Brazil in Focus

Brazil's social priorities need rescuing

by Roberto DaMatta
In Brazil, emergency is a word with many meanings, most of which reveal the deepest dimensions of local culture. If an Englishman screams "Help!" he is immediately helped. If a U.S. airlines, whether small or large, receives a request for an emergency ticket - this has happened with me - a seat will promptly be granted. In both places, words like help, danger, aid, emergency, and expressions such as "life or death" wield the power to suspend the daily routine and trigger effective responses. No one needs to be reminded that the ensuing attention and assistance must be immediate.

In Brazil, it's different. Say emergency and reactions vary widely, depending on who is in need and who stands on the other side of the hospital door or the service desk. Among us Brazilians, there is always mediation. Everything depends on the specific "case" for here, as we all know but don't talk about, there are cases and there are cases. Good looks, fair skin, a way with words - all these factors affect the way a victim is treated when the alarm bells sound. One's fortune or misfortune depends on social rank and pedigree.

In all impersonal encounters in Brazil, personal factors rule. Accents and speech patterns, the tone of voice, a person's carriage, clothing, hairstyle and even hair texture, and skin color (let's face it, skin color is key): all these matter. So does the brand of watch you wear, whether you use jewels or beads, the way you walk, even how clean you appear and the cologne you wear. All these, to a greater or lesser degree, are variables in the sliding scale of a Brazilian emergency. Accustomed as we are to pigeon-holing people as either inferiors or superiors, and never as equals, we need to know who the victim is before deciding whether to jump or shrug our shoulders. No matter that emergencies and calls for help ignore such social codes, showing us all to be equally vulnerable to injury, abuse or death.

Hence, the unpleasant but providential "Do you know whom you're talking to?" - a verbal trump card brandished at the counters of government agencies, hospitals and clinics. In emergencies, we resort to the same sleight of hand that governs politics. When news breaks of suspected crimes - or "misdeeds", as President Dilma Rousseff prefers - we first seek to know who is involved before deciding whether to keep quiet or to condemn the accused, or else to circle the wagons to protect an ally. Never mind that good sense nearly always dictates that the best course is to take immediate action.

We talk a lot about citizenship, but in Brazil some citizens are more equal than others. If a person in trouble happens to be "one of ours", he is shielded at all costs, placed above the law, and regaled with special treatment. However if a particular citizen in his hour of need has no godfather or social pedigree, he is left to the case-sensitive logic of the emergency room, which depending on the gravity of his condition may very well prove to be the antechamber to the funeral parlor.

Anywhere else, help or emergency are words that hold the power to suspend normal circumstances. Last year, I took ill, went to the hospital and learned I had a damaged gallbladder that needed to be removed as soon as possible. So began the familiar medical daisy chain of events that started in the emergency room, proceeded to the operating table, and ended two days later with my complete recovery and return to normalcy.

My emergency was a fortuitous one for the simple reason that I was accompanied the entire time by experienced doctors who also happened to be my friends. I was a beneficiary not only of competent physicians but also crucially of decisive medical intervention and the ready aid and support of people I trust. Mind you, I pay dearly for my health insurance, but even so it took me nearly six hours to clear the thicket of emergency procedures and be admitted to a major hospital in my hometown of Niteroi, across the bay from Rio de Janeiro.

As it happened my health insurance policy authorizes treatment in Rio de Janeiro, while neighboring Niteroi falls under a region called East Fluminense. No matter that Rio and Niteroi are a mere 20 minutes drive apart, separated by a 14 km expansion bridge. In the bureaucratic protocols of Brazilian health insurance, they might as well have been in different time zones. I waited for the red tape to be sorted out, but the medical team waited with me.

Even so I arrived at the hospital at 9 am and was wheeled into the operating room at 6 that afternoon - and only after an interminable exchange of messages and phone calls between the clinic and the health insurance provider. Fortunately, everything turned out well. But what if I had been, say, an ordinary black man, equally in need of emergency care but too ashamed to fall back on the old Brazilian canard of "Do you know whom you're talking to?", a handicap which only reinforces inequality? I might be writing this chronicle from the next world.

We need to rethink the way we manage Brazilian public space, starting with our ethics for emergencies. In a democracy and with a government committed to advancing social justice and helping the poor, there is no excuse for surrendering to legalisms written to blame the victim.

Consider the tragic case of Duvanier Paiva Ferreira, secretary of a federal health agency (an agency dedicated to human resources, no less!), who died recently in Brasilia after being turned away from one emergency room after the next. The tragedy is remarkable because the victim was a prominent black man. More remarkably, Ferreira never resorted to the notorious power game ploy of "Do you know whom you're talking to?" Could it be that in order to receive any kind of attention, the sick are required to pull rank and cause a scandal?

Emergencies and rescue, by definition, cannot support delays or excuses, much less the odious national cult of legalism which satisfies the corporate attorneys but should simply be banished when life and limb are at stake. President Dilma would do well to investigate the Ferreira case. Better yet, we Brazilians need to rethink the rules of social of engagement. The old ones could stand for some emergency care.

Roberto DaMatta is an anthropologist. This is a version of an article published originally in O Estado de São Paulo and O Globo. Translation by Roman Gautam.