Elcylene de Araújo Leocádio

Elcylene Leocadio, a young doctor from Recife in Brazil's Northeast, wants to ensure that poor women receive appropriate, integrated medical assistance and are able to make well-informed decisions on family planning.

Leocadio is launching a project that will systematically monitor, evaluate and press for the full implementation of the "Programa de Assistencia Integral a Saude da Mulher" (PAISM), an integrated women's health program.This program of the national Ministry of Health was formally put in place five years ago and was considered to be a great victory of the women's movement. However, to this day the program has not been implemented anywhere.Leocadio's objective is to see that the program is implemented over the next several years. She is beginning by mapping out carefully what is and is not being done in all the public and private health institutions in Recife. She will then focus in on the two most heavily populated health service areas in the city, areas where the program is supposed to be functioning. By monitoring performance regularly (which she can do given the access she has as a doctor) and by feeding these evaluations back to the women's community and to the health program itself, she hopes to help redefine the community's health agenda.The local women's community groups and the larger regional and national women's organizations will become an active consumer and pressure group. By working closely with the public health and medical institutions, each divided into many bureaucratic compartments, Leocadio hopes to be able to provide some of the missing project management necessary to make this integrated program function.Leocadio will spread the analysis and the model she develops in Recife throughout Brazil, using the women's movement and channels of professional medicine and public health management.

Women's health issues have until recently received inadequate attention in Brazil -- be it neonatal care, gynecological disease, family planning, special nutritional needs, or a host of other concerns. The problem is especially acute for the poor majority. The case of family planning is illustrative. Due to political pressures, especially from the Church, family planning policies in Brazil, when not entirely lacking, have been remarkably ambiguous. A few overstretched non-governmental organizations have been dispensing free birth control devices with questionable controls. Research done among women in the city of Recife showed that the pill accounted for over 90% of the contraceptive methods used with the condom coming second, being used in 7% of the cases. 60.2% of the women using the pill were using it incorrectly. Some women were even giving the pills to their children to fatten them up. The drug stores are another important source of contraceptives. In this case, the monthly or trimester injection (not approved in the U.S.) is the most popular method and is commonly dispersed by non-qualified drug store workers. In certain areas there are very high rates of sterilization; for instance, Elcylene reports that in Recife 40% of the women of fertile age have had tubal ligations.Abortion is highly controversial. Although it is illegal, considered against medical ethics and condemned by the Church, abortion remains widely practiced in Brazil. The best estimates suggest that there are between 3 and 5 million abortions a year. Many of these abortions, particularly in the case of poor women, are performed at home or under unsafe conditions that put the woman's life at risk.Research has repeatedly shown that poor women have very little information, understanding and decision-making power regarding birth control methods. This is only one example of their having little sense of how to obtain quality health services, let alone of how to seek out care alternatives.

Non-governmental citizens' groups played a key role in introducing the national debate on women's health care needs that led to the PAISM program. Leocadio believes that once more, these groups will be the key to assuring the program's implementation.However, winning implementation is a different, almost certainly harder task than winning a policy debate. Every new concept must be translated to changes in behavior -- changes by individual patients as well as by doctors, of community patterns as much as of those of medical institutions. A hundred detailed changes must be designed, and thousands of actors must be persuaded to go along.That is why Leocadio is focusing first on several specific communities and the medical institutions, both public and private, that work there. Working with both favela (slum) women and the health care system -- both groups from which she has won credibility and trust -- over the next several years, she plans to work on and demonstrate the specifics of an integrated women's health program. Once she knows specifically what is required and can demonstrate it working effectively, she can press the approach nationally.In the meantime, Leocadio will continue to build the interest and involvement of sympathetic government officials, health professionals and their associations, women's groups at all levels, and the broader public through publications, meetings, and informal contacts. Their interest will encourage the demonstrations and lay the groundwork for subsequent expansion.

Elcylene Leocadio is a young medical doctor who specializes in public health. Since her medical school days, she has been working with poor communities in Recife and in surrounding areas, gradually learning to understand their problems nd sociology as well as developing a sense of how best to serve the medical needs of the women there.Leocadio has been very active in the women's movement and has worked with the National Council on Women's Rights. Her work recently led to her election as a Director of the Pernambuco State Medical Association.Leocadio's professional, analytic, and community skills have reached the point where her twelve-year-old dream of bringing effective, comprehensive care for women's special health needs promises to become a reality in Recife and on a national level.