Older people and social movements in times of COVID-19 – Brazil’s National Front to Strengthen the Long-Term Care Institutions for Older People. An interview with Karla Giacomin.
In the fight against COVID-19, new mobilizations and social movements have spontaneously appeared around the world (Pleyers, 2020; Breno & Pleyers, 2020; Krinsky & Caldwell, 2020; Seow et al. 2021; Wan et al., 2020). These include examples concerning the care of vulnerable groups, such as older people (Gallo & Wilber, 2021; Aung et al., 2021, Fernandes et al., 2021; Lim et al., 2020). In Brazil the National Front to Strengthen the Long-Term Care Institutions for Older People (NF – LTCIs) (National Front-LTCIs, 2021) was created at the beginning of the pandemic. This movement originated in reaction to the devastating effects caused by the COVID-19 in Europe, and when the Brazilian response to coronavirus was still incipient and uncertain. It also occurred in a context of the growing politicization of the pandemic.
In April 2021, the Global Platform organised a webinar to celebrate the 1st anniversary of the National Front (Corona Older Global Platform, 2021). The NF’s work has been characterised by the participation of professionals and leaders in all five regions of Brazil. They include frontline workers in LTCIs (both administrators and caregivers), psychologists, physiotherapists, nutritionists, geriatricians, and public sector managers. The NF stands out in terms of its close partnerships with actors from these different sectors, making a wide range of tools and documents available on its website. These range from care guides to lectures on hand hygiene and nutrition for older people (National Front – LTCIs, 2021b & 2021c). One of the latest webinars organized by the NF had 3,044 views and reached 12,202 people (July 23, 2021).
To better understand the origin and development of this social movement, on 13 July 2021 we interviewed Dr. Karla Giacomin, who oversaw the creation of the NF, and today coordinates its work in Brazil. Dr. Karla Giacomin is a geriatrician with extensive experience in the health of older people. She is a Technical Reference Officer for Old People’s Health in the Municipal Health Department of Belo Horizonte, a consultant to the World Health Organization for health and aging policies, vice-president of the International Longevity Centre in Brazil, and research member of the Public Health Studies Centre and Aging at the Oswald Cruz Foundation (FIOCRUZ) in Minas Gerais.
How was the NF created?
Karla Giacomin: The pandemic arrived very abruptly here, and we received terrifying news about Europe. Knowing the reality of Brazilian LTCIs, we feared that what happened there would take place here. If the pandemic were to arrive here with the same strength, it would reach unprepared facilities – from the point of view of care, physical space, workforce and resources in general. Therefore, we imagined that it would be a catastrophe. It was in this context that a manifesto called the “Cry of the LTCIs” was made by Yeda Duarte, Marisa Accioly, and Helena Watanabe from the University of São Paulo, warning about those issues. This “Cry” led to an invitation for a public hearing by the Committee for the Defence of Human Rights at the National Congress of Deputies. On that day, on April 7, 2020, we were online with several activists concerned about older people, and there we decided to form a WhatsApp group to talk about it. Then they said: “Karla, could you be the coordinator of this group?” Then we created the National Front for Strengthening the LTCIs.
Tell us more about the spontaneous development of the National Front, as well as the origin of its Regional Groups.
Karla Giacomin: The National Front was created as an urgent national movement. It was urgent in the sense that I was being asked to give a quick response to this new policy challenge. We started adding people to the WhatsApp group. WhatsApp holds 252 people, but in a very short time, all those places had been taken up. Then we realized we needed to form regional groups. The Southeast region was subdivided into Southeast 1 and Southeast 2, because it is very large in terms of people and institutions. We also added activists from other movements that were interested in LTCIs, such as the Ministry of Public Affairs. We contacted several organisations, and the NF just grew. Managers, various types of experts, nurses, social workers, physiotherapists, nutritionists, psychologists, speech therapists, even dentists joined. Everyone felt included. We were very concerned about giving support to LTCIs, because we saw that our federal government did not recognize their particular needs.
What were the National Front’s main objectives?
