Psychosis
“Shut up. I am ordering you to shut up.” A volunteer wearing a white coat approached the cursing man and threatened to lock him up.
The man on the ground was undeterred: “O devil, eat shit! O devil, stick this bread in your ass!”
As the volunteer turned, he saw me talking to Catarina and walked toward us. It was Clóvis, the nurse. He said he had heard a lot about me, and he apologized for all the noise. “Only medication makes this poor thing shut up. We have to sedate him. But he spits it out. What to do?” Clóvis also apologized for being unshaven. “I really don’t have time. Work here begins at 5 A.M. and continues nonstop till 9 P.M.”
“Clóvis gives me the vitamins,” interjected Catarina.
“Yes, I am the one who medicates . . . when there is medication to be dispensed,” added the fifty-four-year-old man. “I give injections, take care of wounds, bathe the grandmas—everything here happens with me.” Clóvis said he had been doing this work for almost a year “out of charity. I don’t get paid.”
He explained that he had learned all these nursing skills while working as a volunteer in Porto Alegre’s major psychiatric hospitals. In an association that sounded strange to me and that linked his work to Catarina’s, Clóvis alluded to a “pharmaceutical dictionary” he used to read at the São Paulo Hospital, which gave him “the knowledge to now manage Vita’s pharmacy.” Clóvis was also the man who had thrown away the second volume of the dictionary that Catarina had entrusted to him.
“But let me tell you the truth,” stated Clóvis. “I have been an alcoholic for almost my entire life.” He began drinking as a teenager. At the age of fifteen, he left his mother’s home in Porto Alegre, becoming a vagabond and a migrant worker. He made brief references to having lived in Uruguay, Paraguay, and Venezuela. For a while, he said, he had a family of his own in Rio de Janeiro, but his only son had died in a car accident.
As we talked, Clóvis disclosed that he had in fact been an inmate in the psychiatric institutions where he had learned about medications and that in the early nineties he had also lived in Vita. “This time, I came back by myself. São Paulo’s social worker is my friend; she wanted to rent a place for me, but I decided to come here. My treatment there had ended, and I was afraid that I would go back to drinking and living in the streets. It’s tough—alcoholism is a bad disease.” This man’s history held much more than his words were ready to tell, I thought.
Like many of the other volunteers and inhabitants of Vita’s recovery area, Clóvis saw the dying creatures in the infirmary as important material for shaping the citizen he wanted to become: “I can see the inhuman conditions here. So I can tune in, find myself again, and forget drinking. Working with the abandoned is a therapy one does with oneself. I still want to get some more years of work outside here so that I can retire and get my social security benefits. We don’t get paid anything here.”
As the man on the ground continued to call out to the devil, Clóvis insisted that we move to the pharmacy. He tried to joke with Catarina, saying, “She fights with me. If I don’t give her attention, she cries like a cat.” Catarina nodded and mentioned something I could not understand.
The infirmary’s small pharmacy was indeed well organized now. More medications were on the shelves, mostly donations (many of them expired, as I later verified), and labels were everywhere. On the table, little plastic cups marked with patients’ names or nicknames contained the various doses to be consumed throughout the day. Clóvis’s services were in high demand. Many men from the recovery area, as well as mothers and children from the village surrounding Vita, knocked at the pharmacy’s door, asking him to fill prescriptions or provide medical advice.
“Before I ran the pharmacy, many more people died in here,” Clóvis asserted.
How so?
“Wrong medication. I guess that some twenty people died here in one month about three years ago. The police even investigated. It was during the time Vita’s administration changed.” According to Clóvis, many of his predecessors in the pharmacy “couldn’t even read and simply put pills in the cups and distributed them to the dirt poor. Many had heart failure.”
Things in Vita changed under the new administration, Clóvis observed. “There are fewer abandonados in the infirmary. I shouldn’t say this, but I will: Vita now works more like a business. There are still some people from the time of Zé das Drogas, but they are dying out. They accept fewer people into the infirmary now, and the new inmates are mostly elderly women who have pensions. Some of them even get three minimum monthly salaries.”
Vita had an organized triage system these days, coordinated by social worker Dalva. “Before,” explained Oscar, the infirmary coordinator, “people who came in here had no identity. We didn’t know whose children they were or whether they were parents. . . . Many came alone. Now at least they have to have an ID card, and the triage makes it possible for us to contact the patient’s family if we have to.”
Captain Osvaldo was straightforward about the institution’s current modus operandi when I spoke to him later that day: “We are not taking in injured persons anymore. . . . We want to reach a level of zero confinements in the infirmary. We are not a hospital. We are basically a rehabilitation service, so that people can return to society and work.”
I asked Oscar to elaborate on the rationale for this shift in policy. Tired of having his pledge to improve the infirmary dismissed, he reluctantly spoke his mind: “Today, the people who administer the institution have their own private interests. This is a political game. They are not interested in the social good of the persons. They are more interested in the visibility the institution has to the outside world. Given all the donations, life in the infirmary should be much better than it is, in terms of food and treatment. I am tired of fighting. . . . They are concerned with the image of Vita outside, while the reality in here is completely different.”
As for the future of the infirmary and its inhabitants, he said, “the vision of the administration that the captain passed on to me is that these people will be terminating themselves until we have zero of them. . . . Perhaps in a few years, none of these people you have been talking to will be left.” As if it had all been self-generated, I noted, and with no accountability for their suffering. Oscar made an affirmative gesture. “How else? This is the social reason: these people don’t produce, they don’t vote.”
Oscar told me that I was standing in front of “a shattered man,” but that he “would move onward with life, with the help of our Lord.” He had recently found out that that he was HIV-positive. “AIDS was not the thing I feared most,” Oscar said. “I was scared to death that my wife and child would be infected as well. They didn’t do anything wrong, like I did, all those years of injecting drugs. But maybe I got infected here in the infirmary as I handled AIDS patients. I finally had the courage to tell my wife, and she was tested. Thank God, she and the child don’t have the virus. She told me that she would not leave me, that she would face it with me.”
With the help of Vita’s social worker, Oscar was learning to navigate the local medical AIDS world. He was being seen by an infectious-disease specialist and had his CD4 levels checked regularly. “The doctor said that I am healthy, that I don’t need the cocktail yet, and I will do whatever I can to postpone using it. But thanks to the government, we now have hope.” Oscar was referring to the free distribution of antiretrovirals by the Brazilian government.
For the abandoned, however, medical assistance remained minimal. A doctor-philanthropist was still visiting Vita once a week, basically
