They sleep at home with their Dad, but I mind them until he comes back from work and do all the washing and cooking for them.´  Marilys, the co-facilitator, clarifies with a question, ´so there are two things worrying you;  both the illness of your sister and the extra load of work that there is for you.´    ´Yes,´ she says, bows her head and goes quiet.   She looks to me now like a scared woman with the weight of the world painfully cutting grooves into her young shoulders.   I soften to her.  Others in the circle ask her questions and she tells us a catalogue of challenges that her sister has had to face, from having a child taken away, black-magic threats from an ex-lover, illness upon illness for herself and a child living with illness.   I imagine her now, down to 29 kilos, her own young children huge at her bedside beside her.   I am struck by the sheer volume of challenges that this tiny, almost-skeletal woman has been faced with in her life.

´Is your family more united because of your sister´s illness?´ I ask, looking for the positive changes that often come hand-in-hand with suffering.  ´Yes,´ she responds tentatively,  ´we have to be.  We all help eachother out.  And because she was sick, I found the daughter that was taken away from her, she is 16 now and she met her mother.  It´s not easy for them with all the history, but I keep in contact with her.´  

I thank Eida for her openness and ask her now to listen to the others who will talk of their experiences.  There is an audible sigh as I invite people from the group to talk of similar challenges they have faced and what they have done to overcome them.   Many of the group share their experience:  the woman whose father spent months between life and death, needing an operation but unlikely to survive it;   the woman whose brother was killed suddenly in an accident, the woman whose sister has a chronic life-threatening illness, the woman whose husband died suddenly.      Each one of us talks of the same overwhelming feelings of helplessness, of sadness, of guilt and of confusion at God or existence.  And when pushed, each of us tries to express how or why we did not curl into a ball and die too.  

It is summed up by one participant´s talk of finding peace through sensing that we are spiritual entities beyond the mortal situation or experiences of our lives:  ´even though nothing is ok,´ she said searching for the right words and then sighing,  ´all is ok.´   Another participant stands in our farewell circle, where we stand with our arms around eachother.   ´What I am taking away from today,´ she says, looking around the tight circle, ´Is the sense that we are all on the same journey, we all experience such similar things.  It feels like we are one.´

We congratulate Eida on her courage, on her active compassion for her sister and her children.   As she cries gently, we send our love to her and her sister and offer our material help through the NGO.   The heaviness of the session is lightened by an off-key song and shared tears and we all leave with the gentle voice reassuring us, ´even though nothing is ok, all is ok.´     

*name changed to avoid exposure

The first three families graduated from Child Health Florianopolis´ two year multidimensional support programme on June 30th. Beyond the donations of medicines, food, bathrooms or houses, a core element of the programme´s longterm impact is to strengthen the mother of each family.      

One mother who was graduating, who has a child with chronic illness, said of the programme:  ´Before, I came here, I was nobody.  Nowadays you could say that I am a very different person.´   

Another mother said:  ´My life changed completely.  I didn´t know how to write and it was here that a teacher gave me my first  classes.  So I have gone back to study and I am still studying.´   

The social worker of the Children´s Hospital praised the programme saying that while the Hospital focuses on sickness, Child Health focuses on promoting life.  She also stated that two years ago they were questioning if one of the graduating families  was able to keep their child.  She concludes that now the family is greatly strengthened and the child´s health is improved.  Together, we have helped to keep this family united - congratulations.  

At the end of 2010, all of the families who responded to Child Health´s Family Satisfaction Survey stated that Child Health makes a positive impact in their lives, 87% of whom stated that it makes a large positive difference.  

CHILD HEALTH FLORIANOPOLIS GRADUATES  TOWARDS LOCAL SUSTAINABILITY

 ARCH´s three years of support to set up Child Health Florianópolis comes to an end in December 2011.   ARCH´s voluntary representative and Alastair´s widow, Bébhinn, will stand down from her post as Chairwoman of the local Board of Trustees and a local supporter will be elected to the position.  

ARCH was committed to fostering the local sustainability of Child Health Florianopolis from the beginning.   In its first year of operations, the local organization was required to raise 15% of its budget locally, 35% in year 2 and 50% in year 3 (2011).   The organization surpassed the matched funding requirements each year to date.   On June 30th, Child Health Florianopolis organised its largest local fundraising event yet, bringing together 330 people at its second Annual Benefit Pasta Party. 

