Health post calls and car calls

January 2002

Interesting characters abound in life, and Acre seems to attract more than its share. In May 2000 Carlos Vicente, the head of the Acre State Secretariat for Forests and Extractivism, invited me to a meeting in Brasilia to discuss the use of public policy in Acre for controlling carbon emissions from deforestation. One of the participants was Manuel Cesario, a specialist in the developing field of carbon emissions trading and conservation. I heard that he was originally an M.D. and thought about his evolution to an environmental profession.

Sometime later I learned through the grapevine that Manuel had decided to move to Acre and return to his original profession to work in the innovative family healthcare program recently begun by the state government. He has since approached our group for an affiliation to keep his hand in the field of ecology. During December 2001, we organized a course on land cover and land-use change in Amazonia with participants from Brazil, Bolivia, and Peru. David Gonzalez, a professor from the University in Cusco, Peru, developed a sharp pain in his back that kept getting worse. Monica and I took him to the central emergency room in Rio Branco. After an hour's wait, I remembered that Manuel was working at a health post and managed to get his number. Even though the post was only a short distance from the University, the road was terrible and my jeep had been running poorly. But then, with perfect timing, my mechanic Ze fixed the trouble, and we cruised to the Jardim da Primavera health post. (Ze will appear again later.)

The health post proved to be a new model of health care, nothing like a standard emergency room. At this modest outpost, two healthcare assistants gave David a preliminary examination and informed him of the dangers of self-medication. Manuel and David spoke in Spanish about his problem. Monica also asked for some medical advice about her back, and Manuel wrote them prescriptions for pain relief and muscle relaxation. David proceeded to pay, but Manuel explained that there was no charge for the public health system. At that point the health post people filled the prescriptions--again without charge. Our visit turned out to be the next best thing to an old-fashioned house call.

A few weeks later, Manuel was due to arrive at my house to talk about research proposal linking health and ecology in Acre's frontier region. Ze drove by after work with his family to tell me that he was fixing my jeep and to give me a piece of birthday cake from his daughter's first birthday party the night before. I took advantage of the moment and told him that he should keep a written record of all the work he was doing. I even mentioned it to his wife, Noemi, with the hope that she could help him. Trying to convince him, I said that if others knew he was keeping such records, his clientele would increase.

As if on cue, Manuel rumbled up in his decades-old Mercedes convertible. Ze knows a potential client when he sees one and declared that he provided 24-hour service. With that bit of advertising, Ze went on his way.

Late one Friday night, someone called on my cellular phone, but it stopped ringing before I could answer it. The number was registered but unknown. I called back. It was Manuel who had called from a public telephone on a lonely road having broken a front wheel strut. He didn't have Ze's number and couldn't make an outgoing call on his cell phone. I called Ze at home and gave him phone number. After about 15 minutes I called Manuel. He reported that Ze had come by with his entire family and then drove off to find a tow truck. I called Ze, who told me that he was ringing the doorbell of one tow truck operator, but no one responded. He gave me the operator's cellular phone number and asked me to call because he was behind in his payments and could only receive calls, not initiate them.

For the next hour, I worked as a telephone operator, relaying calls between Ze and Manuel and trying to locate a tow truck. Then Ze did the incredible: using a rope, he jury-rigged Manuel's car so that it could limp to a gas station. Ze called again at two in the morning to inform me that all was well. The following day, Ze welded the wheel strut and Manuel is again rumbling around town.

Ze may be a bit more circumspect about advertising 24-hour service.

©Woods Hole Research Center, 2008