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Health Promotion in the Amazon Region

Arakawa, Aline Megumi PhD; Xavier, Ângela PhD; Bastos, Roosevelt da Silva DDS; Oliveira, Ariádnes Nóbrega PhD; Bastos, José Roberto de Magalhães DDS; Caldana, Magali de Lourdes SLP

doi: 10.1097/01.HJ.0000416306.04568.90

Dr. Arakawa is a speech-language pathologist, and Dr. Xavier is a dentist, both in the division of public health, and Dr. Roosevelt da Silva Bastos is a professor, all in the department of pediatric dentistry, orthodontics, and public health, Bauru School of Dentistry, University of São Paulo, in Brazil. Dr. Oliveira is a speech-language pathologist, division of public health, department of pediatric dentistry, orthodontics and public health, and staff of the department of speech-language and hearing pathology, Bauru School of Dentistry, University of São Paulo, Brazil. Dr. José Roberto de Magalhães Bastos is a dentist and a full professor in the department of pediatric dentistry, orthodontics and community health, Bauru School of Dentistry, University of São Paulo, Brazil. Dr. Caldana is an associate professor in the department of speech-language and hearing pathology, Bauru School of Dentistry, University of São Paulo, Brazil.

The faculty of the School of Dentistry at Bauru at the University of São Paulo in Brazil started outreach activities in 2002 in the city of Montenegro, a municipality in Rondônia located in the heart of the Brazilian jungle. Undergraduate and postgraduate students as well as staff and professors in dentistry, speech-language-pathology, and hearing sciences at the university joined forces to provide services in the remote Amazonian community, specifically in Montenegro. This year the project called USP in Rondônia celebrates its 10-year anniversary. We provide dental, speech, and hearing healthcare, as well as educational programs for the Amazonian residents, and we have performed 45,105 procedures and helped 14,450 people in the past 10 years.

Montenegro has a population of 14,091, according to the Brazilian Institute of Geography and Statistics. (IBGE. Censo Demográfico 2010 [see FastLinks]; figure 1.) Approximately half of the population lives in rural areas. The economy is based on the wood production, local trade, and agriculture, mainly coffee, corn, rice, and livestock.

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Fifteen-day expeditions are typically carried out twice a year, usually in January and July. A preparatory course is provided to senior undergraduate and postgraduate students before each expedition in dentistry, speech, language, and hearing sciences. An examination is administered at the end of the course, and qualified students are chosen to take part in the first or second expedition.

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USP in Rondônia also partnered with local entities such as Montenegro City Hall and Biomedical Sciences Institute 5, an advanced research center in Montenegro that aims to improve research on tropical diseases in the Brazilian northern region. Montenegro City Hall helped us arrange transportation for access into remote villages. An expedition in 2010 came to fruition to work with the riverine population from Calama, Demarcação, and Rio Preto. The trip, departing from Porto Velho, Rondônia's capital, lasted three hours traveling by river with firefighter support; the trip would have been 12 hours without it because local transportation, like boats, stop in several communities along the river.

BSI5 started to take on other areas of knowledge to promote health among the local population and, because of this, partnership with the faculty was initiated. The Brazilian Air Force (BAF) supported us with moving equipment, saving the team from exhaustion. The trip to Rondônia without BAF is treacherous, and takes about 45 hours to travel 2,510 kilometers, approximately 1,800 miles. The trip was reduced to six hours with the help of BAF.

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USP in Rondônia works in two groups, one in an urban area and the other in a rural area. Traveling to rural areas has been challenging because of dirt roads with many potholes. Traveling becomes worse when it rains, making the roads difficult to cross. (Figure 2.) Sometimes our work is suspended due to the weather.

We traveled six hours and 184.6 miles in 2009 to provide services to Tabajara, a community with 400 inhabitants in the neighboring city district. The district is located riverside in Machado, which was built during the time of Brazil's thriving rubber industry, an important part of the country's economy that provided social and cultural changes. Workers could not go to other places to earn a living after the cycle finished, and are presently living in Tabajara. People living in this community cannot access public services, especially healthcare services, due to the remote location. They rely on homemade medications, such as teas and herbs, and do not have the means for traveling to the nearest location with medical facilities. This region also has a high incidence of malaria. Children's healthcare is especially needed. The USP team provided dental, speech, and hearing services to the people who live in these communities. (Figure 3.)

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Dental Services

We typically perform extractions, fillings, dentures, endodontics, basic periodontal treatment, and education and preventive procedures. Companies donate toothbrushes for distribution to the population. (Figure 4.) Oral health conditions in Montenegro are still lacking as is education. This is a dangerous combination for the citizens that results in a lack of improvement in their health and quality of life.

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Speech, Language, and Hearing Services

We provide language, hearing, voice, and oral facial motor skills services as well as screenings and therapies for children and adults. Most residents did not know about the importance of speech, language, and hearing before we started visiting the villages. Today, information is still lacking, but awareness is much higher for children and adults. We also provide vocal healthcare for teachers.

Hearing aid manufacturers donated analog hearing aids and batteries. We fitted the first hearing aid in 2007 and started a rehabilitation program. (Intl Arch Otorhinolaryngol 2010;14[1]:38.) We have provided almost 100 hearing aids that were fitted unilaterally or bilaterally.

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The dentistry, speech-language, and hearing teams worked together to communicate with the residents, disseminating knowledge and developing transdisciplinary approaches on prosthesis adaptation for oral motor skill assessment, with pre- and postadaptation focused on speech, chewing, and swallowing. Education about hypertension, diabetes, stroke, language, memory, and periodontal disease was also provided.

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Ottawa Charter for Health Promotion established by the World Health Organization defines health promotion as the process of enabling people to increase control over, and to improve, their health. (Health Promot Int 2011;Aug 11. [Epub ahead of print]; see FastLinks.) The activities developed by USP in Rondônia are an effort to promote this concept by looking for relevant healthcare issues to improve quality of life. Health education has been carried out in several ways.

* Communicate with the population while they wait for medical attention.

* Offer supervision from USP undergraduate students to public primary and secondary schools in oral care, such as brushing teeth.

* Give lectures to teachers from public primary and secondary schools.

* Provide training to healthcare professionals from public service, including community health workers, nurses, nursing assistants, and psychologists.

* Provide videoconferences to professors and healthcare professionals who are working on health education activities.

* Develop educational materials to cover speech, language, and hearing pathologies related to the aging process and distributed as CDs.

* Conduct online training sessions for professors who cover public policies about special education, the family's role, educational procedures, relationship between speaking and writing in the literacy process, and the importance of multidisciplinary work.

USP in Rondônia provides a rich experience for everyone. Undergraduate students, professors, and postgraduate students may live a new reality, experiencing the importance of different cultures. This is also relevant for the university because the extension activities serve as part of a tripod that makes the university work. This tripod is structured by teaching, research, and extension projects.

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