Dr. Lucia Dellagnelo, Founder of Florianopolis´ Community Fund ICom and a local government official, who holds a doctorate in education and human development from Harvard University, attended the event.  She congratulated Child Health Florianopolis on the event and stated that: ´the success demonstrates that the community already knows and values the work of Child Health!´

For the workshop, based on a conversation with the group of staff and volunteers, we have dispensed with the familiar safety of the powerpoint presentation suggested by Rio de Janeiro in a bid to communicate more effectively and interactively with the families.  Hence The Hand Workshop is born.  Gabi, the nutritionist and coordinator, and Lari, our new social worker, will lead this workshop together. 

First each family member says their name and how long they have been in the programme.  This first group ranges from two years to six months in the programme.  Then, we all go briefly out to the children, who are playing with our volunteer next door, and each parent sits with a child and traces the front and back of the child´s small hand on coloured paper.   The parents give quizzical looks but go along with it.  In this way, we introduce the theme of the workshop – the hand .. the five fingers of a child´s hand.

Back in the workshop room without the children, Gabi kicks off asking everyone why they are in the Saúde Criança programme – what is the Saúde Criança programme for.  The answers vary:  to help with medicine, to help earn money, to learn to do handicraft, to improve their house.  Gabi listens and nods and brings them back to the name of the organization – Saúde Criança or Child Health.  ´Why is this the name?´ Gabi asks.  A short silence and one mother says slowly as if it is just becoming clear to her,   ´everything we get here helps our children to get better and stay well,´ she says.

´Your child is at the centre of what we are doing,´ Gabi continues,  ´it is due to your child´s illness that you enter the programme.  When we think how we can help you improve your house, we think about your child´s health.    We start with making sure you have a bathroom indoors and a working kitchen.  We look at the need for a water filter or a liquidizer to make healthy soups and drinks.´  This has all been said before, when the family entered the progamme but this is the first time we have asked the family to reflect as a group on what they are doing in the programme, what it is giving to them and what their role is in the programme.

On a big sheet of paper taped to the wall, Lari, the social worker, draws a big hand.  ´The hand explains what we do here,´ Lari begins.  ´have you seen this hand before?´  The mothers start to point out the child´s hand on the wall of the organization, on the cloth bags they are carrying to bring home their donations, on the information leaflets in front of them on the table.   The strapline by the child´s hand on the marketing materials is: ´Give a sick child a hand today, and help him for life.´

´The palm of the hand,´ Lari continues, ´is able to grab things – grab the opportunities that Saúde Criança offers´.   She holds up her hand and grabs the air around her, emphasizing what she is saying.  ´What are the opportunities that you have here?´  she asks.  Each family talks one by one, encouraged by comments and questions from the volunteers around them.  ´You help with giving medicines and paying for us to get the bus to see the doctor,´ one family tells us.  ´Health,´ Lari summarises, ´the first helping finger we give is to your child´s health.´  She draws a smiling child´s face beside the first finger.   ´Sometimes we come here sad and leave happy,´ one mother says shyly.  ´That´s health too,´ Gabi continues, ´when you are happier, that helps your children.  And there are the homeopathy sessions with our two doctors and the free dental care and nutritional advice.´

´What´s very important for me,´ one mother continues ´is the money I make when I make handicraft.  That pays my monthly groceries at the local shop.´  Lari draws a R$ sign and circles it to make the symbol of a coin.  ´Saúde Criança can help you to make more money for your family.  Not just with the handicraft project, but we want to offer other courses too and we let you know about courses in other places that can help you get ready to make a stable income.´  

I write this down in my notebook and circle it.  This is an area we have to greatly strengthen and to work out how to keep mothers motivated in the handicraft project, which builds self-esteem and skills, without creating a dependence on it. 

Lari continues to listen to the families about what they have received from Saúde Criança and she draws a new symbol beside each other finger:  a house, a book for education and an identity card for the help we offer with citizenship, or access to documents and benefits.   The palm of the hand is complete – the opportunities are listed and clarified. 

