Vera, how did you grow up?
I am a Brazilian, born in Rio de Janeiro. Switzerland is my second country. My father was Horst Gaensly, his family came from Switzerland. He was the CEO of a textile company here in Rio. From him I learned how to accomplish things and to be committed. My mother, Cordelia Gaensly went to Switzerland because she sought inspiration in order to build a school for me and my brothers, based on the Swiss education system. My parents were plentiful people, creating things all the time. I grew up in privileged conditions but was raised surrounded by poor people in a suburb of Rio de Janeiro. Since I was a little girl, I was concerned about the social injustice I saw. I used to give away all my toys to the poor because I couldn’t play seeing the others without anything to play with.
Was your later decision to become a doctor influenced by this stark contrast in your childhood?
To tell you the truth, no. I was also inspired by my uncle Mauricio, a physician and wonderful human being. His house was like the United Nations, people from everywhere came to him to be treated. And he treated not only their bodies, but their souls. He understood this connection between the mind and the body. So ultimately it was my uncle and the example of my parents that helped the people around them who inspired me to become a physician.
How did it come about that you founded your own organisation Associação Saúde Criança?
I was nominated head of the psychosomatic department in the Hospital Federal da Lagoa in Rio de Janeiro, where I had been a general practitioner. I was in charge of the psychosomatic department in the paediatric sector, treating children and their diseases. I always wanted to understand the person behind the disease since so often social aspects were the real cause of their diseases. I experienced it many times that mothers who came to the hospitals with their children said, “Doctor Vera, please, keep my child. Please, raise her for me, I have no money”. In these instances I felt like my heart was breaking. I understood back then, that traditional medicine all over the world does not take care of the psychosomatic aspects of the disease. Medicine treats the body but neither the mind nor the environment the patient finds himself in. I saw that we needed to look at the big picture of health care, also at the mind, the social and economic environment, and the psychosomatic problems. I love Margaret Mead’s statement: “Never doubt a very committed group of people because they can change the world. In fact only they can change the world”. In 1991 I founded the Associação Saúde Criança. I came together with people from many backgrounds and different areas of human knowledge. We took a step away from the traditional health care and went beyond the hospital walls. This vicious cycle of poverty, hospitalisation, and re-hospitalisation, and ultimately death these poor urban families experienced we wanted to break. Additional health care, more medicine in other words, doesn’t break it. But taking action together with the whole family, treating the child, the family, and its psychosomatic problems, that is the way to break this vicious cycle.
When you are describing yourself to someone who does not know you, what is the term you use?
I’m a social entrepreneur! Social entrepreneurs see an obstacle and want to commit themselves to solve the problem, though they might not yet know the solution to the problem. I understood early on that traditional health care is not the way to treat people. Not in Brazil, and not anywhere else. I didn’t know the answer but I wanted to commit my life to finding it. And I knew that I would be able to convince many people to get into the same boat. Social entrepreneurs are some sort of crazy people, there is no way out for us. I cannot be anything else than this restless person. What we really want is to change the world even though we know that that which we want to transform is so much bigger than us.
Is this what inspires you from day to day, a wish to change the world?
There are two things which inspire me. I believe that you cannot be happy if the people around you are suffering and live without dignity. Everyone should do something, be it small or great. And this dignity I want to bring to as many families and children as I can. I cannot see anything worse than a mother with children, and all of them dying. We at Saúde Criança have committed our lives to bringing about a life with dignity for them. And second, through dealing with poverty and promoting social inclusion through health, I understood that there is a way out. It’s not impossible. It’s really possible! It’s like we discovered penicillin. And so I just have to tell everyone who wants to listen to join. Join us, we know a way! We want to be a movement for all, not just the poor.
You mentioned your social methodology, what exactly is it that you are offering in Saúde Criança?
We are offering a service that we created bottom-up. We learned from the people we serve that poverty is a multi dimensional problem. We could not just focus on health, although our main area of concern is health. If we really wanted to transform the lives of the people who seek out a hospital with a sick child, we had to work in five areas: health, education, housing, income generation, and citizenship. The methodology we created we called the Family Action Plans. Saúde Criança means “Health Children”, but it is impossible to deal with sick children without dealing with their whole families. And that is what we do. Ten hospitals in Brazil are linked to Saúde Criança, and within them volunteers and staff, social workers, psychologists, and physicians work with the whole family. First, a social worker, a psychologist, volunteers, a lawyer, a nutritionist, and a physician conduct a thorough interview, trying to understand everything about a patient’s life. How can they overcome the challenges they face in a sustainable way? How much does the head of the family, which in 95% of the cases is a woman, earn? How many children are in the family, in what conditions do they live, how many personal documents does the mother have, are the children going to school, etc. We have to make a holistic diagnose of the whole family in order to truly help a child coming to us for medical help. Together with family we create a plan and goals in all of these five areas, health, education, housing, income generation and citizenship. And those goals the whole family will be pursuing within our programme for about two years. We have very clear criteria when to discharge the families, in all of the five areas that we work in. One example regarding income generation: at least one adult in the family must be working and earn a minimum wage [the minimum wage is approximately US$ 320 per month]. Then they can live with dignity, and it’s a dignity which is defined by them. As Muhammad Yunus says, “You have created a powerful methodology to include the poorest among the poor”.