Karla Giacomin: Our first objective was to provide information. It was the only thing we could do, which was within our reach. One of the people in our first online meeting was Aline Salla, an IT professional who lives in Italy. She sent us critical information about the situation of LTCIs in Italy. This further increased our awareness of the race against time. To give you an idea, when the NF was created, Brazil had 822 deaths from COVID, we are now talking about 536,000 deaths. We are sure the NF has helped to halt the spread of COVID-19, because we rapidly advocated specific measures. We urged a ban on visits and informed people on how to avoid contagion from the virus. Then we produced our first consolidated report in Portuguese (National Front-LTCIs, 2020) – [English version: 2020b].
In a very pioneering way, the NF started to provide information and evidence on how to fight COVID-19. Can you tell us more about this process?
Karla Giacomin: The first consolidated report was ready in 3 weeks, with people participating from all over Brazil and helping each other. I edited this report. Professor Alexandre Kalache, who was previously Director of the World Health Organisation’s Global Ageing Programme and is now is a member of the WHO Advisory Council for Age Friendly Cities and Communities, supported the report. We managed to translate this report into English through the Longevity Network here in Belo Horizonte (National Front-LTCIs, 2020b). This translation was made for the World Health Organization. This allowed us to have access to the World Economic Forum, where we went to present it as a successful experience against COVID-19. The whole project started to change, gaining a new scope that was completely beyond our control. That was not the original idea. The original idea was to pass on information. Just to give you an idea, for example, vaccines in Brazil were due to start in February 2021. In January, the NF was already streaming webinars and live sessions via its Facebook and YouTube channels, advising on how the vaccination would take place, who could be vaccinated, why it was important to vaccinate. Because if we had to wait for the government, we would be waiting until now.
How do LTCIs and managers receive information about COVID-19? Can you already see the impact produced by these actions?
Karla Giacomin: The NF was a pioneer in the way its acted: how it related to different people and in its access to people. LTCIs felt very supported because when an outbreak happened, they called us. They called me and Natalia Horta at night. They said: – “Look, I found out that there is a person with a fever, what can I do?”. We also found that there were LTCIs giving care to old people which were not yet known or registered with government agencies. We were producing manuals responding to new demands as they appeared. Questions like this appeared: – “How can I take care of nutrition?” And so, we worked on nutrition, did a manual or a specific online lecture or live session about nutrition. “How do I do oral hygiene?”, and we made an oral hygiene manual. We did live sessions for all the regional groups. We had to do several in some regions because we couldn’t catch everyone in the Northeast or the entire Southeast, for example, in just one day. Today we already have more than 500,000 views of our material. We already have 1,400 volunteer health professionals registered with the NF. We see a mortality rate in Brazilian LTCIs that was lower than in most countries. We attribute this in part, of course not all, to our ability to generate reliable information.
Are there other NF activities that you consider important? Can you talk about your work with universities?
Karla Giacomin: The Front for the Strengthening of Old People’s Councils is a sub-group that emerged within the National Front. There is also a research group involving several universities in Brazil. We managed to map LTCIs in Brazil by working with and consolidating data coming from different sources of information, such as the Annual Social Information Report (Relacao Annual de Informacoes Sociais – RAIS), the Ministry of Women, Family and Human Rights, the Bank of Brazil, and the federal and state public ministries. We found more than 7,000 LTCIs in Brazil. And that number was not known until now. We are still refining this number. This mapping will be very important for public policy in Brazil.
What does the NF hope to achieve in 2021?
Karla Giacomin: Our proposal is to continue advocating for a national care policy, to respond to the lack of a care policy directed to old people in Brazil. LTCIs are the point of an iceberg of a struggling long-term care system, and if a person is unable to access the tip of the iceberg, it means that they have access to nothing.
Do you see the NF as a broader movement that can be formally institutionalized?
Karla Giacomin: I think we are moving towards institutionalization. However, this was not my first intention, which was simply to continue as a free and democratic movement. However, it is important for us to set up the NF in a more legal way, to occupy other spaces. As a voluntary movement, we cannot occupy certain spaces, such as old people’s councils [as they are linked to governmental institutions], for example, to fight for better LTCIs and better care policies. Our movement is now consolidating.
Would you like to make some final remarks?
Karla Giacomin: What drives us is the desire to transform care for older people in this country, to bring LTCIs onto the radar of public policies, whether in health or in social assistance, because they are not even properly noticed by social assistance departments. Therefore, I think we need to improve a lot of things: rules that regulate LTCIs, public funding, access to information, care management, business management. I am sure that the National Front will continue operating, because our work is far from over.
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