Gabi holds her hand in the air.  ´Here in the palm of your hand at Saúde Criança, you have mentioned a lot of different opportunities.´ She turns her hand in the air and points to the back of her hand.  ´The hand has two sides however and the opportunities are only possible if you agree to the other side of the hand too – your responsibilities in the programme.´  

Lari draws another large hand on a second sheet of paper taped to the wall and Gabi starts to talk about each of the five responsibilities one by one.   A clock face denotes regular attendance and punctuality,  a R$ sign denotes the appreciation of the free services they receive which cost between R$100 and R$200 a consultation privately and that donations depend on the support of a wide network of donors.   A sweeping brush denotes the need to keep the space clean, cleaning up after the children and with the children, washing your own plate and cup, separating rubbish and participating in the preparation of the collective lunch.  A drawing of a bus refers to the importance of bringing the children on the 4-5 outings that are organized by volunteers each year to local parks and children´s cinema and theatre.  Often, there are more volunteers than children, as families prefer not to go out of their way to give these opportunities to their children.  The final symbol is the most important – it is a fishing rod. 

´At Saúde Criança,´ Gabi begins, ´it is not just about giving you donations, whether paying for the bus or medicines or building materials or free services.   What we are trying to do is to teach you how to fish and not simply give you the fish served up hot on a plate.  We are here to help you help yourselves.  Can you give me any examples of that?´ 

There is a silence in the room.  I watch the thought form in my mind that it is very important to me that after two years, the families are aware of this.  I realize I am holding my breath.   

Then the father in the room pipes up ´like the time you told us how to get the benefits for Paolo but we had to go to the Pro-Cidadão office and run after it to make it happen?´  ´Yes, that´s it,´ Gabi replies smiling, also visibly relieved.   ´Or telling us which health centre gives out the medicine my husband needs for free and telling me to go there, rather than buying it for me,´ says another mother.

I draw a fishing rod in my notebook and I circle it a couple of times.   This is what we do, this is where we need to focus.  Sometimes in the day-to-day of many demands, of urgent needs communicated with force, of our own desire to please and appease the families and children before us and the number-hungry funders behind us, we busy ourselves so much with making sure the fish is well-seasoned and appetizingly presented and we forget the fishing rod and its centrality to what we do. 

These workshops, it seems, are working on the team as much as on the families. 

At this point, the children come in and show us their work. While the adults were at the workshop, the children cut out the two traced hands, painted them and stuck them together on each side of a stick, making a colourful forearm and hand that they wave now at their parents laughingly. 

The families leave later that morning, laden with food, hygiene and medicine donations and their children wave goodbye to us with their colourful paper hands.  We wave back, hopeful that we are giving a truly transformative hand to these children and their families and in some meaningful way, genuinely helping them for life.      

This month as I neared our NGO headquarters, I saw Faith, one of the volunteers, walk by with a vacuum cleaner tube over her shoulder as she brought another requested donation to one of the families.  As I turned past the front of the NGO to find a parking spot, I saw our nutritionist help another volunteer to unload a donated table and chairs from her pick-up truck. 

I smiled as I parked, hauling out a big box of donated organic courgettes from the boot and slowly walking to the NGO.

I have been wonderfully surprised and reassured by the readiness of Brazilians to donate their time and goods.  Most of the volunteers are women between 25 and 45, like the new legal volunteer who started to help families demand their rights to special milk, to free health exams, to disability benefits for their children.  Some men as well take part like the homeopathic doctor that started this month to work with Dr. Marisa to provide more continuous homeopathic healthcare to the families.    Another man is a local businessman who leads donation drives in his organization.   A new campaign also began this month in a local sports´ club, where new members donate a can of reinforced powdered baby milk when they join.  50 cans arrived at the organization, meeting our need for the month.

As well as providing essential services to the family, volunteers are also central to the organization´s sustainability.   Knowing the families and the work upfront motivates them to look for donations, help fundraising efforts and in a few cases, provide financial support.

We had a training session for the volunteers at the end of the month and approximately 25 people participated.  A psychologist and the family-support manager from Rio de Janeiro came to explain how things are done in Rio de Janeiro and share their extensive experiences.   They talked of volunteers as one of the three pillars that a Saúde Criança social franchise, has to have in place.  The other two are the partnership with a Hospital or other health institution and the use of the Family Action Plan methodology.   Volunteers are key to doing the work and continuing the work.

Already this year, we have had 24 active volunteers, with another 8 people voluntarily involved in the Board.  The NGO has 5 staff members, only one of whom works 40 hours.  These volunteers don´t get a financial salary, but all involved receive a monthly emotional salary or other return. 

This return is sometimes a project that can be used for a thesis or an experience that serves as an internship.   For people new to the city, volunteering can fill otherwise lonely hours and allow access to a friendly group of open minded people. 

