Celerino Almeida Carriconde

Celerino Carriconde is reorienting Brazil's health care system to encourage poor farming communities to rediscover and dignify local knowledge of medicinal plants and to take greater responsibility for their own health.

Brazil is known for a highly centralized and "authoritarian" public health care system in which the professional doctor is the principal, if not sole, source of knowledge. Celerino Carriconde notes that the vast majority of health problems of Brazil's rural poor are as much, or more, social than "medical" in nature, and that the prevailing health care model is poorly disposed to address this social dimension. An experienced medical doctor and a leading expert on healing plants and traditional healing practices, Celerino is using his knowledge of rural culture and traditional medicine to reform the modern health care system. His alternative model for rural health care emphasizes prevention and self-help by means of activities that begin with the rediscovery and endorsement of local knowledge of medicinal plants and lead to education in nutrition and disease prevention. The end result is to improve health dramatically in poor communities, to reduce dependency on medical authorities and the formal health care system and, most importantly, to root a deep sense of responsibility and capacity for good health in the community itself.Having demonstrated his method in the rural interior of Pernambuco state, "Doctor Roots," as Celerino is known throughout Brazil, is now systematically disseminating it throughout rural Brazil.

The per capita use of prescribed pills to treat ailments in Brazil is extremely high. While there is less than one doctor for every one thousand persons in the country, Brazilians remain unaware of the many natural, preventative measures available to maintain optimal health. Northeastern Brazil is one of the country's poorest regions, characterized by severe droughts, extremely disparate land distribution, high unemployment, relatively high rural population densities, severe malnutrition and soaring infant mortality rates. Infant mortality in the northeast is 150 per 1000, compared with 75 per 1000 at the national level. Infant malnutrition in Pernambuco is 45.5 percent statewide for children under five years old, and 62.5 percent in the interior. Complications from a lack of vitamin A alone (including blindness, diarrhea and pneumonia) affect half of the children in the northeast. Illiteracy rates among females are 40 percent in the state capital and 60 percent in the interior.To further complicate health care issues, the region is also characterized by a fatalism that, regrettably, the medical establishment tends to reinforce. Community members are likely to view illness as God's will or otherwise beyond their control. People look to religious authorities or physicians to "cure" them; they do not believe that they have the power to curb, much less cure, their own illnesses.

Celerino's community strategy is straightforward. By collaborative action research with communities, he catalogues and endorses traditional healing practices. Because over 90 percent of the people in Pernambuco, where Celerino developed his model, use medicinal plants in some capacity, there is tremendous popular uptake. Celerino emphasizes how cost-effective traditional remedies may be and makes sure that a "top twenty" list of "most effective" traditional remedies is widely distributed. This activity builds pride and a sense of accomplishment that enables people to participate more effectively in follow-up public health education activities. Ultimately, people begin to take responsibility for their own health and utilize the modern health care system in a more selective and appropriate way.The action research program recruits community and youth leaders as volunteers to interview elders, indigenous people, midwives and others who tend to possess knowledge of medicinal flora (such as teas, ointments and infusions) and of the ways to plant, preserve, prepare and prescribe them. Out of these interviews a technical "information bank and community map" of traditional healing and practitioners is created as a community resource and, simultaneously, a cohort of the best and brightest of the community's younger generation are exposed to "the old ways" and the enduring power of their own culture.Celerino operates weekly TV and monthly radio programs to publicize and raise the profile and status of traditional and community medicine. The fact that "Doctor Roots" is a senior medical doctor is important in validating the traditional alternative. Celerino has also developed a curriculum module for schools in which children learn to grow and use medicinal plants, and gain greater appreciation for the native culture. In addition, his educational activities and workshops actively endorse traditional medicine while they cover more conventional public health topics, such as nutrition, sanitation, essential drugs and emergency medical care.The main challenge facing Celerino at this point is to spread his approach based on the success that he has already demonstrated in Pernambuco. In order to spread it at a large scale, he must convince both communities and health care system professionals of the benefits of his alternative approach. Through media work, the program is spreading throughout the Northeast. Celerino encourages existing organizations to adopt his model through seminars; two new health projects have been set up to extend his model in new areas. He has also broadened his outreach to include nongovernmental organizations not focusing on health, as well as municipal, state and federal government bodies, churches and popular movements. Most recently, his group has begun giving workshops at large companies such as Petrobras, Microlite, Santista and Bhrama.

Celerino was born into the struggle for social justice and has willingly carried forward that struggle throughout his life. His father was a labor union activist and leader, and his mother an extraordinary primary school teacher who, as Celerino describes her, was an "educator of life." Reflecting on his childhood he particularly remembers the desperate state of health among the children of Villa Matara, a poor community near his hometown, and his first direct exposure to social justice work through various "Catholic Action" movements. While he was in medical school he became active in the student movement opposing Brazil's dictatorship, which led to the termination of his studies, imprisonment, torture and exile. While in exile, Celerino completed his medical studies and worked as a doctor, always with a strong social orientation, in Uruguay, Chile, Panama and Canada. After a general amnesty in 1979, he returned to Brazil and began to apply himself to the critical health issues among indigenous peoples, laborers, the favelas (urban slums) and, currently, the poor farming communities of the rural northeast.Since his return Celerino has deepened his study of traditional healing and traditional health practitioners and become known throughout Brazil as a leading advocate for alternative medicine. An engaging conversationalist, it was Celerino's popular media persona that earned him the sobriquet "Doctor Roots." Political parties have recognized his popularity with offers to run for office. But "Doctor Roots" eschews electoral politics in favor of his abiding interest in uprooting Brazil's prevailing top-down, authoritarian health care system and spreading his home-grown alternative.Celerino's main concern, as he says, "is to build and strengthen the Popular Movement for Health as an organism through which communities can struggle for their rights on health."