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Shrinking the Amazon?

There are some people you look at and think: this guy has a story to tell. That’s the impression I got from the bushily grey-bearded guy in the straw hat taking in the breeze on the commuter boat back from Novo Aripuana to Manaus. It may actually be illegal to have a beard like that and be boring.

And wouldn’t you know, he’s Wilson Gonzaga, a psychiatrist from Sao Paulo who is trying to get a boat and equipment funded so he can roam the rivers providing mental health care in cities like Manicore (pop. 47,000) and Novo Aripuana (pop. 19,000) that have very high population to psychiatrist ratios. As in 47,000:0 and 19,000:0.

In fact, Gonzaga said, as far as he knows, there is just one psychiatrist in Amazonas state outside the capital, Manaus, and she’s the wife of a military officer stationed in Tefe who could be transferred out at any time.  Whether there are a few more out there or not, it’s still pretty obvious that there is a huge lack of psychiatric care for the bigger Amazonian cities, not to mention the small, isolated villages.

He cited psychoses and mental deficiencies as major issues that were going untreated, but also noted that “neuroses that exist in the big city also exist here: anxiety, mood disorders, depression.” The lack of care leads to great suffering, and elevated suicide rates, he said, especially among indigenous peoples “on the margin of white culture.”

His idea is called Saude Navegante, which means something like “Health Navigator” or perhaps even “Floating Health.” It would be staffed by him, his wife and a crew that he hopes will be supplied by the state government along with the boat. (So far, no luck there, but he’s also hitting up private businesses.) In addition to providing mental health services, there would have a pharmacy on board, and Gonzaga would provide basic medical care as well. (He recently went back to school to bone up on clinical practice.) He and his wife would also conduct health, drug-prevention and environmental education sessions.

Last week, in Manicore, he saw a case that showed the severe need for help. In Manicore, a father had begun tying up his out-of-control, drug-addicted, 11-year-old daughter with a chain because he didn’t know how to control her. I asked him what how you handle a case like that, but I pretty much knew what was coming.

“First, you treat the father,” he said.