The emotional salary is offered to everyone involved; the volunteers, the staff, the Board, the donors, the partners. 

The emotional salary is the hug from the relieved mother who has a space to cry and feel supported. 

The emotional salary is the smile from the child whose weight or viral count has improved.

As we stand hand in hand in a large circle at the training session, it dawns on me that we are not an organization that works with volunteers. 

Instead, we are centrally a volunteer organization, that hires a small number of staff to make the work happen in a coordinated way.  The volunteers, along with the families supported, are at the heart of the organization.  It is a place of meeting, where everyone has the chance to win!    

This kick-started Marilys, the co-facilitator, and me into our Tuesday morning and brought to the fore questions that I have about how to work effectively with mothers entrenched in depression.  Can we work effectively with mothers suffering from depression?   If so, how?  And will change happen within the two year deadline of the programme? 

The mothers who are making the most progress in the programme are those who have a spark of determination  within them.  They take the opportunities offered, hold their children close to them and move, sometimes quickly, sometimes slowly, towards a better life.  But those without that spark?  What about them? Can it be ignited by others? 

A couple of weeks earlier, another mother had talked of her problems, including her son´s cancer, her loneliness and her lack of privacy and conflict with her in-laws.   Every question or suggestion that hinted of a way forward was batted back with a numbing pessimism.  Nothing would work.   She was in a dark hole and there was no way out.

At both of these therapy sessions, the whole group concentrated on these two women and their world views.  Marilys and I probed them with questions, with some tentative questions coming from the group.  Then we all showered them with our own experiences of how we resolved our difficulties, in the hope that some light might come from that.   A toothless grandmother, in her late forties, sat with her tiny, sunken-eyed grandson in her arms  and talked of how she prayed to God and got the strength to improve her life.   Others spoke of how family members were the ones to help.   

Listening to these mothers, I was transported to another time.   A time shortly after Alastair´s death when I was enmeshed in darkness.  Every way I looked, there was no escape.  I felt like a trapped rat.   ´There is no solution to death,´ I thought breathlessly.  ´There is no solution to this.´   I relayed this to Ana now and I thanked her.  I thanked her for reminding me how far I had come since those dark days.  How lighter my life had become.   ´The tunnel was dark for me,´ I said, ´but even though I didn´t think it would, a light did appear and then gradually it got stronger and stronger.  I just kept saying to myself – I will be happy again, I will be happy again.´  ´When was that?´ she barked at me.  ´Almost four years ago now,´ I noted, surprised by my own answer.  ´Ahh, I´ve been like this for eight years, this can´t change,´ she sneered, dismissing me.  

Ana swatted away life stories like annoying flies, blaming her husband, the doctors, the politicians, the neighbours, the drug-traffickers.  ´ Marilys put her pen down and looked Ana calmly in the eye, ´I did therapy and it worked for me.  It took me twenty years though.  Twenty years of therapy to learn that nobody except me is responsible for my happiness.´ 

´What makes you happy?´ I asked Ana, ´when are you happy or relaxed?´.    ´To relax I smoke,´  she said defiantly, ´or I hit someone.  That´s the only thing that makes me feel better.´  

The group sighed in unison. 

These group sessions provide a sense of community, let the mothers know that they are not alone, but can they break through the most hardened shells? We have a volunteer psychologist who offers individual sessions.  The resistance to this support is strong however and only a few mothers willingly taking part on a regular basis. 

At the end of the community therapy session, I called on everyone to stand up again and to hold hands in a circle.   Everyone stood up, even Ana, though she didn´t take anyone´s hand.   ´Let´s send Ana all of our best wishes, all of our sincere wishes for a brighter future for her and her family.´  Ana half-laughed.  Without saying anything, she held hands with the women on either side of her.

For five minutes we stood there, winding up the session, everyone saying what they had learnt, what they had liked or disliked.  And all the while, I was aware of Ana holding the women´s hands and noticed a tiny spark of hope light up within me.

Joana, one of the mothers who has been in the programme for over a year, welcomes community therapy back enthusiastically and helps out in telling the new mothers the rules of the therapy and prompting some of the usual songs.  I smile deeply in silent appreciation of her help and enthusiasm.

Both mothers and workers talk of things that keep them awake at night.   Maria, a new mother with two small children, talks of her sleepless nights, listening out for rats.  ´My little girl, who is just two, was bitten by a rat one night.  We´ve put down poison and blocked up holes in the house, but since then, I find it hard to sleep.´  She tells this to the group in a matter-of-fact voice and I shudder.   I think about the worry I felt over the last few nights, swatting away mosquitos from Eoin´s chubby cheeks and I quietly put my worry in perspective.  

