The Clinica Sorriso (translated as Smile Clinic) was built in 1993 in the town of Igarassu in northeastern Brazil. It is the result of a solidarity based which was promoted in Italy when I returned from my first trip to Brazil. The clinic was opened in order to meet the health needs of the pupils of Santa Maria School, an activity which was started in 1969 in the city of Santa Maria where the school is located.

The school catered to around 300 children coming from very poor families residing in the suburbs of the city. Because of the prevalently agricultural livelihood in the zone, the majority of the population lived on a minimum wage no higher than about 1 dollar a month, according to the monetary exchange rates of those times. For 10% of the schoolchildren, the lunch taken at the school refectory was the only meal of the day. 40% of the pupils suffered from intermediate degree malnutrition while a large number presented speech impairments and learning retardation. The common diseases were parasitosis, respiratory and gastrointestinal ailments, hypertension and osteoarticular illnesses. Among adolescents, precocious sexual activity was rampant, resulting in undesired pregnancies and a widespread diffusion of sexually transmitted diseases. The population had little access to the health centers due to distance and overcrowding. This is the social context of the Clinica Sorriso which exists «so that children may regain the joy of living together with health» (Chiara Lubich’s message in occasion of the Clinic’s inauguration).
After the inauguration of the Clinic in 1993, the Clinica Sorriso Association was constituted for the management of the Clinic. Dr. Honorina Costa and her husband Josafà who lived in a nearby city, transferred to the area to assume the direction of the clinic. In August 1993, the Clinica Sorriso Association had an assembly meeting to study the working guidelines. Present in the meeting were 2 doctors who were experts in Public Health, the director and some teachers of Santa Maria School, the directors of the “little town of S. Maria” where Clinica Sorriso was located, and two social workers who had already been working for several years among the families of that area. This assembly meeting defined the inspiring idea which has guided Clinica Sorriso’s 13 years of activity in the midst of the joys and sorrows that came from day to day. Clinica Sorriso has set as its aim: the development of holistic health, by considering the person as an integral part of the community where he/she lives, a community where there are rights and duties to be respected, yes, but in the context of a society which is just and respectful of each person’s human dignity. How could this aim be realized? Through the interrelationship of the community, the Santa Maria School and the Clinica Sorriso.
Several projects were carried out according to this guideline:
1) Speech rehabilitation for pupils;
2) Psychological assistance for the pupils and their families;
3) Dental hygiene and caries-prevention;
4) Nutrition project;
5) Treatment for alcoholics with the involvement of their families;
6) Anti-hepatitis vaccination project;
7) Project for sexual education and for prevention of sexually transmitted diseases;
8) Personnel and teacher formation project.

At present there are two pediatricians working at Clinica Sorisso. They do over 800 check-ups a year: to assess the general state of health of the schoolchildren of Santa Maria School, their nutritional condition, how many are in need of vaccination, and they give anti-parasite treatment to those in need. Two foniatre and two psychologists give support to the families of children with speech impairments, with positive repercussions on school performance and learning ability.
The medical team is composed of a general practitioner, a gynaecologist, a cardiologist, a dermatologist and a dentist (odontoiatra). Health care services to the schoolchildren are made possible through funding by a Support-at-a distance project. Also adults who have jobs and insurance benefit from the health care. In order to avoid an assistentialistic relationship, even beneficiaries with no economic means are asked to contribute a minimal quota.
In the Clinic’s 13 years of activity, the global health of the general population has improved, in particular the nutritional health of the children. Since 2003, healthcare intervention has been anticipated with the opening of the nursery in Santa Maria School. Special efforts were made to organize 62 mothers of the community, together with health agents prepared by the formation project. Together they formed a team which was able to make 380 home visits, and 9 meetings with mothers of the schoolchildren and with other groups of women in Igarassu.
They made an assessment of the nutritional condition of children who presented particular necessities; they were then oriented to the Clinica Sorriso and inserted in the personalized programs with good recovery results.
The work being done in the community aroused the interest also on the institutional level, so much so that the mayor’s office of Igarassu requested that the project be presented to other 14 poor communities to get them involved.
Since 2005 the cardiology service has been enlarged with the ergometria, which otherwise was inaccessible to the local population because other centers were distant and high costs were involved.
It is impossible to make in this Congress an analysis of the health care activities which were carried out in all these years; however I would like to emphasize the “additional value” of this initiative to achieve a real health development. Since 1992, I have been going yearly to spend my month-long vacation in Santa Maria. I was able to get my friends and colleagues involved, and live with them moments of exchange of competencies and professional experiences. Those days were for us a refresher course in the true sense of the word. Actually, I am in charge of the Clinic for Immigrant and Adopted Children of the Meyer Hospital of Florence. Even if I work in social and cultural conditions very different from those of Clinica Sorriso, I believe that an integrated activity with all the structures that focus their attention on children and the family, with all forces working in this sector, is needed so as to achieve a real health development.

1. Honorina Costa’e experience

My husband and I, both medical doctors, at that time were already on the road of a promising career, but inspired by the desire to put our professional life at the service of our fellowmen, we chose to move to the smaller city of Igarassu to work in this small polyclinic which was just starting. In Brazil, the medical profession represents a social status, we were running the risk of ignoring the physician-patient relationship in our medical practice. However, the encounter with people whose life and professional work were rooted on the authentic love for fellowmen, brought us back to our original ideal of medicine as a vocation. In the Clinic’s several years of activity, we became aware of the relevance implied in a medical practice focused not only on the treatment of illness, but also on the familiar and social context of the ill person, and carrying out medical and social strategies aimed to achieve an effective prevention and a real health development.

by GIUSEPPINA VENERUSO