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  1. Darby, Mark BS, BSN, RN

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NEARLY 30 YEARS after entering the nursing profession, I decided to earn my BSN. While in school, I was chosen to be part of a group of students who'd attend a 3-week educational trip to Rio de Janeiro, Brazil, sponsored by the University of Nebraska. We worked with several agencies during this trip.


We faced one of our most challenging assignments during the afternoon we spent with Pastoral da Crianca (Pastoral Care for Children). Pastoral da Crianca, founded by pediatrician Dr. Zilda Arns and the confederation of Catholic Bishops in Brazil, is one of the largest public health organizations in Brazil. The organization has trained over 260,000 volunteer leaders to provide education and support to mothers from conception through the first 6 years of a child's life. This article describes how this brief time helped me rediscover the importance of nursing.


During our time in Brazil, we were to follow a lay teacher and observe her work. Our group was led by Maria, a retired Brazilian grade school teacher who volunteers to meet with about 15 mothers living in a favela: an impoverished neighborhood with little electricity and no running water. This favela surrounds Rio de Janeiro, a city famous for beaches and the iconic statue of Christ the Redeemer on Corcovado Mountain in the Tijuca Forest.


As we walked through the streets to the first client's house, Maria proudly showed me her instruction book from the Crianca training program. I dismissed the book as basic nursing information that I'd learned in the first 6 months of school 30 years ago.


Caring about health

The first client lived on the bottom floor of a three-story building made of red clay bricks and cement blocks, all made by hand according to Maria. I thought about how a single section of sidewalk in front of my home took two people and 3 hours to replace. For the first time, I was impressed by the ingenuity of the residents in this favela.


Maria knocked on the door and called the client's name. On her third attempt, the door creaked open and the mother, Nicole, invited us into her small room with one overhead light. Proudly she pointed to her son, a healthy 2-year-old boy playing on the floor. He smiled suddenly, rose up, walked over to me, and stood on his toes so he could gently play with the brightly colored flyer I was holding.


Maria went over the weekly interview quickly, asking questions about what the child was eating, his activity level, his immunizations, and school attendance. Nicole reported that all was going well and the child was healthy and growing. Before we turned to go, she told us, "Without Maria and Crianca, my child wouldn't be so healthy."


Looks can be deceiving

We went two blocks to another house and knocked. While we were waiting, a very young child in diapers who was sitting on the stoop crawled over to us and smiled. He couldn't stand to reach the flyer I was holding. When I noticed his large hands and head, I realized he wasn't so young after all. Maria said to me, "He's 5. We tried to get his mother to sign up for the program but she was too mistrustful so we couldn't help. Sadly, there are many like her."


I stood there in disbelief. When one of the instructors in the group asked me what was wrong, I said, "Here are two children living within two blocks of each other. One is healthy, and the other is delayed by years. The only difference I can see is a caring person applying basic nursing knowledge."


I looked at the child again and said, "I now remember why a caring relationship is so important; it saves lives." When this was translated, Maria said, "Now you know why you came here." I could only nod in agreement. That lesson, learned in a favela, was why I went to Brazil. It's one I intend to never forget.