The subject brought by Malú, another new mother, is chosen as the topic for deeper discussion.   The end of the month is coming and they don´t have enough money to pay the supermarket bill or the rent.  Her husband hasn´t had much work this month and he is out looking for work today.     As the story unravels, we learn that she is both concerned about her husband getting work and also frustrated at not being able to get a job herself.   There are a number of barriers to her going out to work, she tells us, but one of the central ones is that her husband doesn´t let her work.   The statement makes me rev up inside and I breathe away my initial reaction in silent exhalation.  It reminds me that I am in Brazil and that machismo is stronger here than in Ireland or England.

Joana, the ´older´ mother, responds more helpfully to Malú. ´I have been through the same thing,´ she begins. ´My husband didn´t want me to work.  He was jealous and didn´t want me around men.  He wanted me to stay at home with Marcio all the time.  Now though, I have convinced him to agree to putting Marcio in crèche and I am looking for a job.´ 

´What did you do?´ I ask Joana,  ´how did you manage that?´   ´You know, it´s all down to Saúde Criança,´ she says clearly.  ´I had to talk to him again and again and again.  He isn´t open about talking about these things.  But I started by convincing him to let me come here.  He knows it´s all women here.  And then bringing home the little bit of money from the craftwork has shown him that I can help paying the bills.   Then Marcelo (the social worker) helped me find a crèche for Marcio.  I nearly got one job I went for, but it didn´t work out, but now I am looking for another one.´  

Other participants in the group start to echo these words, emphasizing the importance of talking to your partner to get the balance right in the relationship and about using Saúde Criança as a first step towards more autonomy and balance.  

I was already aware of the importance of the craftwork weekly workshops to improve the mother´s self-esteem, as they move from believing they can do nothing to having their work praised and sold.  I was aware of the financial contribution that it was making to some of the families´ budgets.  I was even aware of the support that the mothers found in the friendly atmosphere, as they sewed away amidst cackles of laughter.   I was aware too of the importance of the community lunch and its preparation, which is done by different mothers each time, under the guidance of our nutritionist.   I didn´t know though, that the craftwork was a tool to help the many young mothers take the first steps in their own emancipation and a greater confidence within their relationships.   It surprises me and delights me.

As we sit in a tight circle at the end of the therapy, our arms over eachothers´ shoulders, I thank Malú for her openness.   As a group, we send wishes for success to her husband who is out looking for work.   Hopefully, in time, Malú will assert her choice to join him.       

Maria´s* family, who have been living in the house for the last two weeks, is made up of a couple, both with AIDS and three daughters, two of whom have HIV.  The youngest girl with HIV is just six years old.

Their new house is in the same community where the family has lived for the last ten years.  They wanted the girls´ to stay in the same school and to be close to their neighbours.  The community is on the island of Florianópolis.  It climbs up a hill, not far from the centre and looks out over the sea and the mainland beyond.    It is relatively safe, especially where the family lives, which is just a short climb up concrete steps from the tarmac.  The higher up the hill you go, the more violence and drug-trafficking you encounter.  Our little group of NGO staff and volunteers stay close to the tarmac.

We drive to the community with the car in first gear as we climb the foot of the hill.  There is a clutch of young men hanging around a small shop when we arrive and they eye us carefully.  They scatter languidly as we get out of the car and meet with Luciano*, the father of the family.  We arrive with a contract, a terms of commitment for the family to sign and a cake to celebrate the handover.

I climb up the few concrete steps to their house, with four month old Eoin in his pouch at my front.   I pass a bricklayer who is carrying a heavy sack of sand on his head.  Our social worker Marcelo informs me that he is finishing the short wall, which will help the water drain from the garden and avoid rising damp in the house.  Marcelo is an inspiration.  He has been at this house many times before, helping the bricklayers to renovate the house, painting on Saturday mornings, and visiting Luciano in hospital in his latest health scare.  We have made it a condition of the house that Luciano starts to take his ARVs regularly, as well as taking care of the girls´ health and the house itself. 

