Four mothers, a father and a mix of staff and volunteers sit in a circle at the beginning of the month to kick off a series of meetings which we are calling The Hand Workshop.   We are having ongoing difficulties with families´ regular attendance and punctuality – a key challenge in a culture of ´give me my donation quick and let me get outta here … ´   and needless to say, the families who need the workshop most are not present.

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.