Scenario of fear and violence in the Amazon takes mental health action boat to riverside dwellers

The first image that psychologist Ana Lúcia Castello had when she landed in a riverside community on the Tapajós River (PA), in February, was that of an 11-year-old girl five months pregnant. She was in the area as a volunteer in a mental health action in the Legal Amazon regions.

The professional is part of the unprecedented project that takes psychologists and psychiatrists to this Amazonian area, a partnership with the City Hall of Belterra (PA), the Federal University of Western Pará, and developed by the NGO Zoé.

During their visits to the Pará region, the volunteers encountered situations of violence, such as physical, mental and sexual abuse. They also found a scenario of alcoholism, anxiety attacks and outbreaks.

The pregnant child on the Tapajós River had contractions when her father carried her to the Abaré, a university boat that docks in needy communities to provide medical care.

She was scared, according to Ana Lúcia. The young woman told the psychologist she had no idea that having sex made you pregnant. Then the girl began to have stronger contractions and was referred to the ultrasound room. Preterm birth started.

The baby died nine minutes after being born. The girl was shocked, according to the psychologist. “The organic part of her didn’t stabilize. Then I applied a psychology technique used for major traumas and she finally managed to sleep.”

Childhood pregnancy caught the country’s attention recently when a child of the same age was banned from having a legal abortion after being raped in Santa Catarina. After the repercussion of the case, the girl was able to have the procedure, only in the 29th week.

Ana Lúcia, who was moved to tell this story, says that after being stable, the child was taken to a hospital in Santarém, on a three-hour trip on a speedboat-Samu. “She was lucky we were there that day. She could even have died, it distressed me so much.”

Psychiatrist Raquel Chilvarquer, also from the group of volunteers, says that, in general, there is prejudice in treating mental health, not only in remote populations. But the lack of assistance in this more isolated region, she says, can further worsen the situation of patients.

Medical assistance is rare in riverside communities, often accessible only by boat. Raquel was on the Tapajós River on the most recent expedition, in June, and says that she saw a complex emotional scenario.

“There is a fear of violence there. This causes stress, fear and trauma. Some patients freak out, when they could be medicated. Many suffer from insomnia, anguish and anxiety. Usually, they do not undergo treatment and the bitterness lingers.”

For Ana Lúcia, PhD in health sciences from Unifesp, disinformation is one of the most complicated situations. “It worries the emotional development of the children, who face serious problems. They are treated very badly. We have seen too much of everything. There is urgent psychological work there.”

The specialist also came across a family torn apart after the murder of a young woman by her fiancé. “The entire community was related. I provided collective and individual assistance to the most shaken people.”

Raquel and Ana Lúcia intend to continue the mental health mapping and follow up patients there. They are training professionals from cities close to riverside communities for basic care, which may take place on a monthly basis.

A health worker in Belterra for ten years, Rafael Siqueira da Silva, 37, has a positive assessment of the work carried out by Zoé’s volunteers. He says that people in this community are needy and have difficulty accessing the SUS (Unified Health System) due to the shortage of doctors. “They took many patients from a queue of years who were waiting for surgery by the SUS.”

The NGO Zoé has been working on the Tapajós River since 2019 with clinical care and surgeries. In that time, he helped to equip the Belterra Municipal Hospital for more complex treatments. The simplest, in addition to exams, are carried out on the Abaré boat. Medical help is free.

Each more complete trip to Pará can cost BRL 80,000, without considering the supplies, which arrive via donations from companies, says colonoscopist and surgeon Marcelo Averbach, from Hospital Sírio-Libanês. He is one of the founders of Zoé and director of expeditions.

Reduction of disparities

Access to mental health is important everywhere, according to a report released this month by the WHO (World Health Organization). According to the document, mental disorders affect one in eight people around the world and take a heavy toll on public health.

The lack of skilled labor in less developed areas is a barrier to improving the health of the population. Training medical professionals in regions without medical care would reduce disparities in Brazil. This is the conclusion of an Insper study released by three researchers who analyzed the behavior of generalists.

One of those responsible for the exhibition, Insper professor Letícia Nunes reports that the doctor’s decision on where to work is linked to the place of birth or graduation. Only later does he think about wages and structure in the work environment.

“One solution would be to bring medical schools to remote regions. It would attract local students, teachers and health professionals. There would be more structure for these communities.”

Averbach agrees. “To attract professionals, it is necessary to have schools for children, for example. There are several issues to consider. It’s not just salary, which is usually very attractive.”