The house is made of bricks and is bright and airy.  Inside it is painted white with baby-pink window sills.  ´A real girls´ house,´ I smile. I ask permission to enter as is the custom in Brazil and kiss Maria and her daughters.   We have a tour of the house, which has two good sized bedrooms, each with the requisite TV and a large open area downstairs, with two comfortable sofas and a kitchen area.  It looks out over the roofs of the houses below and glimpses the sea.  Outside in their slanting garden, which still needs work, there is a smattering of fruit trees.  ´We have avocado and pitanga, grapes and mango,´ Maria tells us as we sit together on the couch.     Eoin is sitting now in Maria´s lap and she and her daughters are cooing at him.  Children are such blessings for bonding in unlikely moments. 

Their old house is nearby and we visit that too.  Niamh, ARCH board member and champion fundraiser visited this house on one of her visits to Brazil.   The steps up to the house are very steep and I have to lean on Marcelo´s shoulder as I make my way down, with the other hand on Eoin in the pouch.   Their old house is made of wood and appears to be on stilts. The bathroom is tiny and outdoors.  Three streams of water trickle down the property.  It seems as if a strong wind or heavy downpour will blow the house down.  When the volunteer arquitect came to see this house last year to see if we could renovate it, he told the children not to jump indoors, as the house was in danger of falling down.  The workmen, with Luciano´s help, are going to knock down the house as it is not fit for anyone to live in it.   Then the family will sell the land and use the money to buy furniture and electric appliances for their new house.

Luciano talks as he walks,  ´as well as the girls´ and our illness, we were worried that the house would fall down.  Now we feel safe and comfortable.  There is someone there for us.´  Marcelo asks if he had thought about moving before he joined the programme.  ´Without the help of Saúde Criança, it would have been very difficult to change house.  Now the children play in the garden, in the trees.  It´s very good that Saúde Criança came into our lives,´ he puffs as he walks.  At the top of the steep steps, he coughs up for several minutes.  His health is precarious.   

Improving the housing of this family is important to them.  As we drive away, I feel gratitude that all of us involved with Saúde Criança and ARCH can help the family in such a concrete way.   Making a long-term difference however in the family´s wellbeing is the less tangible support that Saúde Criança provides.  And there are no photo-opps for this. 

Leveraging the donation of a house to coax them into taking better care of their own health and their children´s health and education brings more long-term benefits for the family.   Other help such as psychological support, training for the mother and benefits´ advice is of help to the family´s financial and psychological wellbeing in the longer term too.  

Maybe though where Saúde Criança most helps is in Marcelo´s visits and informal talks.  Maybe the greatest help is when Marcelo goes to the hospital to sit with Luciano when he is taken ill on the street and Maria cannot be contacted.  ´Tem alguém pela gente,´ Luciano said.  ´There is someone there for us.´  

When the struggle is uphill and as steep as the concrete steps to their old house, maybe having someone there for them is the most important thing.

*fictitious names to protect the family

20 new families signed up to the full Saúde Criança support programme in the last six months.  This is almost double the number of families that signed up in 2009.   This is largely due to our new partnership with the local public health centre/GP surgery, which attends to people living in the five communities surrounding the children´s hospital.  Like Rio de Janeiro, these communities grow informally, clutching to the hills for survival.  They are characterized by financial poverty, drug-related violence, families continuously moving in and moving out and precarious housing and sanitation. 

In the same six months however, 9 families have either left or been asked to leave the programme.    This is almost double the drop-out rate of 2009.  When I sat down with the social worker and psychologist to understand the reasons behind this, I stumbled on a situation reminiscent of social policies and anti-poverty initiatives in Ireland and England.  

Most of those dropping out are local families from Agronomica, which is near to the centre of Florianopolis and there are a number of social programmes offered there.  These social programmes are largely focused on providing direct services to children and adolescents.  They include public and NGO crèches and homes for abandoned children, health services for children and programmes with monthly stipends for adolescents.  The main family supports are small government cash benefits for those on extremely low-incomes and a religious organization that offers monthly food baskets.  The requirement for all of these benefits both governmental and religious is simply poverty.  The government´s small cash benefit Bolsa Família (around EURO 20 year month per child) is conditional on the child attending school at least 75% of the academic year and being up-to-date with vaccines.     