What do you mean by that, “including the poorest among the poor”?
When you live in a country like Brazil, you understand that there is a huge difference between the poorest and the poor. When a family tells me “As poor people, Doctor Vera, we have everything”, then I know they have internal and external tools to deal with poverty. But when I see a person with lack of money and internal tools, like joy, inner strength, and the ability to deal with the everyday life, I know I’m dealing with the poorest among the poor. So when we chose to help a family with a sick child, according to our methodology, we choose to help those poorest among the poor.
Is Saúde Criança a foundation or are you a financially self-sustaining organisation?
We are a Non-governmental organisation, we are dependent on donations and grants. But we are trying to become a social business. We are providing consulting services to other organizations, to private sector companies, and to the government about how to best implement our methodology. We are learning how to make use of our most valuable product, our social methodology and are aiming to becoming financially self-sustaining in the near future. My team and I were deeply committed to finding a way to transform our work into a social business because other organisations started to approach us for a share in our social methodology. If I want to help as many people as possible, I know Saúde Criança has to become a social business.
Do you have competitors in what you do?
I would not use the word “competitors”. I went to 16 countries and gave more than 60 talks about Saude Criança, and of course attendees of these talks asked me to send them further information. And so they got to know our methodology and created something based on it. But they are not competitors, they implement our methodology for the benefit of the people. And that is good! When an idea is good, I don’t want to be the “mother” of this idea, it should be spread to wherever it is needed. It was after all not solely myself who created the Family Action Plans. It was organizations like Ashoka, AVINA, the Schwab Foundation for Social Entrepreneurship, the Skoll Foundation, Praxair, Johnson & Johnson, and other sponsors, dedicated volunteers, and the mothers and children that we serve: it was a group of people listening to people. I led this group of people for 23 years but it was all of us together who created this powerful methodology. But after all, we were pioneers with our multidisciplinary approach to deal with health problems and promote social inclusion in order to fight poverty.
Did you ever encounter failure as a social entrepreneur?
There was no model to follow, so we learned from trial and error. For example, one main challenge was to figure out how we should organise our governance. Via network or social franchise? What is the right way? We only discovered with time that for us, a social franchise is the best way. We had originally inspired 23 institutions with different names, linked to 23 different public hospitals in a network. In 2010, I had to change the governance from a network, which was confusing due to its variety of names, to a social franchise. Nobody really knows how to maintain a social franchise, but we asked a consulting company for help. And together with them we changed our governance. We chose ten hospitals, which are linked to 10 Saude Criança units today. They are located in Rio de Janeiro, in São Paulo, San Jose dos Campos, Porto Alegre, Florianopolis, Goiania and Recife. We agreed that we want to work first and foremost in Brazil. If we can create a movement of social inclusion here, it will spread all over the world. Three researchers from Georgetown University made an in-depth study about the long-term impact of Saúde Criança and found long term benefits for the families we have helped. Three to five years after the families have graduated from the program, there is a decrease of 86% in hospitalisation, a 92% increase in family income. We are confident that our methodology can be linked to schools, nurseries, hospitals, governments and NGOs, as social franchises.
What are your goals for the coming years?
We want to consolidate our centre of excellence of social inclusion [Centre of Reference for Social Inclusion] and spread our social methodology from Rio to wherever it is needed. Rio de Janeiro is like a resume of the world, with all social strata and living conditions. It is the perfect city to talk about social inclusion. We plan annual meetings, training, and consulting for people from all over the world. We will not only pass on our knowledge, but also learn from other people and organisations.
Thank you very much, Vera, for this interview. Is there anything you would like to add to what we have been talking about?
I want to thank all the volunteers, board members, our staff, sponsors, partners, and health professionals that built this powerful social methodology. And finally I also want to deeply thank my whole family, my parents, my husband, my two daughters and granddaughters for always believing in me and supporting me. I especially want to thank my mother since today was her birthday and she also dedicated a lot of her time to this organisation. She made it possible. I read everything about C.G. Jung who created the concept of synchronicity. The history of Saúde Criança is a history of synchronicity. So thank you!