Our programme has a much higher level of conditionality.  The families receive direct benefits of food, housing support, hygiene kits, clothes on the condition that they take part in a monthly support session, which includes advice and support from the social worker, the nutritionist, the psychologist, the lawyer and the dentist; professionals continually questioning their often chaotic and unconscious ways of living their lives and providing them with information and encouragement to change.  The mothers must also participate in the handicraft workshops, unless they are in another course or employment.   They must show commitment to improve their families´ situation.  They need to adhere to the treatment of their children and take care of their own health, with annual smear tests (a frequency recommended in Brazil) and show up to doctor, ophthalmologist and other health-related appointments that we make for them.  They get materials to improve their housing, but they must provide some of the work if they can. 

For some families, it would seem, it is easier to live from unconditional or low-condition payments.  They entered the programme looking for the easy benefits they are used to and found too much asked in return.   So, despite the encouragement of the social worker and psychologist, they drop out.  Perhaps it is easier for them to leave their children in full-time crèche or abandon them to live in institutions, to rotate from charitable donation to charitable donation and to receive any benefits that the government is offering rather than truly try to transform their life situation.       Getting by may be preferable to improving their lives, especially if that´s all they´ve ever known and they have neither sufficient confidence in their abilities nor motivation to break out of the rut they are in. 

Some families do try to change their situations but the benefits actively discourage it.  One mother from the programme was going to be employed by the NGO but decided against it when she learnt that she would then lose an almost equivalent benefit for her child, who has a weak heart.   My cleaner asked me to write a letter stating that her salary was half of what I pay, so she would not lose her child´s free crèche place.   Ireland and the UK are rife with examples of the counteractive incentives of benefits too: benefits that encourage couples with children not to marry or live together, benefits that are greater than the salary they are able to earn, benefits that encourage single mothers to stay out of any kind of work for over twenty years and then are thrown unprepared into the workforce once their youngest child reaches 18. 

When I think of my own actions and those of my middle-class counterparts, I remember how often the road of least effort and lazy passivity has been chosen over the braver and more exacting road of self and life-improvement.  Maybe we all only really change when there is no other real option.  When we can´t handle the situation any more.   Perhaps the unconditional or low-condition benefits provide an anesthetic to make the situation just bearable enough for the person living in poverty, to rob him of the necessary internal motivation to make changes in his live.  

So what is the alternative? 

Do we move our programme to a poorer area that has less easy government and charitable support, to make recruiting and maintaining families easier?  Do we suggest that government reduces or cuts benefits entirely to force families into improving their material living standards on their own?  This has happened to a degree with the welfare to work programmes in the US and there is lots of controversy over them. 

Or do we just accept the dependency culture and appease our own charitable urges and guilt complexes by providing people with what they seem to want: easy and generous benefits, no conditions attached?

I remember an experience I had when I was in my early twenties in Dublin with a friend of mine, after we left the pub one night.  We came across a homeless guy who was sitting wrapped in a sleeping bag, trying to escape the cold in the doorway of a shop.   I bought him a cup of tea, asking him first if he wanted milk and sugar.  My friend gave him a pound note.  As we walked up Grafton Street, I turned to my friend and questioned her actions, saying that it was clear that a hot cup of tea would do him good on a cold night but he could spend the money she gave him on drugs, which would be worse for him.  She shrugged and replied humbly, ´who I am to tell him what he needs?´ 

This experience still swirls, unresolved, in my mind. 

For the most part, efforts like the Saúde Criança programme seem to make sense.  They provide immediate support, both in-kind and cash, but focus on helping the family to be self-sufficient.  The length of the programme depends on the needs of the family, given that each situation and family is different.   I know that in Ireland and the UK there are increasing efforts to provide time-limited benefits, while providing parallel training and encouragement to promote cultural change.  But they are facing significant barriers by a prevailing dependency culture.  

And what of the families that don´t make it?  Families that can´t rise above their upbringing or their own limitations or just plain don´t want to jump through our middle-class hoops?  Do we leave them, and their children, to live in poverty without support, in the hope that they will hit rock bottom and the illusive motivation will appear? 

Or do we let the government continue to provide undemanding benefits, accepting the additional barriers it creates for families and those who support them in transforming their own situations?  

Perhaps, in our extremely limited influence, this is all we can do here at Saúde Criança.   Do the best job we can, accept our limitations and the counter-culture nature of what we are doing and celebrate the times when what we offer chimes with what the family really needs and is willing to take on.  We can also look to expanding only into areas that have less support services of any kind.   Depending on the demonstrable success of our experience, we can offer what we have learnt to government and help them to replicate it, if they are interested.   For now, that feels like a pretty full plate.

Not saving the world, but making a small contribution to what we believe is its improvement: and helping one child and receptive family at a time.